Untangling the Professional Web: Understanding the Impact of Work-Related Factors on the Mental Health of Healthcare Professionals During the Late Stages of Covid-19 Pandemic

Ruxandra Laza,1 Anca Lustrea,2 Voichita Elena Lazureanu,1 Adelina Raluca Marinescu,1 Narcisa Nicolescu,1 Alexandra Herlo,1 Talida Georgiana Cut,1,3,4 Tamara Mirela Porosnicu,3,5 Ion Papava,6 Radu Stefan Romosan,6 Ana-Maria Romosan,6 Mariana Bondrescu,3,6 Cristian Zoltan Dimeny,7 Cristina Bianca Nica-Bacaiteanu,7 Minodora Andor,8,9 Liana Dehelean6 1Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 2Department of Educational Sciences, University Clinic of Therapies and Psycho-Pedagogical Counseling, West University of Timisoara, Timisoara, Romania; 3Doctoral School Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 4Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 5Intensive Care Unit, Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology Timisoara, Timisoara, Romania; 6Department of Neurosciences-Psychiatry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 7Department of Psychiatry, Timis County Emergency Clinical Hospital Pius Brinzeu, Timisoara, Romania; 8Department of Medical Semiology II, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 9Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Anca Lustrea, Department of Educational Sciences, University Clinic of Therapies and Psycho-Pedagogical Counseling, West University of Timisoara, Bd. Vasile Parvan 4, Timisoara, 300223, Romania, Email [email protected]: The COVID-19 pandemic has determined an extraordinary challenge to healthcare systems worldwide. The extraordinary circumstances, characterized by elevated stress levels, prolonged working hours, new medical procedures, media attention, and high population expectations, have created an extremely stressful situation for healthcare professionals. This period has offered a unique opportunity to examine the medical system and the responses of healthcare practitioners to stress. This research aimed to identify the work-related factors that significantly impact the mental health of healthcare professionals.Patients and Methods: Three mental health variables were assessed: anxiety, depression and stress. The work-related factors considered were professional degree, type of medical unit (COVID or non-COVID), the number of hours spent at work in a single shift, type of shifts, monthly on-call frequency, and number of COVID-19 treated patients per month. In the spring of 2022, three inventories and a demographic survey were distributed and completed online by 300 healthcare professionals from Timisoara’s public hospitals in Romania.Results: Among the respondents, 47.7% reported mild symptoms of anxiety, 65.3% reported moderate levels of stress, and 33% of the participants reported mild symptoms of depression. The intensity of anxious, depressive, and stress symptoms varied significantly depending on the professional degree, number of on-calls per month, the type of medical unit where the participants worked, and the number of SARS CoV-2 patients treated in the previous month.Conclusion: Current data underlines the urgency of implementing effective strategies to reduce the stress and anxiety of medical practitioners who work with COVID-19 patients. Possible interventions encompass a variety of approaches, such as improving working conditions, reducing working hours where possible, increasing access to mental health services, and promoting team-building activities to enhance social support among colleagues. Digital mental health interventions, including online counseling and stress management programs, have also shown promise in these challenging times. Sustaining the mental health of medical practitioners is vital to support the continued provision of first-rate care to patients and to build a resilient healthcare workforce capable of navigating future health crises.Keywords: healthcare professionals, SARS-CoV-2, stress, anxiety, depressio

Beryllium melting and erosion on the upper dump plates in JET during three ITER-like wall campaigns

