Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Temporal Trends in Traumatic Brain Injury

Aims Traumatic brain injury (TBI) is a leading cause of preventable mortality and morbidity. Our aim was to examine the demographics, injury characteristics and management of TBI patients treated in an intensive care unit (ICU) in an Irish tertiary-level hospital with a neurosurgical department. Methods A retrospective, longitudinal study of all TBI patients treated in ICU between 2013-2018. Results 77% (n=171) were male and median age was 46 (Q1-Q3: 28-62). The most common mechanism of injury was fall from less than two meters (<2m) followed by road traffic accident (RTA). The proportion of injuries due to RTA increased over the six-year period (p=0.006). 41.4% (n=92) of injuries had reported alcohol involvement. Patients with fall<2m had double the median age and double the rate of alcohol involvement compared to those suffering RTA (p<0.001, p<0.001). The neurosurgical intervention rate was 74% (n=165). The median duration of ICU admission and of intracranial-pressure monitoring, advanced ventilation and inotropic therapy increased over the six-year period (p=0.031, p=0.038, p=0.033, p<0.001). Discussion This study's findings could inform precise and impactful public prevention measures. The increasing duration of ICU admission and of other interventions should be examined further for their effect on patient outcome and resource consumption.

Mission, Organization and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Global efforts are needed to elucidate the epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19) including seroprevalence, risk factors and long-term sequelae, as well as immune responses following vaccination across populations and the social dimensions of prevention and treatment strategies. In the U.S., the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation’s largest coordinated effort to study COVID-19. The network is comprised of multidisciplinary researchers bridging gaps and fostering collaborations between immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policy makers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, HIV, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including health care workers and first responders). Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes. In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.

Experimentally Inferred Fusion Yield Dependencies of OMEGA Inertial Confinement Fusion Implosions

Statistical modeling of experimental and simulation databases has enabled the development of an accurate predictive capability for deuterium-tritium layered cryogenic implosions at the OMEGA laser [V. Gopalaswamy et al.,Nature 565, 581 (2019)10.1038/s41586-019-0877-0]. In this letter, a physics-based statistical mapping framework is described and used to uncover the dependencies of the fusion yield. This model is used to identify and quantify the degradation mechanisms of the fusion yield in direct-drive implosions on OMEGA. The yield is found to be reduced by the ratio of laser beam to target radius, the asymmetry in inferred ion temperatures from the ℓ=1 mode, the time span over which tritium fuel has decayed, and parameters related to the implosion hydrodynamic stability. When adjusted for tritium decay and ℓ=1 mode, the highest yield in OMEGA cryogenic implosions is predicted to exceed 2×10^{14} fusion reactions.

Thermal decoupling of deuterium and tritium during the inertial confinement fusion shock-convergence phase

A series of thin glass-shell shock-driven DT gas-filled capsule implosions was conducted at the OMEGA laser facility. These experiments generate conditions relevant to the central plasma during the shock-convergence phase of ablatively driven inertial confinement fusion (ICF) implosions. The spectral temperatures inferred from the DTn and DDn spectra are most consistent with a two-ion-temperature plasma, where the initial apparent temperature ratio, T_{T}/T_{D}, is 1.5. This is an experimental confirmation of the long-standing conjecture that plasma shocks couple energy directly proportional to the species mass in multi-ion plasmas. The apparent temperature ratio trend with equilibration time matches expected thermal equilibration described by hydrodynamic theory. This indicates that deuterium and tritium ions have different energy distributions for the time period surrounding shock convergence in ignition-relevant ICF implosions.

Extracraniofacial anomalies in Treacher Collins syndrome: A multicentre study of 248 patients

