Performance Scaling in Magnetized Liner Inertial Fusion Experiments.

We present experimental results from the first systematic study of performance scaling with drive parameters for a magnetoinertial fusion concept. In magnetized liner inertial fusion experiments, the burn-averaged ion temperature doubles to 3.1 keV and the primary deuterium-deuterium neutron yield increases by more than an order of magnitude to 1.1×10^{13} (2 kJ deuterium-tritium equivalent) through a simultaneous increase in the applied magnetic field (from 10.4 to 15.9 T), laser preheat energy (from 0.46 to 1.2 kJ), and current coupling (from 16 to 20 MA). Individual parametric scans of the initial magnetic field and laser preheat energy show the expected trends, demonstrating the importance of magnetic insulation and the impact of the Nernst effect for this concept. A drive-current scan shows that present experiments operate close to the point where implosion stability is a limiting factor in performance, demonstrating the need to raise fuel pressure as drive current is increased. Simulations that capture these experimental trends indicate that another order of magnitude increase in yield on the Z facility is possible with additional increases of input parameters.

Neutron source reconstruction using a generalized expectation-maximization algorithm on one-dimensional neutron images from the Z facility.

Magnetized Liner Inertial Fusion experiments have been performed at the Z facility at Sandia National Laboratories. These experiments use deuterium fuel, which produces 2.45 MeV neutrons on reaching thermonuclear conditions. To study the spatial structure of neutron production, the one-dimensional imager of neutrons diagnostic was fielded to record axial resolved neutron images. In this diagnostic, neutrons passing through a rolled edge aperture form an image on a CR-39-based solid state nuclear track detector. Here, we present a modified generalized expectation-maximization algorithm to reconstruct an axial neutron emission profile of the stagnated fusion plasma. We validate the approach by comparing the reconstructed neutron emission profile to an x-ray emission profile provided by a time-integrated pinhole camera.

Radiation, optical, power flow, and electrical diagnostics at the Z facility: Layout and techniques utilized to operate in the harsh environment.

The Z machine is a current driver producing up to 30 MA in 100 ns that utilizes a wide range of diagnostics to assess accelerator performance and target behavior conduct experiments that use the Z target as a source of radiation or high pressures. We review the existing suite of diagnostic systems, including their locations and primary configurations. The diagnostics are grouped in the following categories: pulsed power diagnostics, x-ray power and energy, x-ray spectroscopy, x-ray imaging (including backlighting, power flow, and velocimetry), and nuclear detectors (including neutron activation). We will also briefly summarize the primary imaging detectors we use at Z: image plates, x-ray and visible film, microchannel plates, and the ultrafast x-ray imager. The Z shot produces a harsh environment that interferes with diagnostic operation and data retrieval. We term these detrimental processes "threats" of which only partial quantifications and precise sources are known. We summarize the threats and describe techniques utilized in many of the systems to reduce noise and backgrounds.

Demonstration of improved laser preheat with a cryogenically cooled magnetized liner inertial fusion platform.

We report on progress implementing and testing cryogenically cooled platforms for Magnetized Liner Inertial Fusion (MagLIF) experiments. Two cryogenically cooled experimental platforms were developed: an integrated platform fielded on the Z pulsed power generator that combines magnetization, laser preheat, and pulsed-power-driven fuel compression and a laser-only platform in a separate chamber that enables measurements of the laser preheat energy using shadowgraphy measurements. The laser-only experiments suggest that ∼89% ± 10% of the incident energy is coupled to the fuel in cooled targets across the energy range tested, significantly higher than previous warm experiments that achieved at most 67% coupling and in line with simulation predictions. The laser preheat configuration was applied to a cryogenically cooled integrated experiment that used a novel cryostat configuration that cooled the MagLIF liner from both ends. The integrated experiment, z3576, coupled 2.32 ± 0.25 kJ preheat energy to the fuel, the highest to-date, demonstrated excellent temperature control and nominal current delivery, and produced one of the highest pressure stagnations as determined by a Bayesian analysis of the data.

Inferring neutron yields using indium activation samples for small fractions of tritium added to deuterium fuel in inertial confinement fusion (ICF) experiments.

