PROPOSTA DI UN PERCORSO INTEGRATO DI CURE PER LA CONTINUITA' ASSISTENZIALE OSPEDALE TERRITORIO NEL BAMBINO FRAGILE

“PROPOSTA DI UN PERCORSO INTEGRATO DI CURE PER LA CONTINUITA' ASSISTENZIALE OSPEDALE TERRITORIO NEL BAMBINO FRAGILE” Il nostro Paese è tra i primi al mondo nel garantire la salute e lo sviluppo del bambino: le comuni malattie acute sono diminuite, e le malattie infettive sono controllate. Rimangono le malattie complesse, i difetti congeniti dello sviluppo, le malattie croniche, che non trovano ancora, nel mondo, una soluzione soddisfacente. Si evidenziano le particolarità riferite alla fragilità e alla complessità dell'assistenza infermieristica pediatrica soprattutto nel caso di patologie gravi ed evolutive. Il panorama normativo e le evidenze scientifiche a disposizione richiamano alla valorizzazione dell'assistenza a domicilio quale migliore soluzione per il bambino e la famiglia a patto che il percorso sia accompagnato dalle figure professionali idonee al caso attraverso una reale “presa in carico”, e che ci sia un effettivo sostegno emotivo e psicologico oltre che di risorse per il piccolo paziente e la sua famiglia. Questo porterebbe ad una riduzione delle giornate di degenza e maggior appropriatezza del ricovero, ad un miglioramento della qualità di vita del paziente e un risparmio di risorse, che potrebbero essere altrimenti impiegate. Pertanto, se si deve predisporre un percorso di cura tra ospedale e domicilio, la figura dell'infermiere domiciliare diventa fondamentale. Qual’é la sua percezione al riguardo: il personale assiste abitualmente i bambini? Si sente competente nell'affrontare l'assistenza domiciliare al bambino fragile? Da ciò è nata l'idea di effettuare un’indagine conoscitiva coinvolgendo gli infermieri dell’assistenza domiciliare di Prato. Obiettivo: Definire le percezioni degli infermieri delle Cure Domiciliari in relazione all’assistenza del bambino con patologia complessa. Campione: 39 infermieri che lavorano sull'area del comune di Prato. Metodologia e strumenti: questionario con 7 item che indagano: l'esperienza lavorativa degli infermieri in ambito pediatrico, sia in ospedale che in assistenza domiciliare, il supporto dei colleghi esperti in materia, la percezione di adeguatezza delle competenze professionali in ambito pediatrico specificando: quali caratteristiche emotive e tecniche li contraddistingua nell'assistenza al bambino. Infine, quali supporti siano necessari a migliorare la loro adeguatezza. Analisi dati: il 91% non ha mai lavorato in reparti pediatrici; solo il 12,1% dichiara di assistere spesso o sempre bambini al domicilio; il 42% degli operatori si sente abbastanza o molto efficiente sull’assistenza pediatrica, mentre solo il 24% si sente abile tecnicamente, il 64% si sente empatico. Il 51% presenta stress e il 42% prova ansia nell'assistenza pediatrica, anche se il 49% è resiliente. Il 57,6% degli infermieri dichiara di essere abbastanza o molto sostenuto dai colleghi più esperti in campo pediatrico. Il 70% degli infermieri si sente poco o per niente adeguato nell'affrontare l'assistenza ai bambini. L'85% degli infermieri chiede un supporto formativo mentre il 48,5% quello emotivo e psicologico. Il 39,4% chiede di lavorare in equipe multiprofessionale. Il 24% degli operatori chiedono l'acquisizione di supporto di ausili e tecnologie, e l'addestramento strutturato dei genitori dei bambini presi in carico. I risultati mettono in evidenza che gli infermieri dell'assistenza domiciliare di Prato non si sentono abbastanza preparati per l'assistenza pediatrica sopratutto nei casi complessi e chiedono un forte supporto di tipo formativo, emotivo e psicologico. Inoltre, si evidenzia la necessità di un percorso pediatrico, che in questo lavoro si propone, che permetta di: valutare i bambini a rischio nella dimissione e garantire la continuità tra ospedale e domicilio, attraverso: • presa in carico territoriale del bambino fragile in continuità con l'ospedale • attivazione del'equipe multidisciplinare • affiancamento a cura degli infermieri dell'ospedale pediatrico, nei primi giorni dal rientro del bambino al proprio domicilio L'introduzione di un nuovo strumento: scheda “Brass modificata per uso pediatrico”, una volta testato, aiuterà a valutare in modo strutturato e uniforme la necessità di una dimissione protetta e programmata del bambino/ragazzo. Un percorso formativo teorico-pratico, da sviluppare prima dell'implementazione del percorso, e l'adozione di strumenti quali: retraining, audit, m&m, da adottare in seguito, possono ridurre le difficoltà percepite nell'assistenza pediatrica e garantire maggiore adeguatezza al personale infermieristico. Prato li 30.11.15 Relatore Autore Dott.ssa Coscetti Flora Perseo Valeri