Data on erosion and melting of beryllium upper limiter tiles, so-called dump plates (DP), are presented for all three campaigns in the JET tokamak with the ITER-like wall. High-resolution images of the upper wall of JET show clear signs of flash melting on the ridge of the roofshaped tiles. The melt layers move in the poloidal direction from the inboard to the outboard tile, ending on the last DP tile with an upward going waterfall-like melt structure. Melting was caused mainly by unmitigated plasma disruptions. During three ILW campaigns, around 15% of all 12376 plasma pulses were catalogued as disruptions. Thermocouple data from the upper dump plates tiles showed a reduction in energy delivered by disruptions with fewer extreme events in the third campaign, ILW-3, in comparison to ILW-1 and ILW-2. The total Be erosion assessed via precision weighing of tiles retrieved from JET during shutdowns indicated the increasing mass loss across campaigns of up to 0.6 g from a single tile. The mass of splashed melted Be on the upper walls was also estimated using the high-resolution images of wall components taken after each campaign. The results agree with the total material loss estimated by tile weighing (similar to 130 g). Morphological and structural analysis performed on Be melt layers revealed a multilayer structure of re-solidified material composed mainly of Be and BeO with some heavy metal impurities Ni, Fe, W. IBA analysis performed across the affected tile ridge in both poloidal and toroidal direction revealed a low D concentration, in the range 1-4 x 10(17) D atoms cm(-2)

Micro ion beam analysis for the erosion of beryllium marker tiles in a tokamak limiter

Beryllium limiter marker tiles were exposed to plasma in the Joint European Torus to diagnose the erosion of main chamber wall materials. A limiter marker tile consists of a beryllium coating layer (7-9 mu m) on the top of bulk beryllium, with a nickel interlayer (2-3 mu m) between them. The thickness variation of the beryllium coating layer, after exposure to plasma, could indicate the erosion measured by ion beam analysis with backscattering spectrometry. However, interpretations from broad beam backscattering spectra were limited by the non-uniform surface structures. Therefore, micro-ion beam analysis (mu-IBA) with 3 MeV proton beam for Elastic back scattering spectrometry (EBS) and PIXE was used to scan samples. The spot size was in the range of 3-10 mu m. Scanned areas were analysed with scanning electron microscopy (SEM) as well. Combining results from mu-IBA and SEM, we obtained local spectra from carefully chosen areas on which the surface structures were relatively uniform. Local spectra suggested that the scanned area (approximate to 600 mu m x 1200 mu m) contained regions with serious erosion with only 2-3 mu m coating beryllium left, regions with intact marker tile, and droplets with 90% beryllium. The nonuniform erosion, droplets mainly formed by beryllium, and the possible mixture of beryllium and nickel were the major reasons that confused interpretation from broad beam EBS

Ion cyclotron resonance heating scenarios for DEMO

The present paper offers an overview of the potential of ion cyclotron resonance heating (ICRH) or radio frequency heating for the DEMO machine. It is found that various suitable heating schemes are available. Similar to ITER and in view of the limited bandwidth of about 10 MHz that can be achieved to ensure optimal functioning of the launcher, it is proposed to make core second harmonic tritium heating the key ion heating scheme, assisted by fundamental cyclotron heating He-3 in the early phase of the discharge; for the present design of DEMO-with a static magnetic field strength of B-o = 5.855 T-that places the T and 3He layers in the core for f = 60 MHz and suggests centering the bandwidth around that main operating frequency. In line with earlier studies for hot, dense plasmas in large-size magnetic confinement machines, it is shown that good single pass absorption is achieved but that the size as well as the operating density and temperature of the machine cause the electrons to absorb a non-negligible fraction of the power away from the core when core ion heating is aimed at. Current drive and alternative heating options are briefly discussed and a dedicated computation is done for the traveling wave antenna, proposed for DEMO in view of its compatibility with substantial antenna-plasma distances. The various tasks that ICRH can fulfill are briefly listed. Finally, the impact of transport and the sensitivity of the obtained results to changes in the machine parameters is commented on

Direct gyrokinetic comparison of pedestal transport in JET with carbon and ITER-like walls

