Performance projections for the lithium tokamak experiment (LTX)

Use of a large-area liquid lithium limiter in the CDX-U tokamak produced the largest relative increase (an enhancement factor of 5-10) in Ohmic tokamak confinement ever observed. The confinement results from CDX-U do not agree with existing scaling laws, and cannot easily be projected to the new lithium tokamak experiment (LTX). Numerical simulations of CDX-U low recycling discharges have now been performed with the ASTRA-ESC code with a special reference transport model suitable for a diffusion-based confinement regime, incorporating boundary conditions for nonrecycling walls, with fuelling via edge gas puffing. This model has been successful at reproducing the experimental values of the energy confinement (4-6 ms), loop voltage (<0.5 V), and density for a typical CDX-U lithium discharge. The same transport model has also been used to project the performance of the LTX, in Ohmic operation, or with modest neutral beam injection (NBI). NBI in LTX, with a low recycling wall of liquid lithium, is predicted to result in core electron and ion temperatures of 1-2 keV, and energy confinement times in excess of 50 ms. Finally, the unique design features of LTX are summarized

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642

16-member ring metal chelate

US7557205; US7557205 B2; US7557205B2; US7,557,205; US 7,557,205 B2; 7557205; Application No. 10/948,458USVersion of Recor

α-Zinc O-Vinyl Carbamates as Anionic Friedel-Crafts Equivalents. Cross Coupling Reactions with Aryl and Heteroaryl Halides and Triflates

A mild, efficient, and general Negishi cross coupling protocol, 4 + 5 --> 6 is reported; the hydrolysis of products 6 to acetophenones demonstrates the anionic Friedel-Crafts equivalency of the overall synthetic operatio

α-Aryl O-Vinyl Carbamates. Tandem Carbolithiation-α-Alkylation and [1,2]-Wittig Rearrangement Reactions

Efficient, one-pot carbolithiation - alpha-alkylation and -[1.2]-Wittig rearrangement processes of alpha-aryl O-vinyl carbamates 1 to branched benzyl O-carbamates 3 and 2-aryl-2-hydroxypropionamides 4, including Naproxen analogues, is describe