Analysis of the neutral fluxes in the divertor region of Wendelstein 7-X under attached and detached conditions using EMC3-EIRENE

This paper analyzes the neutral fluxes in the divertor region of the W7-X standard configuration for different input powers, both under attached and detached conditions. The performed analysis is conducted through EMC3-EIRENE simulations. They show the importance of the horizontal divertor to generate neutrals, and resolve the neutral plugging in the divertor region. Simulations of detached cases show a decrease in the number of generated neutrals compared to the attached simulations, in addition to a higher fraction of the ion flux arriving on the baffles during detachment. As the ionization takes place further inside the plasma during detachment, a larger percentage of the generated neutral particles leave the divertor as neutrals. The leakage in the poloidal and toroidal direction increases, just as the fraction of collected particles at the pumping gap. The fraction of pumped particles increases with a factor two, but stays below one percent. This demonstrates that detachment with the current target geometry, although it improves the power exhaust, is not yet leading to an increased particle exhaust

Impurity flow measurements with Coherence Imaging Spectroscopy at Wendelstein 7-X

An experimental investigation of particle parallel flows has been carried out at Wendelstein 7-X (W7-X), one of the most advanced stellarators in the world. The studies are restricted to the outermost plasma region, the scrape-off layer (SOL), which is shaped to tackle the exhaust problem in vision of future fusion reactors based on plasma magnetic confinement. The aim of the measurements is to set the basis for a physics analysis of the SOL dynamics by obtaining direct information on convective heat transport, together with the assessment of the predominant flow directions of the main plasma ions and of fusion-products or wall-released impurities. In this way, a better comprehension of the interplay between the transport parallel and perpendicular to the SOL field lines can be achieved, contributing to the understanding of the effectiveness of the island divertor configuration. The chosen instrument for the experimental studies is the Coherence Imaging Spectroscopy (CIS) diagnostic, a camera-based interferometer capable of measuring 2D Doppler particle flows associated with a selected visible line from the plasma. The diagnostic is distinguished by its high time resolution and spatial coverage, allowing the visualisation and measurements of flow velocities for a full module of W7-X simultaneously. A CIS diagnostic has been fully designed for W7-X with an improved level of accuracy achieved thanks to the implementation of a new calibration source, a continuous-wave-emission tunable laser. The laser allowed a full characterization of the diagnostic and a frequent precise calibration, making the CIS system reliable for parallel flow investigations during the operational campaign OP1.2. The validity and importance of the CIS measurements have been further confirmed with dedicated simulation of the SOL plasma parameters by the EMC3-EIRENE code, and by comparisons with other edge diagnostics. The CIS results show the effects related to dynamical changes in the SOL due to impurity gas puffs or the development of a plasma current. Moreover, CIS can be used as a powerful tool to test the limits of the current theoretical models, for example in the case of forward and reversed field experiments.Am Wendelstein 7-X (W7-X), einem der fortschrittlichsten Stellaratoren der Welt, wurde eine experimentelle Untersuchung von Teilchenparallelströmungen durchgeführt. Die Untersuchungen beschränken sich auf den äußersten Plasmabereich, den Scrape-Off-Layer (SOL), die so geformt ist, dass das Abgasproblem in der Vision zukünftiger Fusionsreaktoren, die auf dem magnetischen Plasmaeinschluss basieren, angegangen werden kann. Ziel der Messungen ist es, die Grundlage für eine physikalische Analyse der SOL-Dynamik zu schaffen, indem direkte Informationen über den konvektiven Wärmetransport zusammen mit der Bewertung der vorherrschenden Strömungsrichtungen der Hauptplasma-Ionen und der Fusionsprodukte oder von der Wand abgelösten Verunreinigungen gewonnen werden. Auf diese Weise kann ein besseres Verständnis des Wechselspiels zwischen dem Transport parallel und senkrecht zu den SOL-Feldlinien erreicht werden, was zum Verständnis der Wirksamkeit der Insel-Divertor-Konfiguration beiträgt. Das für die experimentellen Studien gewählte Instrument ist die Coherence- Imaging-Spektroskopie (CIS) Diagnostik, ein kamerabasiertes Interferometer, das in der Lage ist, 2D-Doppler-Teilchenströme zu messen, die mit einer ausgewählten sichtbaren Emissions-Linie aus dem Plasma assoziiert sind. Das Diagnosegerät zeichnet sich durch seine hohe zeitliche Auflösung und räumliche Abdeckung aus und ermöglicht die gleichzeitige Visualisierung und Messung von Strömungsgeschwindigkeiten für ein ganzes Modul von W7-X. Eine CIS-Diagnose wurde vollständig für W7-X entwickelt, wobei dank der Implementierung einer neuen Kalibrierquelle, eines durchstimmbaren Lasers mit kontinuierlicher Wellenemission, eine verbesserte Genauigkeit erreicht wurde. Der Laser ermöglichte eine vollständige Charakterisierung der Diagnose und eine häufige präzise Kalibrierung, wodurch das CIS-System für Parallelflussuntersuchungen während der Betriebskampagne OP1.2 zuverlässig betrieben wurde. Die Gültigkeit und Bedeutung der CIS-Messungen wurden durch eine spezielle Simulation der SOL-Plasmaparameter mit dem EMC3-EIRENE-Code und durch Vergleiche mit anderen Diagnostiken bestätigt. Die CIS-Ergebnisse zeigen die Auswirkungen dynamischer Änderungen im SOL bei Zugabe von Spurengas oder der Entwicklung des Plasmastroms. Darüber hinaus kann CIS als leistungsstarkes Werkzeug verwendet werden, um die Grenzen der aktuellen theoretischen Modelle zu testen, zum Beispiel im Falle von Feldumkehrexperimenten