Treacher Collins syndrome (TCS) is a congenital malformation of the craniofacial structures derived from the first and second pharyngeal arches. The craniofacial deformities are well described in the literature. However, little is known about whether there are associated extracraniofacial anomalies. A retrospective study was conducted using data from four craniofacial units. Medical charts were reviewed for the presence and type of extracraniofacial anomalies, as well as age at diagnosis. A possible correlation between the severity of the phenotype and the presence of extracraniofacial anomalies was assessed using the Hayashi classification. A total of 248 patients with TCS were identified; 240 were confirmed to have TCS, of whom 61 (25.4%) were diagnosed with one or more extracraniofacial anomalies. Ninety-five different extracraniofacial anomalies were found; vertebral (n=32) and cardiac (n=13) anomalies were most frequently seen, followed by reproductive system (n=11), central nervous system (n=7), and limb (n=7) anomalies. No correlations between tracts were found. Extracraniofacial anomalies were more prevalent in these patients with TCS compared to the general population (25.4% vs 0.001-2%, respectively). Furthermore, a positive trend was seen between the severity of the syndrome and the presence of extracraniofacial anomalies. A full clinical examination should be performed on any new TCS patient to detect any extracraniofacial anomalies on first encounter with the craniofacial team.

Using millimeter-sized carbon-deuterium foils for high-precision deuterium-tritium neutron spectrum measurements in direct-drive inertial confinement fusion at the OMEGA laser facility

Millimeter-sized CD foils fielded close (order mm) to inertial confinement fusion (ICF) implosions have been proposed as a game-changer for improving energy resolution and allowing time-resolution in neutron spectrum measurements using the magnetic recoil technique. This paper presents results from initial experiments testing this concept for direct drive ICF at the OMEGA Laser Facility. While the foils are shown to produce reasonable signals, inferred spectral broadening is seen to be high (∼5 keV) and signal levels are low (by ∼20%) compared to expectation. Before this type of foil is used for precision experiments, the foil mount must be improved, oxygen uptake in the foils must be better characterized, and impact of uncontrolled foil motion prior to detection must be investigated.

Modifying laboratory testing via home brew during the COVID-19 pandemic

Rapid development and deployment of diagnostic testing for COVID-19 have been a key component of the public health response to the pandemic. Out of necessity, academic and other clinical laboratories developed laboratory testing innovations for COVID-19 to meet clinical testing demands. In addition to constraints on local testing supplies and equipment, a rapidly changing regulatory framework created challenges for translational scientists. Illustrative examples of approaches used to develop laboratory tests during the early stages of the COVID-19 pandemic demonstrate effective team science approaches to this challenging clinical care and public health emergency. These experiences and the associated lessons learned are relevant to the development of public health response plans for future pandemics.

0981 Sleep Practices In Pediatric Cancer—Does Sleep Hygiene Matter For Reducing Cancer Symptom Burden?

Introduction

Sleep disturbances are common during pediatric cancer treatment and recent evidence suggests a correlation between sleep and symptom burden. Improving nighttime sleep may impact patients’ ability to cope with symptoms. The current study tests the interaction between sleep hygiene and sleep disturbances in predicting cancer-related symptoms to determine if the relationship between sleep and symptoms is different for patients with better sleep hygiene.

Methods

102 caregivers of children with cancer (ages 5-17, M=10.12, SD=4.02; 58% female) completed parent-proxy Pediatric Sleep Practices Questionnaire (yielding routine consistency and sleep opportunity scores) and measures of cancer-related symptoms (PROMIS Sleep Disturbance, Fatigue, and Pain Interference; PedsQL—Cancer Module-Nausea subscale). The interaction between sleep disturbances and sleep hygiene (consistency, opportunity) on each symptom (pain, nausea, fatigue) were tested using PROCESS moderation.

Results

81% of caregivers report that their child receives sufficient sleep but only 12% reported regular consistent sleep patterns/routines. Sleep opportunity was not related to sleep disturbances or cancer-related symptoms, but more routine consistency was related to fewer sleep disturbances (r=.30, p=.003). The interaction between sleep disturbances and routine consistency significantly predicted pain interference [R2=.16, F(3, 98)=6.37, p&lt;.001; Bint =-0.17, p=.028] and nausea [R2=.16, F(3, 98)=6.47, p&lt;.001; Bint=0.46, p=.004]. The interaction between sleep disturbances and sleep opportunity significantly predicted nausea [R2=.15, F(3, 98)=5.76, p=.001; Bint =0.68, p=.016] but not pain interference. Both interaction models predicting fatigue were not significant.

Conclusion

The sleep/pain and sleep/nausea relationships are stronger in patients with more consistent sleep routines and the sleep/nausea relationship is also stronger in patients with sufficient/well-timed sleep opportunities. Sleep and fatigue were moderately related across all levels of both sleep hygiene components. Clinical interventions that target sleep hygiene together with sleep disturbances such as nighttime awakenings and poor sleep quality may be more effective in addressing cancer-related symptoms such as pain and nausea.

