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The electron cyclotron (EC) heating and current drive (H&CD) system developed for the ITER is made of 12 sets of high-voltage power supplies feeding 24 gyrotrons connected through 24 transmission lines (TL), to five launchers, four located in upper ports and one at the equatorial level. Nearly all procurements are in-kind, following general ITER philosophy, and will come from Europe, India, Japan, Russia and the USA. The full system is designed to couple to the plasma 20 MW among the 24 MW generated power, at the frequency of 170 GHz, for various physics applications such as plasma start-up, central H&CD and magnetohydrodynamic (MHD) activity control. The design takes present day technology and extends toward high-power continuous operation, which represents a large step forward as compared to the present state of the art. The ITER EC system will be a stepping stone to future EC systems for DEMO and beyond. The development of the EC system is facing significant challenges, which includes not only an advanced microwave system but also compliance with stringent requirements associated with nuclear safety as ITER became the first fusion device licensed as basic nuclear installations as of 9 November 2012. Since the conceptual design of the EC system was established in 2007, the EC system has progressed to a preliminary design stage in 2012 and is now moving forward toward a final design.

Background Prone positioning improves survival in patients with acute respiratory distress syndrome (ARDS) by reducing ventilator-induced lung injury and enhancing ventilation–perfusion matching. Whether these physiological benefits translate to patients supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) remains uncertain. Methods This study compared the effects of prone versus supine positioning on the wet-to-dry lung weight ratio, gas exchange, respiratory mechanics, electrical impedance tomography, histopathology, microbiology, hemodynamics, and extracorporeal circuit function in pigs with severe ARDS undergoing VV-ECMO. Pigs with severe ARDS were placed on VV-ECMO according to EOLIA criteria and then randomized to either prone or supine positioning for 48 h, while receiving an ultraprotective ventilation strategy. Futility analyses were performed at half of the planned sample size using conditional power calculations, with early termination criteria set at < 10% probability of achieving statistical significance. Results Eight pigs with severe ARDS were randomized after VV-ECMO initiation. Prone positioning, compared with the supine position, resulted in a similar wet-to-dry lung weight ratio (6.77 [6.13–8.17] vs. 6.70 [6.22–8.48]; p = 0.89), meeting the futility threshold. Compared with the supine position, prone positioning significantly reduced the proportion of ventilation in non-dependent lung regions (51 [47–61.25]% vs. 86 [68.50–90]%; p = 0.02), thereby indicating a redistribution of ventilation toward dependent areas. Consistent with this shift in ventilation distribution, prone positioning redistributed histopathological lung injury, with relative preservation of non-dependent regions and greater damage in dependent zones, but without a net global decrease. Shunt fraction approached 100% in both groups, with no significant differences. Pulmonary CO₂ elimination was 8.45 (1.45–26.13) mL/min in the prone group and 0 (0–0.70) mL/min in the supine group (p = 0.23). Lung compliance showed no intergroup differences (14.67 [12.75–19.91] vs. 16.68 [15.51–19.47] mL/cmH₂O; p = 0.88), with similarly elevated end-inspiratory transpulmonary pressures. No significant differences were observed in systemic or pulmonary hemodynamics, nor in VV-ECMO circuit function. Conclusions Prone positioning did not decrease the overall severity of lung injury. Rather, it shifted the distribution of damage, with greater involvement of dependent regions and relative preservation of non-dependent areas. Graphical abstract

The ITER ECRH&CD system is designed to inject 20 MW of millimetre-wave at 170 GHz into the vacuum vessel. The system is composed of many sub-systems, namely High-Voltage Power Supplies (HVPS), Gyrotrons, Transmission Lines (TL), Ex-vessel Waveguides (EW), Launchers. It is the role of the EC Plant Controller (ECPC) to integrate all the Sub-system Control Units (SCU), to prepare the system for operation and to execute the real-time requests coming from the plasma control system. Plant level protections are also implemented by the ECPC, in charge of ensuring the safe operation of the plant, while optimizing the power availability. While control and protection functions are always pushed to the lower possible controller able to implement them, the operational requirements and flexibility of the system make it impossible to fully segregate many functions, since each gyrotron is connected to at least two different launching mirrors. To simplify the SCUs’ development and to respect the responsibility boundaries imposed by the procurement strategy, all the functions involving more than one sub-system are implemented in the ECPC, which exposes a single operational interface towards the ITER Central I&C. The status of the control system development is presented in this work.