This paper compares the gyrokinetic instabilities and transport in two representative JET pedestals, one (pulse 78697) from the JET configuration with a carbon wall (C) and another (pulse 92432) from after the installation of JET's ITER-like Wall (ILW). The discharges were selected for a comparison of JET-ILW and JET-C discharges with good confinement at high current (3 MA, corresponding also to low rho(*)) and retain the distinguishing features of JET-C and JET-ILW, notably, decreased pedestal top temperature for JET-ILW. A comparison of the profiles and heating power reveals a stark qualitative difference between the discharges: the JET-ILW pulse (92432) requires twice the heating power, at a gas rate of 1.9 x 10(22) e s(-1), to sustain roughly half the temperature gradient of the JET-C pulse (78697), operated at zero gas rate. This points to heat transport as a central component of the dynamics limiting the JET-ILW pedestal and reinforces the following emerging JET-ILW pedestal transport paradigm, which is proposed for further examination by both theory and experiment. ILW conditions modify the density pedestal in ways that decrease the normalized pedestal density gradient a/L-n, often via an outward shift in relation to the temperature pedestal. This is attributable to some combination of direct metal wall effects and the need for increased fueling to mitigate tungsten contamination. The modification to the density profile increases eta = L-n/L-T, thereby producing more robust ion temperature gradient (ITG) and electron temperature gradient driven instability. The decreased pedestal gradients for JET-ILW (92432) also result in a strongly reduced E x B shear rate, further enhancing the ion scale turbulence. Collectively, these effects limit the pedestal temperature and demand more heating power to achieve good pedestal performance. Our simulations, consistent with basic theoretical arguments, find higher ITG turbulence, stronger stiffness, and higher pedestal transport in the ILW plasma at lower rho(*)

Role of fast ion pressure in the isotope effect in JET L-mode plasmas

This paper presents results of JET ITER-like wall L-mode experiments in hydrogen and deuterium (D) plasmas, dedicated to the study of the isotope dependence of ion heat transport by determination of the ion critical gradient and stiffness by varying the ion cyclotron resonance heating power deposition. When no strong role of fast ions in the plasma core is expected, the main difference between the two isotope plasmas is determined by the plasma edge and the core behavior is consistent with a gyro-Bohm scaling. When the heating power (and the fast ion pressure) is increased, in addition to the difference in the edge region, also the plasma core shows substantial changes. The stabilization of ion heat transport by fast ions, clearly visible in D plasmas, appears to be weaker in H plasmas, resulting in a higher ion heat flux in H with apparent anti-gyro-Bohm mass scaling. The difference is found to be caused by the different fast ion pressure between H and D plasmas, related to the heating power settings and to the different fast ion slowing down time, and is completely accounted for in non-linear gyrokinetic simulations. The application of the TGLF quasi-linear model to this set of data is also discussed

Long-lived coupled peeling ballooning modes preceding ELMs on JET

In some JET discharges, type-I edge localised modes (ELMs) are preceded by a class of low-frequency oscillations (Perez et al 2004 Nucl. Fusion 44 609). While in many cases the ELM is triggered during the growth phase of this oscillation, it is also observed that this type of oscillation can saturate and last for several tens of ms until an ELM occurs. In order to identify the nature of these modes, a wide pre-ELM oscillation database, including detailed pedestal profile information, has been assembled and analysed in terms of MHD stability parameters. The existence domain of these pre-ELM oscillations and the statistical distribution of toroidal mode numbers (n) up to n = 16 have been mapped in ballooning alpha (alpha(ball)) and either edge current density (J(edge)) or pedestal collisionality (nu(ee,ped)*) coordinates and compared to linear MHD stability predictions. The pre-ELM oscillations are reliably observed when the J/alpha ratio is high enough for the pedestal to access the coupled peeling-ballooning (PB) domain (aka stability nose). Conversely, when the pedestal is found to be in or near the high-n ballooning domain (which is at low J/alpha ratio), ELMs are usually triggered promptly, i.e. with no detectable pre-ELM oscillations, or with pre-ELM oscillations only observable on ECE whose n appears to be too high to be resolved by the magnetics. Individual discharges can sometimes exhibit a fairly wide range of pre-ELM mode numbers, but for a wider database, the statistical n-number domains are found to be well ordered along the J - alpha stability boundary and behave as expected from PB theory: the higher the J/alpha ratio, the lower the mode's measured n tends to be. Within the measurement uncertainties, the measured n is usually found to be compatible with the most unstable n predicted by the linear stability code MISHKA1. These results confirm the earlier hypothesis that these modes are coupled peeling-ballooning modes, and extend and generalise to higher-mode numbers the work by Huysmans et al (1998 Nucl. Fusion 38 179), who identified the lowest n modes as pure external kink modes. Since the destabilisation of PB modes is widely accepted to give rise to ELMs, the mode saturation and delayed ELM triggering that is sometimes observed is rather unexpected. Possibilities to reconcile the extended lifetime of these modes with current ELM models are briefly discussed, but will require further investigation