Support

This work was supported in part by funding from the Patient-Centered Outcomes Research Institute (PCORI-D-17-00187; PI Christopher Forrest).

Observation of persistent species temperature separation in inertial confinement fusion mixtures

The injection and mixing of contaminant mass into the fuel in inertial confinement fusion (ICF) implosions is a primary factor preventing ignition. ICF experiments have recently achieved an alpha-heating regime, in which fusion self-heating is the dominant source of yield, by reducing the susceptibility of implosions to instabilities that inject this mass. We report the results of unique separated reactants implosion experiments studying pre-mixed contaminant as well as detailed high-resolution three-dimensional simulations that are in good agreement with experiments. At conditions relevant to mixing regions in high-yield implosions, we observe persistent chunks of contaminant that do not achieve thermal equilibrium with the fuel throughout the burn phase. The assumption of thermal equilibrium is made in nearly all computational ICF modeling and methods used to infer levels of contaminant from experiments. We estimate that these methods may underestimate the amount of contaminant by a factor of two or more.

Improved calibration of the OMEGA gas Cherenkov detector

Inertial fusion implosions are diagnosed using γ rays to characterize the implosion physics or measure basic nuclear properties, including cross sections. For the latter, previously reported measurements at laser facilities using gas Cherenkov detectors are limited by a large systematic uncertainty in the detector response. We present a novel in situ calibration technique using neutron inelastic scattering, which we apply to the new GCD-3 detector. The calibration accuracy is improved by ∼3× over the previous method.

Measurement of apparent ion temperature using the magnetic recoil spectrometer at the OMEGA laser facility

The Magnetic Recoil neutron Spectrometer (MRS) at the OMEGA laser facility has been routinely used to measure deuterium-tritium (DT) yield and areal density in cryogenically layered implosions since 2008. Recently, operation of the OMEGA MRS in higher-resolution mode with a new smaller, thinner (4 cm², 57 μm thick) CD₂ conversion foil has also enabled inference of the apparent DT ion temperature (T _ion) from MRS data. MRS-inferred T _ion compares well with T _ion as measured using neutron time-of-flight spectrometers, which is important as it demonstrates good understanding of the very different systematics associated with the two independent measurements. The MRS resolution in this configuration, ΔE _MRS = 0.91 MeV FWHM, is still higher than that required for a high-precision T _ion measurement. We show how fielding a smaller foil closer to the target chamber center and redesigning the MRS detector array could bring the resolution to ΔE _MRS = 0.45 MeV, reducing the systematic T _ion uncertainty by more than a factor of 4.

Diffusion-dominated mixing in moderate convergence implosions

High-Z material mixed into the fuel degrades inertial fusion implosions and can prevent ignition. Mix is often assumed to be dominated by hydrodynamic instabilities, but we report Omega data, using shells with ∼150nm deuterated layers to gain unprecedented resolution, which give strong evidence that the dominant mix mechanism is diffusion for these moderate temperature (≲6 keV) and convergence (∼12) implosions. Small-scale instability-driven or turbulent mix is negligible.

An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

OBJECTIVES

Colorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim of this study was to develop a treatment algorithm for patients with screen-detected polyp cancers.

DESIGN

This national cohort study included all patients with a polyp cancer identified through the Scottish Bowel Screening Programme between 2000 and 2012. Multivariate regression analysis was used to assess the impact of clinical, endoscopic and pathological variables on the rate of adverse events (residual tumour in patients undergoing segmental resection or cancer-related death or disease recurrence in any patient). These data were used to develop a clinically relevant treatment algorithm.

RESULTS

485 patients with polyp cancers were included. 186/485 (38%) underwent segmental resection and residual tumour was identified in 41/186 (22%). The only factor associated with an increased risk of residual tumour in the bowel wall was incomplete excision of the original polyp (OR 5.61, p=0.001), while only lymphovascular invasion was associated with an increased risk of lymph node metastases (OR 5.95, p=0.002). When patients undergoing segmental resection or endoscopic surveillance were considered together, the risk of adverse events was significantly higher in patients with incomplete excision (OR 10.23, p<0.001) or lymphovascular invasion (OR 2.65, p=0.023).

