Developing symptom-specific dietary leaflets to address radiotherapy side effects using an eDelphi method.

INTRODUCTION: Patients suffering from head and neck (HN) cancer undergoing Radiotherapy (RT) suffer from various debilitating side effects that greatly hinder their eating ability. This leads to patients having a poor nutritional status causing weight loss. This study aimed to assess if an e-Delphi method variation allowed efficiently developing dietary advice leaflets addressing these side effects and achieving a consensus among healthcare professionals. METHODS: An e-Delphi style approach was used. Six participants representing the professions working with HN patients were asked to give feedback on four symptom-specific dietary leaflets. These leaflets were designed based on a previous extensive literature review. After each round, the participants' suggested changes were applied. Before applying major changes to the leaflet, the participants were asked to vote if they agreed with each major change. RESULTS: Overall consensus was reached after three rounds since all participants voted "highly likely" to use it in their clinical practice. Most suggestions by the participants agreed with the existing literature. The only change (accepted as a result of voting) that contradicted the literature was concerning sugar intake. CONCLUSION: The participants reached consensus and developed leaflets that were based on literature recommendations for use for patients that, in their opinion, were acceptable for clinical use. This e-Delphi variation proved to be efficient to achieve consensus among healthcare professionals regarding patient information tools. IMPLICATIONS FOR PRACTICE: This eDelphi method is an efficient and effective way to revise and achieve consensus regarding the development of patient information material.

Observation of Hydrodynamic Flows in Imploding Fusion Plasmas on the National Ignition Facility.

Inertial confinement fusion implosions designed to have minimal fluid motion at peak compression often show significant linear flows in the laboratory, attributable per simulations to percent-level imbalances in the laser drive illumination symmetry. We present experimental results which intentionally varied the mode 1 drive imbalance by up to 4% to test hydrodynamic predictions of flows and the resultant imploded core asymmetries and performance, as measured by a combination of DT neutron spectroscopy and high-resolution x-ray core imaging. Neutron yields decrease by up to 50%, and anisotropic neutron Doppler broadening increases by 20%, in agreement with simulations. Furthermore, a tracer jet from the capsule fill-tube perturbation that is entrained by the hot-spot flow confirms the average flow speeds deduced from neutron spectroscopy.

Experiences of Student Circus Arts Performers Undertaking a Shoulder Rehabilitation Program Via Telehealth Consultation During the COVID-19 Pandemic.

OBJECTIVE: To explore the subjective experiences of student circus arts performers with atraumatic shoulder instability undertaking a 12-week shoulder rehabilitation program during the COVID-19 pandemic lockdown, in Melbourne, Australia. METHODS: Using a qualitative design, 14 circus arts students from the National Institute of Circus Arts (Australia) were individually interviewed via teleconsultation. All interviews were recorded, transcribed, and analysed using inductive thematic analysis. RESULTS: Five overarching themes were identified: (i) impact (physical and mental), (ii) opportunity, (iii) developing routine, (iv) client-therapist relationship, and (v) transformation. All participants reported positive physical changes to their shoulder including increases in strength, stability, range of motion, less pain, "clicking" and "clunking," improved posture, muscle memory, as well as carry-over to functional circus activities. The pandemic's mental impact varied across the cohort, with positive and negative experiences described in relation to cognitive, social, and affective factors. Most performers felt the pandemic provided an opportunity to focus on rehabilitation of their shoulder. The program effects were also underpinned by positive client-therapist relationships and a progressive transformation of learning where students gained knowledge of their condition, developed tools to manage their current shoulder impairment, and learned how to apply this new knowledge to future management of their condition. CONCLUSION: A shoulder exercise intervention delivered via teleconsultation during the COVID-19 pandemic resulted in subjective reports of positive physical changes to the participants' shoulder health complaint. This was facilitated through client-physiotherapist relationships, providing structure during uncertain times, and by providing education to help in understanding their condition and its future management.

Interpolating individual line-of-sight neutron spectrometer measurements onto the "sky" at the National Ignition Facility (NIF).

