Unit-Level Variations in Healthcare Professionals' Availability for Preterm Neonates <29 Weeks' Gestation: An International Survey

INTRODUCTION The availability of and variability in healthcare professionals in neonatal units in different countries has not been well characterized. Our objective was to identify variations in the healthcare professionals for preterm neonates in 10 national or regional neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of neonates. METHOD Online, pre-piloted questionnaires about the availability of healthcare professionals were sent to the directors of 390 tertiary neonatal units in 10 international networks: Australia/New Zealand, Canada, Finland, Illinois, Israel, Japan, Spain, Sweden, Switzerland, and Tuscany. RESULTS Overall, 325 of 390 units (83%) responded. About half of the units (48%; 156/325) cared for 11-30 neonates/day and had team-based (43%; 138/325) care models. Neonatologists were present 24 h a day in 59% of the units (191/325), junior doctors in 60% (194/325), and nurse practitioners in 36% (116/325). A nurse-to-patient ratio of 1:1 for infants who are unstable and require complex care was used in 52% of the units (170/325), whereas a ratio of 1:1 or 1:2 for neonates requiring multisystem support was available in 59% (192/325) of the units. Availability of a respiratory therapist (15%, 49/325), pharmacist (40%, 130/325), dietitian (34%, 112/325), social worker (81%, 263/325), lactation consultant (45%, 146/325), parent buddy (6%, 19/325), or parents' resource personnel (11%, 34/325) were widely variable between units. CONCLUSIONS We identified variability in the availability and organization of the healthcare professionals between and within countries for the care of extremely preterm neonates. Further research is needed to associate healthcare workers' availability and outcomes

Over-investigation and overtreatment in pediatrics: a survey from the European Academy of Paediatrics and Japan Pediatric Society

IntroductionAvoiding over-investigation and overtreatment in health care is a challenge for clinicians across the world, prompting the international Choosing Wisely campaign. Lists of recommendations regarding medical overactivity are helpful tools to guide clinicians and quality improvement initiatives. We aimed to identify the most frequent and important clinical challenges related to pediatric medical overactivity in Europe and Japan. Based on the results, we aim to establish a (European) list of Choosing Wisely recommendations.MethodsIn an online survey, clinicians responsible for child health care in Europe and Japan were invited to rate 18 predefined examples of medical overactivity. This list was compiled by a specific strategic advisory group belonging to the European Academy of Paediatrics (EAP). Participants were asked to rate on a Likert scale (5 as the most frequent/important) according to how frequent these examples were in their working environment, and how important they were considered for change in practice.ResultsOf 2,716 physicians who completed the survey, 93% (n = 2,524) came from 17 countries, Japan (n = 549) being the largest contributor. Pediatricians or pediatric residents comprised 89%, and 51% had 10–30 years of clinical experience. Cough and cold medicines, and inhaled drugs in bronchiolitis were ranked as the most frequent (3.18 and 3.07 on the Likert scale, respectively), followed by intravenous antibiotics for a predefined duration (3.01), antibiotics in uncomplicated acute otitis media (2.96) and in well-appearing newborns. Regarding importance, the above-mentioned five topics in addition to two other examples of antibiotic overtreatment were among the top 10. Also, IgE tests for food allergies without relevant medical history and acid blockers for infant GER were ranked high.ConclusionOvertreatment with antibiotics together with cough/cold medicines and inhaled drugs in bronchiolitis were rated as the most frequent and important examples of overtreatment across countries in Europe and Japan

Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

BACKGROUND Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO2) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations. OBJECTIVES To survey variations in SpO2 targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo). METHODS Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared. RESULTS Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO2 target limits, with the median set higher than previously by 2-3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO2 target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy. CONCLUSIONS There is considerable variation in SpO2 targets and ROP screening and treatment criteria, both within networks and between countries

Recent Results from LHD Experiment with Emphasis on Relation to Theory from Experimentalist’s View

he Large Helical Device (LHD) has been extending an operational regime of net-current free plasmas towardsthe fusion relevant condition with taking advantage of a net current-free heliotron concept and employing a superconducting coil system. Heating capability has exceeded 10 MW and the central ion and electron temperatureshave reached 7 and 10 keV, respectively. The maximum value of β and pulse length have been extended to 3.2% and 150 s, respectively. Many encouraging physical findings have been obtained. Topics from recent experiments, which should be emphasized from the aspect of theoretical approaches, are reviewed. Those are (1) Prominent features in the inward shifted configuration, i.e., mitigation of an ideal interchange mode in the configuration with magnetic hill, and confinement improvement due to suppression of both anomalous and neoclassical transport, (2) Demonstration ofbifurcation of radial electric field and associated formation of an internal transport barrier, and (3) Dynamics of magnetic islands and clarification of the role of separatrix