CONCLUSION

A policy of surveillance is adequate for the majority of patients with screen-detected colorectal polyp cancers. Consideration of segmental resection should be reserved for those with incomplete excision or evidence of lymphovascular invasion.

Simultaneous measurement of the HT and DT fusion burn histories in inertial fusion implosions

Measuring the thermonuclear burn history is an important way to diagnose inertial fusion implosions. Using the gas Cherenkov detectors at the OMEGA laser facility, we measure the HT fusion burn in a H₂+T₂ gas-fueled implosion for the first time. Using multiple detectors with varied Cherenkov thresholds, we demonstrate a technique for simultaneously measuring both the HT and DT burn histories from an implosion where the total reaction yields are comparable. This new technique will be used to study material mixing and kinetic phenomena in implosions.

Sensitivity of chemical vapor deposition diamonds to DD and DT neutrons at OMEGA and the National Ignition Facility

The particle-time-of-flight (pTOF) detector at the National Ignition Facility (NIF) is used routinely to measure nuclear bang-times in inertial confinement fusion implosions. The active detector medium in pTOF is a chemical vapor deposition diamond. Calibration of the detectors sensitivity to neutrons and protons would allow measurement of nuclear bang times and hot spot areal density (ρR) on a single diagnostic. This study utilizes data collected at both NIF and Omega in an attempt to determine pTOF's absolute sensitivity to neutrons. At Omega pTOF's sensitivity to DT-n is found to be stable to within 8% at different bias voltages. At the NIF pTOF's sensitivity to DD-n varies by up to 59%. This variability must be decreased substantially for pTOF to function as a neutron yield detector at the NIF. Some possible causes of this variability are ruled out.

Using Inertial Fusion Implosions to Measure the T+^{3}He Fusion Cross Section at Nucleosynthesis-Relevant Energies

Light nuclei were created during big-bang nucleosynthesis (BBN). Standard BBN theory, using rates inferred from accelerator-beam data, cannot explain high levels of ^{6}Li in low-metallicity stars. Using high-energy-density plasmas we measure the T(^{3}He,γ)^{6}Li reaction rate, a candidate for anomalously high ^{6}Li production; we find that the rate is too low to explain the observations, and different than values used in common BBN models. This is the first data directly relevant to BBN, and also the first use of laboratory plasmas, at comparable conditions to astrophysical systems, to address a problem in nuclear astrophysics.

A compact neutron spectrometer for characterizing inertial confinement fusion implosions at OMEGA and the NIF

A compact spectrometer for measurements of the primary deuterium-tritium neutron spectrum has been designed and implemented on the OMEGA laser facility [T. Boehly et al., Opt. Commun. 133, 495 (1997)]. This instrument uses the recoil spectrometry technique, where neutrons produced in an implosion elastically scatter protons in a plastic foil, which are subsequently detected by a proton spectrometer. This diagnostic is currently capable of measuring the yield to ~±10% accuracy, and mean neutron energy to ~±50 keV precision. As these compact spectrometers can be readily placed at several locations around an implosion, effects of residual fuel bulk flows during burn can be measured. Future improvements to reduce the neutron energy uncertainty to ±15-20 keV are discussed, which will enable measurements of fuel velocities to an accuracy of ~±25-40 km/s.

Testing a new NIF neutron time-of-flight detector with a bibenzyl scintillator on OMEGA

A new neutron time-of-flight (nTOF) detector with a bibenzyl crystal as a scintillator has been designed and manufactured for the National Ignition Facility (NIF). This detector will replace a nTOF20-Spec detector with an oxygenated xylene scintillator currently operational on the NIF to improve the areal-density measurements. In addition to areal density, the bibenzyl detector will measure the D-D and D-T neutron yield and the ion temperature of indirect- and direct-drive-implosion experiments. The design of the bibenzyl detector and results of tests on the OMEGA Laser System are presented.