In inertial confinement fusion experiments, the neutron yield is an important metric for thermonuclear fusion performance. Neutron activation diagnostics can be used to infer neutron yields. The material used for neutron activation diagnostic undergoes a threshold reaction so that only neutrons having energies above the threshold energy are observed. For thermonuclear experiments using deuterium (D) and tritium (T) fuel constituents, neutrons arising from D + D reactions (DD-neutrons) and neutrons resulting from D + T reactions (DT-neutrons) are of primary interest. Indium has two neutron activation reactions that can be used to infer yields of DD-neutrons and DT-neutrons. One threshold is high enough that only DT-neutrons can induce activation, the second reaction can be activated by both DD-neutrons and DT-neutrons. Thus, to obtain the DD-neutron yield, the contribution made by DT-neutrons to the total induced activity must be extracted. In DD-fuel experiments, DT-neutrons arise from secondary reactions, which are significantly lower in number than primary DD-neutrons, and their contribution to the inferred DD-neutron yield can be ignored. When the DD- and DT-neutron yields become comparable, such as when low tritium fractions are added to DD-fuel, the contribution of DT-neutrons must be extracted to obtain accurate yields. A general method is described for this correction to DD-neutron yields.

Neutron time-of-flight detectors (nTOF) used at Sandia's Z-Machine.

Neutron time-of-flight (nTOF) detectors have been used on Sandia National Laboratories' Z-Machine for inertial confinement fusion and magnetized liner fusion experiments to infer physics parameters including the apparent fuel-ion temperature, neutron yield, the magnetic-radius product (BR), and the liner rho-r. Single-paddle, dual-paddle, and co-axial scintillation nTOF detectors are used in axial lines-of-sight (LOS) and LOS that are 12° from the midplane. Detector fabrication, characterization, and calibration are discussed.

A neutron recoil-spectrometer for measuring yield and determining liner areal densities at the Z facility.

A proof-of-principle CR-39 based neutron-recoil-spectrometer was built and fielded on the Z facility. Data from this experiment match indium activation yields within a factor of 2 using simplified instrument response function models. The data also demonstrate the need for neutron shielding in order to infer liner areal densities. A new shielded design has been developed. The spectrometer is expected to achieve signal-to-background greater than 2 for the down-scattered neutron signal and greater than 30 for the primary signal.

Prochlorperazine tablets repackaged into dose administration aids: can the patient be assured of quality?

BACKGROUND AND OBJECTIVE: Patients are increasingly requiring their medications to be repackaged into dose administration aids because of the positive outcomes associated with reduction in medication related hospitalization and adverse effects due to improved medicines management. Since the stability of these repackaged medications is not the responsibility of manufacturer, it is important that drug substances with potential stability issues be identified. Thus the objective of this study was to evaluate the stability of prochlorperazine, a light sensitive drug repackaged into dose administration aids (DAAs), in order to provide guidelines to the pharmacist and advice to the patient on appropriate storage. METHODS: Prochlorperazine tablets were stored repackaged in DAAs and in their original packaging for 8 weeks at ambient (25 +/- 1 degrees C; 60 +/- 1.5% RH), accelerated (40 +/- 1 degrees C; 75 +/- 1.5% RH) and in-use conditions encountered in situ both in a pharmacy and the patients' home. They were assessed for both chemical (using a validated HPLC method) and physical stability according to British Pharmacopoeial (BP) standards. In addition, photostability testing was undertaken under ICH conditions. RESULTS AND DISCUSSION: Chemical and physical stability was confirmed to be within BP Limits. There were, however, noticeable organoleptic changes in the tablets stored under in-use conditions with a progressive grey discolouration over the 8 weeks, starting in week 2. CONCLUSION: Despite the confirmation of physical and chemical stability within BP limits, the discoloration and the potential for photodegradants to cause adverse effects in patients must lead us to draw the conclusion that the quality of this medication has been compromised. Pharmacists thus need to take this into account in repackaging and storage of prochlorperazine in DAAs and advise patients to store their DAA protected from light, heat and humidity.

Analysing the crystal purity of mebendazole raw material and its stability in a suspension formulation.

