EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Computation of Alfvèn eigenmode stability and saturation through a reduced fast ion transport model in the TRANSP tokamak transport code

Alfvénic instabilities (AEs) are well known as a potential cause of enhanced fast ion transport in fusion devices. Given a specific plasma scenario, quantitative predictions of (i) expected unstable AE spectrum and (ii) resulting fast ion transport are required to prevent or mitigate the AE- induced degradation in fusion performance. Reduced models are becoming an attractive tool to analyze existing scenarios as well as for scenario prediction in time-dependent simulations. In this work, a neutral beam heated NSTX discharge is used as reference to illustrate the potential of a reduced fast ion transport model, known as kick model, that has been recently implemented for interpretive and predictive analysis within the framework of the time-dependent tokamak transport code TRANSP. Predictive capabilities for AE stability and saturation amplitude are first assessed, based on given thermal plasma profiles only. Predictions are then compared to experimental results, and the interpretive capabilities of the model further discussed. Overall, the reduced model captures the main properties of the instabilities and associated effects on the fast ion population. Additional information from the actual experiment enables further tuning of the model’s parameters to achieve a close match with measurements.readme, data file

Fast-ion Energy Loss During TAE Avalanches in the National Spherical Torus Experiment

Strong TAE avalanches on NSTX, the National Spherical Torus Experiment [M. Ono, et al., Nucl. Fusion 40 (2000) 557] are typically correlated with drops in the neutron rate in the range of 5% - 15%. In previous studies of avalanches in L-mode plasmas, these neutron drops were found to be consistent with modeled losses of fast ions. Here we expand the study to TAE avalanches in NSTX H-mode plasmas with improved analysis techniques. At the measured TAE mode amplitudes, simulations with the ORBIT code predict that fast ion losses are negligible. However, the simulations predict that the TAE scatter the fast ions in energy, resulting in a small (≈ 6%) drop in fast ion β. The net decrease in energy of the fast ions is sufficient to account for the bulk of the drop in neutron rate, even in the absence of fast ion losses. This loss of energy from the fast ion population is comparable to the estimated energy lost by damping from the Alfven wave during the burst. The previously studied TAE avalanches in L-mode are re-evaluated using an improved calculation of the potential fluctuations in the ORBIT code

Energetic particle instabilities in fusion plasmas

Remarkable progress has been made in diagnosing energetic particle instabilities on present-day machines and in establishing a theoretical framework for describing them. This overview describes the much improved diagnostics of Alfvén instabilities and modelling tools developed world-wide, and discusses progress in interpreting the observed phenomena. A multi-machine comparison is presented giving information on the performance of both diagnostics and modelling tools for different plasma conditions outlining expectations for ITER based on our present knowledge

NSTX-U theory, modeling and analysis results

The mission of the low aspect ratio spherical tokamak NSTX-U is to advance the physics basis and technical solutions required for optimizing the configuration of next-step steady-state tokamak fusion devices. NSTX-U will ultimately operate at up to 2 MA of plasma current and 1 T toroidal field on axis for 5 s, and has available up to 15 MW of neutral beam injection power at different tangency radii and 6 MW of high harmonic fast wave heating. With these capabilities NSTX-U will develop the physics understanding and control tools to ramp-up and sustain high performance fully non-inductive plasmas with large bootstrap fraction and enhanced confinement enabled via the low aspect ratio, high beta configuration. With its unique capabilities, NSTX-U research also supports ITER and other critical fusion development needs. Super-Alfvenic ions in beam-heated NSTX-U plasmas access energetic particle (EP) parameter space that is relevant for both α-heated conventional and low aspect ratio burning plasmas. NSTX-U can also generate very large target heat fluxes to test conventional and innovative plasma exhaust and plasma facing component solutions. This paper summarizes recent analysis, theory and modelling progress to advance the tokamak physics basis in the areas of macrostability and 3D fields, EP stability and fast ion transport, thermal transport and pedestal structure, boundary and plasma material interaction, RF heating, scenario optimization and real-time control

Many Labs 2: Investigating Variation in Replicability Across Samples and Settings

We conducted preregistered replications of 28 classic and contemporary published findings, with protocols that were peer reviewed in advance, to examine variation in effect magnitudes across samples and settings. Each protocol was administered to approximately half of 125 samples that comprised 15,305 participants from 36 countries and territories. Using the conventional criterion of statistical significance (p < .05), we found that 15 (54%) of the replications provided evidence of a statistically significant effect in the same direction as the original finding. With a strict significance criterion (p < .0001), 14 (50%) of the replications still provided such evidence, a reflection of the extremely high-powered design. Seven (25%) of the replications yielded effect sizes larger than the original ones, and 21 (75%) yielded effect sizes smaller than the original ones. The median comparable Cohen’s ds were 0.60 for the original findings and 0.15 for the replications. The effect sizes were small (< 0.20) in 16 of the replications (57%), and 9 effects (32%) were in the direction opposite the direction of the original effect. Across settings, the Q statistic indicated significant heterogeneity in 11 (39%) of the replication effects, and most of those were among the findings with the largest overall effect sizes; only 1 effect that was near zero in the aggregate showed significant heterogeneity according to this measure. Only 1 effect had a tau value greater than .20, an indication of moderate heterogeneity. Eight others had tau values near or slightly above .10, an indication of slight heterogeneity. Moderation tests indicated that very little heterogeneity was attributable to the order in which the tasks were performed or whether the tasks were administered in lab versus online. Exploratory comparisons revealed little heterogeneity between Western, educated, industrialized, rich, and democratic (WEIRD) cultures and less WEIRD cultures (i.e., cultures with relatively high and low WEIRDness scores, respectively). Cumulatively, variability in the observed effect sizes was attributable more to the effect being studied than to the sample or setting in which it was studied