Self-consistent runaway beam formation in 3D magnetic fields during radiation-driven disruptions

Fluid modeling of runaway electron generation [A. Matsuyama, et al., Nucl. Fusion 57, 066038 (2017)] is extended as an integrated simulator of whole disruption phase from thermal quench due to disruptive instabilities to full current conversion by the runaway beam. Such an integrated simulation is useful to provide a consistent picture of the runaway beam formation in mitigated disruptions of ITER-grade devices. While seed runaway currents are lost by the magnetic surface break-up, they can be confined after the recovery of nested surfaces. Because of its burst-like nature, hot-tail electrons survive if the central TQ occurs after the recovery of the edge boundary. It is suggested that the steady runaway seed generation due to tritium decay and Compton scattering poses an irreducible minimum for runaway seeds in the D-T activation phase. On the longer timescale, the avalanche growth rate is shown to be affected by drop of internal inductance due to internal reconnection. For the efficacy of runaway avoidance with massive deuterium deposition, the reduced ohmic heating and the associated changes of atomic processes to a recombining state are suggested as a key characteristic

In-bore laser welding tool for actively cooled divertor cassettes in JT-60SA

In-bore remote pipe welding tool has been upgraded for divertor cassettes of JT-60SA, where all plasma-facing components are actively cooled. Because the cooling pipes are surrounded by divertor cassette frame, pipe welding should be done from the inside of the pipe. The tool was equipped with a mirror to reflect the laser radially. Circumferential welding was performed by rotating the tool while injecting the laser. If fumes and spatters adhere to the laser reflecting mirror during welding, the laser will not reach the groove and the welding will not be stable. Upgrading the welding tool has realized to perform welding tests with a well-protected mirror and stable laser power. A misalignment between pipes at the groove is unavoidable in actual divertor cassettes of JT-60SA. The results of butt welding of short pipes indicated that it was possible not only in the gap but also in the combined state with angular and axial misalignment, covering a larger range than required by the actual cassette. It is notable that welding was possible even with an angular misalignment of 0.9◦ and an axial misalignment of 0.3 mm, where the maximum gap between pipes was about 0.9 mm

Manufacturing of lower divertor cassette of JT-60SA

A lower divertor cassette of JT-60SA, which is the largest superconducting tokamak, has been designed, and the first divertor cassette covering a 10◦ sector in the toroidal direction has been manufactured. Modularized plasma facing components such as vertical targets, baffles, and domes will be assembled into the divertor cassette. All plasma facing components will be actively cooled. Carbon armor tiles bolted to water-cooled copper alloy heat sinks are used to remove heat loads of 0.3–2MW/m2 for 100 s and 10MW/m2 for less than 10 s. The divertor cassette integrated with coolant pipe connections will be used for remote handling / hands-on maintenance. A remote pipe welding tool, which is accessed from the inside of the pipe, has been developed to assemble the inboard vertical target. The space around the cooling pipes is so limited that they are cut and welded remotely from the inside for maintenance. The laser welding method was used, and the focusing mirror inside the pipe was rotated to perform circumferential welding. As a countermeasure for welding groove misalignment, the aiming accuracy of the laser was improved by simultaneously controlling the rotation and lifting of the tool. Thereby, reliable welding has been achieved even with a groove that is misaligned by 0.5 degrees or more. The outer diameter of the cooling pipe is 59.8 mm, the wall thickness is 2.8 mm, and the material is SUS316L. After connecting the inboard vertical target, the other plasma facing components have been assembled into the first lower divertor cassette. When installing the divertor cassette towards the vacuum vessel, the laser welding tool described above is used to connect the cooling pipe between divertor cassette and vacuum vessel in JT-60SA, because the outer diameter and wall thickness of the cooling pipe are the same as the inboard vertical target.31st Symposium on Fusion Technology (SOFT2020