The objective of this study was to develop a simple, direct and non-destructive method to assess crystal purity of mebendazole raw material and to establish its stability in a suspension formulation using diffuse reflectance ultraviolet (DRA-UV) spectroscopy and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Quantitation of mebendazole, found to exhibit polymorphism with three polymorphic forms A, B and C identified, was carried out with ATR-FTIR spectroscopy. Artificial neural network (ANN) was employed as a data-modelling tool. The developed ANN models confirmed that the characteristic absorptions in the infrared (IR) spectral region are directly proportional to the measured amounts of mebendazole crystal forms present in the samples (r(2)>0.94), which was confirmed with X-ray diffraction (XRD) at r(2)>0.97. These models also predicted that the mebendazole raw material contained 7.21+/-1.25% (ATR-FTIR data) and 10.38+/-0.18% (XRD data) of form A as an impurity. ATR-FTIR data for the suspension formulation showed some dissolution of form C and recrystalisation as the more stable form A. These quantitative results obtained for the binary crystal form mixtures clearly demonstrate the strong potential of ATR-FTIR for use in the determination of the polymorphic content not only in bulk pharmaceuticals but also in liquid formulations.

Compatibility studies between mannitol and omeprazole sodium isomers.

Omeprazole, commonly used in the treatment of various gastrointestinal disorders degrades rapidly in acidic pHs and results in inter-individual variability due to different rates of metabolism amongst patients. Since S-omeprazole shows more predictable bioavailability and excipients have been known to interact with active pharmaceutical ingredients to produce altered bioavailability, it was decided to investigate the compatibility of omeprazole sodium isomers with mannitol, the major excipient in omeprazole formulations using differential scanning calorimetry (DSC) for bulk drug, attenuated total reflectance (ATR) infrared (IR) spectroscopy in a powder mixture and localized thermal analysis (LTA) from a drug disk. DSC results clearly indicate an interaction between mannitol and R-omeprazole sodium due to decreased melting temperatures and broadening peaks. The DSC of S-omeprazole sodium does not show melting temperature although the drug was crystalline. Because of the accelerated temperature conditions during DSC experiments applied in this work, ATR-IR was undertaken to determine whether these results occurred at room temperature for the solid dosage form. The ATR-IR results show a difference between R- and S-omeprazole sodium with mannitol by the appearance of both the amino (N-H) and imino (N-H) stretching frequencies for R-omeprazole and only the N-H for the S-omeprazole sodium. It may thus be concluded that different ratios for the tautomeric forms for S- and R-omeprazole sodium result in changes in the degree of crystallinity and are responsible for the interaction with mannitol, common excipient in formulation. These interactions may be directly related to the difference in terms of bioavailability.

Serpinb9 is a marker of antigen cross-presenting dendritic cells.

Serpinb9 (Sb9, also called Spi6) is an intracellular inhibitor of granzyme B (grB) that protects cytotoxic lymphocytes from grB-mediated death. In addition, Sb9 is also expressed in accessory immune cells, including dendritic cells (DCs), although its role is debated. Recently, we have demonstrated that Sb9 plays a grB-independent role in cross-presentation of antigens by CD8+ DCs. Here, using a mouse line expressing green fluorescent protein knocked in under the control of the Sb9 promoter, we demonstrate that Sb9 expression is highest in those tissue-resident and migratory DC subsets capable of cross-presentation. Further, we show that CD8+ DCs can be divided into two subsets based on Sb9 expression, and that only the subset expressing higher levels of Sb9 is capable of cross-presentation. These findings add support for role for Sb9 cross-presentation, and indicate that high Sb9 expression is a novel marker of cross-presentation capable DCs.

Combined testing of anterior pituitary gland with insulin, thyrotropin-releasing hormone, and luteinizing hormone-releasing hormone.

Provocative tests of hypothalamic-pituitary function were performed in 20 healthy subjects to learn whether the simultaneous testing by three agents--insulin, thyrotropin-releasing hormone, and luteinizing hormone-releasing hormone--was feasible. The responses to simultaneous testing on one day did not differ significantly from those to testing on three separate days. The time and expense of pituitary-hypothalamic testing can thus be much reduced with no impairment of reliability and with no increased risk to the patient.

Random insertion mutagenesis of the intracellular pathogen Rhodococcus equi using transposomes.

The identification of virulence factors in Rhodococcus equi has been severely hampered by the lack of a method for in vivo random insertion mutagenesis. This study reports the use of transposomes to generate random insertions of a gene conferring kanamycin resistance into the genome of R. equi ATCC 33701. Southern hybridisation using the kanamycin resistance gene as probe showed that insertion of transposome is random. This was confirmed following nucleotide sequence analysis of the junction between the transposome and chromosomal DNA. The presence of a 9 bp duplication of the target sequence showed that random integration of the transposome was due to a bona fide Tn5 transposition event.