Nuclear diagnostics provide measurements of inertial confinement fusion implosions used as metrics of performance for the shot. The interpretation of these measurements for shots with low mode asymmetries requires a way of combining the data to produce a "sky map" where the individual line-of-sight values are used to interpolate to other positions in the sky. These interpolations can provide information regarding the orientation of the low mode asymmetries. We describe the interpolation method, associated uncertainties, and correlations between different metrics, e.g., Tion, down scatter ratio, and hot-spot velocity direction. This work is also related to recently reported studies [H. G. Rinderknecht et al., Phys. Rev. Lett. 124, 145002 (2020) and K. M. Woo et al., Phys. Plasmas 27, 062702 (2020)] of low mode asymmetries. We report an analysis that makes use of a newly commissioned line of sight, a scheme for incorporating multiple neutron spectrum measurement types, and recent work on the sources of implosion asymmetry to provide a more complete picture of implosion performance.

Optimal choice of multiple line-of-sight measurements determining plasma hotspot velocity at the National Ignition Facility.

The measurement of plasma hotspot velocity provides an important diagnostic of implosion performance for inertial confinement fusion experiments at the National Ignition Facility. The shift of the fusion product neutron mean kinetic energy as measured along multiple line-of-sight time-of-flight spectrometers provides velocity vector components from which the hotspot velocity is inferred. Multiple measurements improve the hotspot velocity inference; however, practical considerations of available space, operational overhead, and instrumentation costs limit the number of possible line-of-sight measurements. We propose a solution to this classical "experiment design" problem that optimizes the precision of the velocity inference for a limited number of measurements.

Fluence-compensated down-scattered neutron imaging using the neutron imaging system at the National Ignition Facility.

The Neutron Imaging System at the National Ignition Facility is used to observe the primary ∼14 MeV neutrons from the hotspot and down-scattered neutrons (6-12 MeV) from the assembled shell. Due to the strong spatial dependence of the primary neutron fluence through the dense shell, the down-scattered image is convolved with the primary-neutron fluence much like a backlighter profile. Using a characteristic scattering angle assumption, we estimate the primary neutron fluence and compensate the down-scattered image, which reveals information about asymmetry that is otherwise difficult to extract without invoking complicated models.

Uncertainty analysis of signal deconvolution using a measured instrument response function.

A common analysis procedure minimizes the ln-likelihood that a set of experimental observables matches a parameterized model of the observation. The model includes a description of the underlying physical process as well as the instrument response function (IRF). In the case investigated here, the National Ignition Facility (NIF) neutron time-of-flight (nTOF) spectrometers, the IRF is constructed from measurements and models. IRF measurements have a finite precision that can make significant contributions to determine the uncertainty estimate of the physical model's parameters. We apply a Bayesian analysis to properly account for IRF uncertainties in calculating the ln-likelihood function used to find the optimum physical parameters.

Indications of flow near maximum compression in layered deuterium-tritium implosions at the National Ignition Facility.

An accurate understanding of burn dynamics in implosions of cryogenically layered deuterium (D) and tritium (T) filled capsules, obtained partly through precision diagnosis of these experiments, is essential for assessing the impediments to achieving ignition at the National Ignition Facility. We present measurements of neutrons from such implosions. The apparent ion temperatures T_{ion} are inferred from the variance of the primary neutron spectrum. Consistently higher DT than DD T_{ion} are observed and the difference is seen to increase with increasing apparent DT T_{ion}. The line-of-sight rms variations of both DD and DT T_{ion} are small, ∼150eV, indicating an isotropic source. The DD neutron yields are consistently high relative to the DT neutron yields given the observed T_{ion}. Spatial and temporal variations of the DT temperature and density, DD-DT differential attenuation in the surrounding DT fuel, and fluid motion variations contribute to a DT T_{ion} greater than the DD T_{ion}, but are in a one-dimensional model insufficient to explain the data. We hypothesize that in a three-dimensional interpretation, these effects combined could explain the results.

Neutron spectrometry--an essential tool for diagnosing implosions at the National Ignition Facility (invited).

DT neutron yield (Y(n)), ion temperature (T(i)), and down-scatter ratio (dsr) determined from measured neutron spectra are essential metrics for diagnosing the performance of inertial confinement fusion (ICF) implosions at the National Ignition Facility (NIF). A suite of neutron-time-of-flight (nTOF) spectrometers and a magnetic recoil spectrometer (MRS) have been implemented in different locations around the NIF target chamber, providing good implosion coverage and the complementarity required for reliable measurements of Y(n), T(i), and dsr. From the measured dsr value, an areal density (ρR) is determined through the relationship ρR(tot) (g∕cm(2)) = (20.4 ± 0.6) × dsr(10-12 MeV). The proportionality constant is determined considering implosion geometry, neutron attenuation, and energy range used for the dsr measurement. To ensure high accuracy in the measurements, a series of commissioning experiments using exploding pushers have been used for in situ calibration of the as-built spectrometers, which are now performing to the required accuracy. Recent data obtained with the MRS and nTOFs indicate that the implosion performance of cryogenically layered DT implosions, characterized by the experimental ignition threshold factor (ITFx), which is a function of dsr (or fuel ρR) and Y(n), has improved almost two orders of magnitude since the first shot in September, 2010.