The ITER ECRH&CD system is designed to inject 20 MW of millimetre-wave at 170 GHz into the vacuum vessel. The system is composed of many sub-systems, namely High-Voltage Power Supplies (HVPS), Gyrotrons, Transmission Lines (TL), Ex-vessel Waveguides (EW), Launchers. It is the role of the EC Plant Controller (ECPC) to integrate all the Sub-system Control Units (SCU), to prepare the system for operation and to execute the real-time requests coming from the plasma control system. Plant level protections are also implemented by the ECPC, in charge of ensuring the safe operation of the plant, while optimizing the power availability. While control and protection functions are always pushed to the lower possible controller able to implement them, the operational requirements and flexibility of the system make it impossible to fully segregate many functions, since each gyrotron is connected to at least two different launching mirrors. To simplify the SCUs’ development and to respect the responsibility boundaries imposed by the procurement strategy, all the functions involving more than one sub-system are implemented in the ECPC, which exposes a single operational interface towards the ITER Central I&C. The status of the control system development is presented in this work.

The ITER ECH&CD system is designed to inject 20 MW of millimetre-wave at 170 GHz into the vacuum vessel. The system is composed of many sub-systems, namely High-Voltage Power Supplies (HVPS), Gyrotrons, Transmission Lines (TL), Ex-vessel Waveguides (EW), Launchers. It is the role of the EC Plant Controller (ECPC) to integrate all the Sub-system Control Units (SCU), to prepare the system for operation and to execute the real-time requests coming from the plasma control system. The ECPC also implements plant level protection functions involving more than one sub-system and it interfaces with the ITER Central I&C. This paper gives an overview of the EC system and a description of the control system development focusing on the architecture and the interfaces. Control and protection functions are presented together with a functional allocation to better define interfaces and responsibilities. The preliminary design of the interface with the Plasma Control System to implement advanced control functions is also presented.

The ITER ECH&CD system is designed to inject 20 MW of millimetre-wave at 170 GHz into the vacuum vessel. The system is composed of many sub-systems, namely High-Voltage Power Supplies (HVPS), Gyrotrons, Transmission Lines (TL), Ex-vessel Waveguides (EW), Launchers. It is the role of the EC Plant Controller (ECPC) to integrate all the Sub-system Control Units (SCU), to prepare the system for operation and to execute the real-time requests coming from the plasma control system. The ECPC also implements plant level protection functions involving more than one sub-system and it interfaces with the ITER Central I&C. This paper gives an overview of the EC system and a description of the control system development focusing on the architecture and the interfaces. Control and protection functions are presented together with a functional allocation to better define interfaces and responsibilities. The preliminary design of the interface with the Plasma Control System to implement advanced control functions is also presented.

BACKGROUND: A poor communication with immigrants can lead to inappropriate use of healthcare services, greater risk of misdiagnosis, and lower compliance with treatment. As precise information about communication between emergency physicians(EPs) and immigrants is lacking, we analyzed difficulties in communicating with immigrants in the emergency department(ED) and their possible associations with demographic data, geographical origin and clinical characteristics.METHODS: In an ED with approximately 85 000 visits per year, a multiple-choice questionnaire was given to the EPs 4 months after discharge of each immigrant in 2011.RESULTS: Linguistic comprehension was optimal or partial in the majority of patients. Signifi cant barriers were noted in nearly one fourth of patients, for only half of them compatriots who were able to translate. Linguistic barriers were mainly found in older and sicker patients; they were also frequently seen in patients coming from western Africa and southern Europe. Non-linguistic barriers were perceived by EPs in a minority of patients, more frequently in the elderly and frequent attenders. Factors independently associated with a poor f inal comprehension led to linguistic barriers, non-linguistic obstacles, the absence of intermediaries, and the presence of patient’s fear and hostility. The latter probably is a consequence, not the cause, of a poor comprehension.CONCLUSION: Linguistic and non-linguistic barriers, although quite infrequent, are the main factors that compromise communication with immigrants in the ED, with negative effects especially on elderly and more seriously ill patients as well as on physician satisfaction and appropriateness in using services.