Directional limits on persistent gravitational waves using LIGO S5 science data

The gravitational-wave (GW) sky may include nearby pointlike sources as well as stochastic backgrounds. We perform two directional searches for persistent GWs using data from the LIGO S5 science run: one optimized for pointlike sources and one for arbitrary extended sources. Finding no evidence to support the detection of GWs, we present 90% confidence level (C.L.) upper-limit maps of GW strain power with typical values between 2-20×10(-50)  strain(2) Hz(-1) and 5-35×10(-49)  strain(2) Hz(-1) sr(-1) for pointlike and extended sources, respectively. The latter result is the first of its kind. We also set 90% C.L. limits on the narrow-band root-mean-square GW strain from interesting targets including Sco X-1, SN 1987A and the Galactic center as low as ≈7×10(-25) in the most sensitive frequency range near 160 Hz.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

All-sky LIGO search for periodic gravitational waves in the early fifth-science-run data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50-1100 Hz and with the frequency's time derivative in the range -5 x 10{-9}-0 Hz s{-1}. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semicoherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 10{-24} are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 10{-6}, the search is sensitive to distances as great as 500 pc.

Cognition, functioning and quality of life in schizophrenia treatment: results of a one-year randomized controlled trial of olanzapine and quetiapine

BACKGROUND

Cognitive deficits are recognized as a critical determinant of functional outcomes in schizophrenia; and second generation antipsychotic drugs have been touted for their potential to enhance cognitive functioning and community tenure.

OBJECTIVES

The study examined the relative merits of olanzapine and quetiapine in improving cognitive deficits and enhancing psychosocial functioning in a sample of community dwelling adults previously treated with first generation antipsychotic drugs for schizophrenia.

METHODS

In a prospective, rater-blinded study, 86 participants were randomized to receive either olanzapine or quetiapine, and assessed at baseline and after 3, 6, 9 and 12 months. Outcome measures included, besides symptoms and side effects rating scales, the subjective scale to investigate cognition in schizophrenia (SSTICS), a computer-assisted cognitive test battery (COGLAB), the sickness impact profile (SIP), the global assessment of functioning (GAF) scale, and the drug attitude inventory (DAI).

RESULTS

Both olanzapine and quetiapine were equally effective in improving symptom severity and decreasing the neurological side effects. Quetiapine was significantly better tolerated (p=0.002), improved self-rated cognitive dysfunction (p=0.002) and subjects' performance on selected neurocognitive tasks (p=0.01). Olanzapine use was associated with greater symptom stability, fewer drop outs (p=0.01) and frequent metabolic aberrations (p=0.001). The accrued benefits of drug therapy, however, were not reflected as significant gains in daily functioning and quality of life.

CONCLUSIONS

Quetiapine is noted to have specific cognition enhancing properties in schizophrenia that warrants further exploration. The observed clinical and cognitive benefits associated with quetiapine may likely be attributable to its loose binding to, and fast dissociation from the dopamine receptors. Olanzapine has proved to be a reliable antipsychotic drug with a greater liability to cause metabolic abnormalities.

Elementary school-aged children's reports of their health: a cognitive interviewing study

There are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. This research involved three cross-sectional studies using cognitive interviews of 5-11-year-old children (N = 114) to determine their ability to respond to various presentations of pictorially illustrated questions about their health. The samples had a predominance of children in the 5-7-year-old range and families of lower and middle socio-economic status. The research questions in Study 1 involved children's ability to convert their health experiences into scaled responses and relate them to illustrated items (n = 35); Study 2 focused on the type of response format most effectively used by children (n = 19); and Study 3 involved testing children's understanding of health-related terms and use of a specific recall period (n = 60). The results of Study 1 showed that children identified with the cartoon drawing of a child depicted in the illustrated items, typically responding that the child was at or near their own age and of the same gender, with no differences related to race. Study 2 results indicated that children responded effectively to circles of graduated sizes to indicate their response and preferred them to same-size circles or a visual analogue scale. Tests of three-, four-, and five-point response formats demonstrated that children could use them all without confusion. In Study 3, expected age-related differences in understanding were obtained. In fact, the 5-year-old children were unable to understand a sufficient number of items to adequately describe their health. Virtually all children 8 years of age and older were able to fully understand the key terms and presentation of items, used the full five-point range of response options, and accurately used a 4-week recall period. Six- and seven-year-olds were more likely than older children to use only the extreme and middle responses on a five-point scale. No pattern of gender differences in understanding or in use of response options was found. We conclude that children as young as eight are able to report on all aspects of their health experiences and can use a five-point response format. Children aged 6-7 had difficulty with some health-related terms and tended to use extreme responses, but they understood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6-11 years old.