Precision shock tuning on the national ignition facility.

Ignition implosions on the National Ignition Facility [J. D. Lindl et al., Phys. Plasmas 11, 339 (2004)] are underway with the goal of compressing deuterium-tritium fuel to a sufficiently high areal density (ρR) to sustain a self-propagating burn wave required for fusion power gain greater than unity. These implosions are driven with a very carefully tailored sequence of four shock waves that must be timed to very high precision to keep the fuel entropy and adiabat low and ρR high. The first series of precision tuning experiments on the National Ignition Facility, which use optical diagnostics to directly measure the strength and timing of all four shocks inside a hohlraum-driven, cryogenic liquid-deuterium-filled capsule interior have now been performed. The results of these experiments are presented demonstrating a significant decrease in adiabat over previously untuned implosions. The impact of the improved shock timing is confirmed in related deuterium-tritium layered capsule implosions, which show the highest fuel compression (ρR~1.0 g/cm(2)) measured to date, exceeding the previous record [V. Goncharov et al., Phys. Rev. Lett. 104, 165001 (2010)] by more than a factor of 3. The experiments also clearly reveal an issue with the 4th shock velocity, which is observed to be 20% slower than predictions from numerical simulation.

The National Ignition Facility neutron time-of-flight system and its initial performance (invited).

The National Ignition Facility (NIF) successfully completed its first inertial confinement fusion (ICF) campaign in 2009. A neutron time-of-flight (nTOF) system was part of the nuclear diagnostics used in this campaign. The nTOF technique has been used for decades on ICF facilities to infer the ion temperature of hot deuterium (D(2)) and deuterium-tritium (DT) plasmas based on the temporal Doppler broadening of the primary neutron peak. Once calibrated for absolute neutron sensitivity, the nTOF detectors can be used to measure the yield with high accuracy. The NIF nTOF system is designed to measure neutron yield and ion temperature over 11 orders of magnitude (from 10(8) to 10(19)), neutron bang time in DT implosions between 10(12) and 10(16), and to infer areal density for DT yields above 10(12). During the 2009 campaign, the three most sensitive neutron time-of-flight detectors were installed and used to measure the primary neutron yield and ion temperature from 25 high-convergence implosions using D(2) fuel. The OMEGA yield calibration of these detectors was successfully transferred to the NIF.

Modeling the National Ignition Facility neutron imaging system.

Numerical modeling of the neutron imaging system for the National Ignition Facility (NIF), forward from calculated target neutron emission to a camera image, will guide both the reduction of data and the future development of the system. Located 28 m from target chamber center, the system can produce two images at different neutron energies by gating on neutron arrival time. The brighter image, using neutrons near 14 MeV, reflects the size and symmetry of the implosion "hot spot." A second image in scattered neutrons, 10-12 MeV, reflects the size and symmetry of colder, denser fuel, but with only ∼1%-7% of the neutrons. A misalignment of the pinhole assembly up to ±175 µm is covered by a set of 37 subapertures with different pointings. The model includes the variability of the pinhole point spread function across the field of view. Omega experiments provided absolute calibration, scintillator spatial broadening, and the level of residual light in the down-scattered image from the primary neutrons. Application of the model to light decay measurements of EJ399, BC422, BCF99-55, Xylene, DPAC-30, and Liquid A suggests that DPAC-30 and Liquid A would be preferred over the BCF99-55 scintillator chosen for the first NIF system, if they could be fabricated into detectors with sufficient resolution.

X-ray Thomson-scattering measurements of density and temperature in shock-compressed beryllium.

We present the first x-ray scattering measurements of the state of compression and heating in laser irradiated solid beryllium. The scattered spectra at two different angles show Compton and plasmon features indicating a dense Fermi-degenerate plasma state with a Fermi energy above 30 eV and with temperatures in the range of 10-15 eV. These measurements indicate compression by a factor of 3 in agreement with Hugoniot data and detailed radiation-hydrodynamic modeling.