Effect of toroidal plasma currents on the Wendelstein 7-X Scrape-Off Layer

The role of toroidal plasma currents for the island divertor scrape-off layer in the stellarator Wendelstein 7-X is investigated using reciprocating electric probes. Experiments show that small amounts (of a few kA) of plasma current are sufficient to significantly affect the scrape-off layer plasma conditions, whereas higher plasma currents above 10kA result in more drastic changes. This behavior is linked to the effect of the plasma current on the rotational transform profile, which can result in significant shifts of the edge magnetic islands. These shifts affect the interaction of the islands with the divertor and can eventually result in a transition from a diverted to a limited plasma configuration. The probe observations are complemented by further edge diagnostics including plasma flow measurements, divertor Langmuir probes, divertor thermography and impurity spectroscopy.This work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014-2018 and 2019-2020 under grant agreement number 633053

Confirmation of the topology of the Wendelstein 7-X magnetic field to better than 1:100,000

Fusion energy research has in the past 40 years focused primarily on the tokamak concept, but recent advances in plasma theory and computational power have led to renewed interest in stellarators. The largest and most sophisticated stellarator in the world, Wendelstein 7-X (W7-X), has just started operation, with the aim to show that the earlier weaknesses of this concept have been addressed successfully, and that the intrinsic advantages of the concept persist, also at plasma parameters approaching those of a future fusion power plant. Here we show the first physics results, obtained before plasma operation: that the carefully tailored topology of nested magnetic surfaces needed for good confinement is realized, and that the measured deviations are smaller than one part in 100,000. This is a significant step forward in stellarator research, since it shows that the complicated and delicate magnetic topology can be created and verified with the required accuracy

Major results from the first plasma campaign of the Wendelstein 7-X stellarator

After completing the main construction phase of Wendelstein 7-X (W7-X) and successfully commissioning the device, first plasma operation started at the end of 2015. Integral commissioning of plasma start-up and operation using electron cyclotron resonance heating (ECRH) and an extensive set of plasma diagnostics have been completed, allowing initial physics studies during the first operational campaign. Both in helium and hydrogen, plasma breakdown was easily achieved. Gaining experience with plasma vessel conditioning, discharge lengths could be extended gradually. Eventually, discharges lasted up to 6 s, reaching an injected energy of 4 MJ, which is twice the limit originally agreed for the limiter configuration employed during the first operational campaign. At power levels of 4 MW central electron densities reached 3 1019 m-3, central electron temperatures reached values of 7 keV and ion temperatures reached just above 2 keV. Important physics studies during this first operational phase include a first assessment of power balance and energy confinement, ECRH power deposition experiments, 2nd harmonic O-mode ECRH using multi-pass absorption, and current drive experiments using electron cyclotron current drive. As in many plasma discharges the electron temperature exceeds the ion temperature significantly, these plasmas are governed by core electron root confinement showing a strong positive electric field in the plasma centre.Peer reviewe

Major results from the first plasma campaign of the Wendelstein 7-X stellarator

\u3cp\u3eAfter completing the main construction phase of Wendelstein 7-X (W7-X) and successfully commissioning the device, first plasma operation started at the end of 2015. Integral commissioning of plasma start-up and operation using electron cyclotron resonance heating (ECRH) and an extensive set of plasma diagnostics have been completed, allowing initial physics studies during the first operational campaign. Both in helium and hydrogen, plasma breakdown was easily achieved. Gaining experience with plasma vessel conditioning, discharge lengths could be extended gradually. Eventually, discharges lasted up to 6 s, reaching an injected energy of 4 MJ, which is twice the limit originally agreed for the limiter configuration employed during the first operational campaign. At power levels of 4 MW central electron densities reached 3 10\u3csup\u3e19\u3c/sup\u3e m\u3csup\u3e-3\u3c/sup\u3e, central electron temperatures reached values of 7 keV and ion temperatures reached just above 2 keV. Important physics studies during this first operational phase include a first assessment of power balance and energy confinement, ECRH power deposition experiments, 2nd harmonic O-mode ECRH using multi-pass absorption, and current drive experiments using electron cyclotron current drive. As in many plasma discharges the electron temperature exceeds the ion temperature significantly, these plasmas are governed by core electron root confinement showing a strong positive electric field in the plasma centre.\u3c/p\u3