Diagnosis and treatment of erectile dysfunction: the process of care model

The new era of erectile dysfunction (ED) medicine ushered in by the availability of an effective and safe oral medication paves the way toward managing ED in a primary care setting. The Process of Care Model for the Evaluation and Treatment of Erectile Dysfunction was developed to advance new guidelines for the diagnosis and management of ED. This paper discusses these guidelines.

2-Tetradecylglycidic acid, an inhibitor of carnitine palmitoyltransferase-1, induces myocardial hypertrophy via the AT1 receptor

Activation of the antiogensin II, type 1 (AT1) receptor mediates the myocardial response to numerous hypertrophic stimuli. This study tested the hypothesis that 2-tetradecylglycidic acid (TDGA), an oxirane carboxylate inhibitor of mitochondrial carnitine plamitoyltransferase-1, induces myocardial hypertrophy via the AT1 receptor system. Male Sprague-Dawley rats treated with 10 mg TDGA/kg/day for 7 days had a heart wet weight:body weight ratio of 3. 58+/-0.16 mg/g compared with a ratio of 2.79+/-0.07 for rats treated with vehicle (P<0.05). The plasma level of antiogensin II was 117. 75+/-17.39 pg/ml in rats treated with 10 mg TDGA/kg/day compared with 54.0+/-11.38 pg/ml for rats treated with vehicle (P<0.05). The plasma level of angiotensin I in these two groups of rats was not different statistically. Rats treated with TDGA and given drinking water containing 1 mg losartan/ml had a heart wet weight:body weight ratio of 2.84+/-0.05 mg/g. This value was not statistically different from the value measured in rats given drinking water containing 1 mg losartan/ml and treated with vehicle alone. No significant difference in the heart wet weight:dry weight ratio occurred among these groups of rats. Finally, treating rats with TDGA or giving rats drinking water that contained 1 mg losartan/ml altered neither their heart rate nor their mean arterial blood pressure when compared with untreated rats. This data, therefore, suggests that oxirane carboxylates induce myocardial hypertrophy by activating the AT1 receptor independent of changes in systemic hemodynamics.

Comparison of secondary ischemic tolerance between pedicled and free island buttock skin flaps in the pig

We compared the secondary ischemic tolerance of 8 x 12 cm surgically denervated pedicled island skin flaps and skin free flaps raised contralaterally on the buttocks of 50 pigs. The pedicled flaps and free flaps were subjected to 2 hours of primary warm global ischemia followed by 12 hours of reperfusion and 0, 2, 4, 6, or 10 hours of secondary warm global ischemia (n = 10 flaps). Skin necrosis was assessed 7 days after secondary ischemia. Pedicled skin flaps tolerated up to 10 hours of secondary ischemia without skin necrosis. However, incidences of skin necrosis (partial and total) in free flaps subjected to 0, 2, 4, 6, or 10 hours of secondary ischemia were 0, 10, 50, 80, and 100 percent, respectively. In a separate experiment, skin blood flow and hematology were studied in contralateral pedicled flaps and free flaps (n = 20) subjected to 4 hours of secondary ischemia. The skin blood flow measured by 15-micron microspheres at 1.5 hours of reperfusion was significantly higher (p < 0.01, n = 20) in pedicled skin flaps than in skin free flaps (1.91 +/- 0.35 versus 0.67 +/- 0.53 ml/min/100 gm). Under an operating microscope, microthrombi were observed near the arterial and/or venous anastomoses in 8 of 20 skin free flaps but none in the pedicled skin flaps. We obtained venous blood samples by cannulation of the major venae comitantes in 12 of the 20 skin free flaps in which there was no thrombosis in the vascular pedicle for hematologic studies. The venous plasma level of thromboxane B2 was significantly higher (p < 0.05) in the skin free flaps than in their contralateral pedicled skin flaps (195 +/- 49 versus 124 +/- 30 pg/ml). In addition, venous hematocrit, hemoglobin concentration, and white blood cell count also were significantly (p < 0.05) higher in skin free flaps compared with their contralateral pedicled skin flaps. Taken together, these observations were interpreted to indicate that buttock skin free flaps in the pig were less tolerant of secondary ischemia compared with their contralateral pedicled skin flaps subjected to the same ischemic protocol, and this reduced ischemic tolerance in skin free flaps was associated with compromised skin blood flow, hemoconcentration, and thrombosis in the vascular pedicle.