Climate and resource determinants of fundamental and realized metabolic niches of hibernating chipmunks.

Torpor is a reversible reduction in endotherm body temperature and metabolic rate. Because torpid endotherms can attain lower body temperatures in colder environments, minimum torpor metabolism generally increases with rising air temperature whereas euthermic metabolism generally declines with rising air temperature. As a result, the fundamental metabolic niche of endotherms that express torpor should be driven by climate and should be broadest in colder environments. On the other hand, if torpor serves primarily as an energy conservation strategy and its expression is influenced by energy availability, then the realized metabolic niche should be defined by resources. To evaluate the influence of resource and climate on torpor use and metabolism of hibernating mammals, we monitored the torpor expression of free-ranging eastern chipmunks (Tamias striatus) over two winters of varying resource abundance. In the low-food year, soil temperature constrained maximum torpor expression but was too invariant across small spatial scales to explain individual variation in torpor expression. In the high-food year, torpor was drastically reduced, and local density of seed-producing trees predicted fine-scale spatial variation in torpor expression. Thus, the fundamental metabolic niche of hibernating chipmunks in cold environments is broad and constrained by climate, whereas the realized metabolic niche is highly variable among individuals and years and is determined primarily by local resource abundance.

Radiation-driven hydrodynamics of high- hohlraums on the national ignition facility.

The first hohlraum experiments on the National Ignition Facility (NIF) using the initial four laser beams tested radiation temperature limits imposed by plasma filling. For a variety of hohlraum sizes and pulse lengths, the measured x-ray flux shows signatures of filling that coincide with hard x-ray emission from plasma streaming out of the hohlraum. These observations agree with hydrodynamic simulations and with an analytical model that includes hydrodynamic and coronal radiative losses. The modeling predicts radiation temperature limits with full NIF (1.8 MJ), greater, and of longer duration than required for ignition hohlraums.

Is it possible to assess the "ethics" of medical school applicants?

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.

Sensitive and rapid immunoassays for Salmonella enteritidis.

In order to develop more sensitive, specific, and rapid immunoassays to detect Salmonella enteritidis in food supplies, we have applied various approaches by using several different antibody preparations. Utilizing ELISA in both a plate and immunodot assay, we employed (i) a polycolonal rabbit antiserum to a boiled suspension of the organism; (ii) a monoclonal antibody to the cell surface of the bacterium; and (iii) mouse antisera to two oligosaccharides each containing the rare sugar tyvelose, and exhibited by S. enteritidis, a member of the group D salmonellae. We showed that the polyclonal antiserum and monoclonal antibody IG-10 to the cell surface could specifically detect from 10(2) to 10(3) organisms in a 10-microl sample in the plate and immunodot assay. Both assays are read in 4-5 hr. Further, in the mice immunized to the trisaccharide, (alpha-D-galactose-alpha-tyvelose-alpha-D-mannose), as well as those mice immunized to the tetrasaccharide, (alpha-D-galactose-alpha-tyvelose-alpha-D-mannose-alpha-L-rhamnose), specificity to tyvelose was determined by inhibition studies. The inhibitors of the antisera to the trisaccharide included the single sugar tyvelose conjugated to bovine serum albumin (BSA), a tetrasaccharide in which tyvelose is excluded, but contains alpha-D-galactose, alpha-ascarose, alpha-D-mannose, and alpha-L-rhamnose (conjugated to BSA), and others. The inhibition studies suggest that the mouse antisera are specific for tyvelose and also contain antibodies for mannose and rhamnose. The antibodies that have been made to the unique sugar tyvelose should improve the specificity in assays for S. enteritidis.

Monophasic group B Salmonella species infecting harbour porpoises (Phocoena phocoena) inhabiting Scottish coastal waters.

A monophasic strain of Salmonella group B having the antigenic structure 4, 12: a: - was isolated in culture from various tissues of 39 harbour porpoises (Phocoena phocoena). The tissue from which the organism was recovered most frequently was lung in 33 animals and intestine in 16 animals, but it was also isolated from heart valve, liver, kidney, spleen, mesenteric lymph node, pulmonary lymph node, hepatic lymph node, urethra, sheath and epididymis. As far as we are aware this is the first record of this strain from an animal source, raising the possibility that it may be host-adapted to harbour porpoises. The possible modes of transmission of monophasic group B Salmonella between porpoises are discussed.