Acute spinal cord compression by subarachnoid and subdural hematoma occurring in association with brachial plexus avulsion. Case report.

The authors report a case of acute spinal cord compression caused by a subarachnoid and subdural hematoma. This occurred following traumatic brachial plexus avulsion. It is believed to be the first such case recorded.

Project LEAP of New Jersey: lower extremity amputation prevention in persons with type 2 diabetes.

OBJECTIVE: To reduce type 2 diabetes-related lower extremity amputations (LEAs) in New Jersey through a statewide training program for primary care providers at healthcare agencies in high-risk areas. STUDY DESIGN: Project LEAP provided 27 1-day training workshops to 560 healthcare professionals representing 85 organizations. The effect of training was evaluated based on a multiple-choice knowledge test, self-reported practice behaviors, and a medical records audit of practice behaviors, and pre- and postprogram LEA rates. PATIENTS AND METHODS: We evaluated statistically significant differences in pre- and postprogram knowledge scores using Student's t-tests. We also evaluated providers' intentions to change clinical foot-care practices and compared them with actual practices documented in medical records. We used analysis of variance to determine any statistically significant differences in pre- and postprogram LEA rates at various types of institutions. In addition, we assisted facilities in the development of self-education programs containing specific foot-care modules. RESULTS: Participating providers were: 70.6% nurses, 7.8% physicians, 4.5% podiatrists, 4.2% dietitians, and 12.9% all others. Pre- and postprogram knowledge scores increased by 12% (T = 13.29; P < 0.0001) and were maintained for 9 months (T = 7.58; P < 0.05). Provider intentions to change clinical practice behaviors correlated with self-reported practice changes 9 months postprogram (r = .51; P < 0.001). Medical record audits 1 year before and 9 months after training demonstrated marked improvement in foot-care practices in the following areas: (1) foot-care education given to patients by primary care providers; 2) documentation of peripheral vascular disease; 3) documentation of patient preventive care practices; and 4) referrals to diabetes educators, orthopedists, podiatrists, and diabetologists. Education programs with specific foot-care components increased 10%. The overall incidence of pre- and posttraining LEAs did not change significantly but differed depending on institution type. Hospitals and community healthcare centers were more likely to show postprogram reductions in LEAs than nursing homes and rehabilitation centers. CONCLUSION: Institutionalization of a LEAP program resulted in improved provider knowledge and certain clinical practice behaviors. There was a trend toward an overall reduction in the number of LEAs at participating institutions.

The Chiari malformation in adults.

The clinical features of the Chiari Malformation in seven adult patients are presented. It is suggested that the clinical syndromes associated with this malformation, in adults, can be classified as (a) compression of structures at the level of foramen magnum (with or without radiologically demonstrable associated bony anomaly at the cranio-vertebral junction (b) increased intracranial pressure or obstructive hydrocephalus and (c) intramedullary cervical cord syndrome. The usefulness of tomography, and demonstration of the vertebro-basilar circulation in the neuro-radiologic investigation of these patients is emphasized. The surgical procedures performed in the management of these patients are outlined.

Hemifacial spasm and craniovertebral anomaly.

Two patients with congenital anomaly of the craniovertebral junction causing disabling hemifacial spasm (HFS) are presented. In one patient, complete cessation of the HFS occurred for a period of two years following simple bony decompression of the craniovertebral junction raising unanswered questions as to the exact pathogenesis of HFS. Eventually both patients required microvascular decompression at the root entry zone of the facial nerve.

Primary malignant tumours of the trigeminal nerve.

We report a case of primary malignant schwannoma of the trigeminal nerve, and review the 5 previously reported cases. Clinical presentation, along with radiological and pathological features are discussed.

Diabetes self-management education programs in the Veterans Health Administration.

The role of diabetes educators is likely to evolve and expand due to the development of chronic disease management programs that are based on a multidisciplinary approach of healthcare providers. In addition to providing self-management education and training to more patients with diabetes, educators will most likely need to expand their services to include case management and quality management of process and health outcomes.

Adult diastematomyelia: a complex dysraphic state.

It is rare for patients with diastematomyelia to manifest initial symptoms in adult life. Clinical, radiological, and surgical features of a patient with symptomatic adult diastematomyelia are presented. Pathogenetic mechanisms are considered to include a variety of congenital spinal anomalies, distinct from the spur, as well as mechanical factors.