Transport of the critically ill patient: an example of an integrated model

AIMS

To demonstrate a model for the transport of critically ill patients between hospitals, and the aiding of primary emergency responses (A-Zeros).

METHOD

A review of a model based on Waikato Hospital is carried out.

RESULTS

Categories of transport, modes of transport, standards, and the funding model are described. The total Waikato experience includes over 2500 patients transported between hospitals and 325 A-Zeros. A detailed analysis of cases between 1988-94 is presented.

CONCLUSIONS

The Waikato model has worked well. A formal system needs to be instituted in New Zealand to handle interhospital transport of the critically ill and also to provide medical help at the scene of emergencies based on advanced trauma and intensive care centres.

Preconditioning: a new technique for improved muscle flap survival

Musculocutaneous regional and distal flaps have become an important tool available to the head and neck surgeon. Vascularized autogenous muscle transplants allow single-stage reconstruction of complex defects. Ischemic muscle necrosis is a well-recognized complication with serious potential morbidity. It has been shown that myocardial muscle is protected from ischemic damage by brief periods of coronary artery occlusion and reperfusion subsequent to prolonged ischemia. This is called preconditioning. To our knowledge, this technique has never been extrapolated to skeletal muscle. This article presents a discussion of preconditioning and the potential benefits of this new technique as a means to enhance skeletal muscle survival to sustained normothermic global ischemia. Theories behind ischemic muscle injury are presented. A review of the development of preconditioning in myocardial muscle is discussed. Experimental models used to investigate this phenomenon are also presented. In addition, results of our laboratory investigations using the latissimus dorsi porcine model are discussed. Preconditioning is a new, nonpharmacologic means to improve muscle flap survival. This simple technique may have great clinical application in reducing ischemic muscle necrosis in regional and distal muscle transplantation.

The free vascularised iliac crest tissue transfer: donor site complications associated with eighty-two cases

Seventy-eight patients who had undergone a total of 82 free vascularised iliac crest tissue transfers were reviewed to determine the incidence of donor site complications. The most frequent problems encountered were early postoperative pain and long term sensory changes. Major complications such as femoral neuropathy and incisional hernia formation were encountered infrequently. More serious potential complications are discussed. In general, the functional loss associated with the free vascularised iliac crest tissue transfer was found to be acceptable, but the inclusion of a skin paddle was noted to be associated with a greater incidence of sensory changes, hernia formation and contour abnormalities.

Kirner's deformity: a review of the literature and case presentation

Kirner's deformity is a relatively uncommon condition involving fingers in young children. A case of a 12-year-old girl who was successfully treated by serial splinting of the involved fingers is described and contrasted with other treatments described in the literature.

Prevention of spinal osteoporosis in oophorectomised women

100 women who had taken part in a prospective controlled trial of oestrogen therapy for prevention of post-oophorectomy bone loss were reviewed after a median follow-up period of nine years. A significant reduction in height occurred among the placebo-treated group, but not in the group treated with mestranol (mean 23 x 3 micrograms/day). The placebo-treated group had a higher spine score, lower central vertebral height, and larger wedge-angle than the oestrogen group. Within each group none of these spinal morphometric changes correlated with changes in mineral content of metacarpal or radial bones as measured by photon absorptiometry or X-ray densitometry, although both peripheral and central measurements showed highly significant differences between groups. Oestrogen treatment, therefore, prevents against central, as well as peripheral, bone loss, and reduces the incidence of vertebral compression.

Effect of a natural and artificial menopause on serum, urinary and erythrocyte magnesium

1. Serum, urinary and erythrocyte magnesium concentrations were measured in groups of premenopausal, postmenopausal and oophorectomized women. 2. Serum and urinary magnesium were both significantly higher in postmenopausal and oophorectomized women than in the premenopausal group. 3. Oestrogen therapy reduced both serum and urinary magnesium values in oophorectomized women to premenopausal concentrations. 4. Erythrocyte magnesium concentrations were not affected by menstrual status or oestrogen therapy.