Diagnostic of fast-ion energy spectra and densities in magnetized plasmas

The measurement of the energy spectra and densities of alpha-particles and other fast ions are part of the ITER measurement requirements, highlighting the importance of energy-resolved energetic-particle measurements for the mission of ITER. However, it has been found in recent years that the velocity-space interrogation regions of the foreseen energetic-particle diagnostics do not allow these measurements directly. We will demonstrate this for gamma-ray spectroscopy (GRS), collective Thomson scattering (CTS), neutron emission spectroscopy and fast-ion D-alpha spectroscopy by invoking energy and momentum conservation in each case, highlighting analogies and differences between the different diagnostic velocity-space sensitivities. Nevertheless, energy spectra and densities can be inferred by velocity-space tomography which we demonstrate using measurements at JET and ASDEX Upgrade. The measured energy spectra agree well with corresponding simulations. At ITER, alpha-particle energy spectra and densities can be inferred for energies larger than 1.7 MeV by velocity-space tomography based on GRS and CTS. Further, assuming isotropy of the alpha-particles in velocity space, their energy spectra and densities can be inferred by 1D inversion of spectral single-detector measurements down to about 300 keV by CTS. The alpha-particle density can also be found by fitting a model to the CTS measurements assuming the alpha-particle distribution to be an isotropic slowing-down distribution

EDGE2D-EIRENE simulations of the influence of isotope effects and anomalous transport coefficients on near scrape-off layer radial electric field

EDGE2D-EIRENE (the 'code') simulations show that radial electric field, Er, in the near scrape-off layer (SOL) of tokamaks can have large variations leading to a strong local E x B shear greatly exceeding that in the core region. This was pointed out in simulations of JET plasmas with varying divertor geometry, where the magnetic configuration with larger predicted near SOL E-r was found to have lower H-mode power threshold, suggesting that turbulence suppression in the SOL by local E. x. B shear can be a player in the L-H transition physics (Delabie et al 2015 42nd EPS Conf. on Plasma Physics (Lisbon, Portugal, 22-26 June 2015) paper O3.113 (http://ocs.ciemat.es/EPS2015PAP/pdf/O3.113.pdf), Chankin et al 2017 Nucl. Mater. Energy 12 273). Further code modeling of JET plasmas by changing hydrogen isotopes (H-D-T) showed that the magnitude of the near SOL E-r is lower in H cases in which the H-mode threshold power is higher (Chankin et al 2017 Plasma Phys. Control. Fusion 59 045012). From the experiment it is also known that hydrogen plasmas have poorer particle and energy confinement than deuterium plasmas, consistent with the code simulation results showing larger particle diffusion coefficients at the plasma edge, including SOL, in hydrogen plasmas (Maggi et al 2018 Plasma Phys. Control. Fusion 60 014045). All these experimental observations and code results support the hypothesis that the near SOL E x B shear can have an impact on the plasma confinement. The present work analyzes neutral ionization patterns of JET plasmas with different hydrogen isotopes in L-mode cases with fixed input power and gas puffing rate, and its impact on target electron temperature, T-e, and SOL E-r. The possibility of a self-feeding mechanism for the increase in the SOL E-r via the interplay between poloidal E x B drift and target T-e is discussed. It is also shown that reducing anomalous turbulent transport coefficients, particle diffusion and electron and ion heat conductivities, leads to higher peak target T-e and larger E-r, suggesting the possibility of a positive feedback loop, under an implicitly made assumption that the E x B shear in the SOL is capable of suppressing turbulence