Ultrabroadband flying-focus using an axiparabola-echelon pair

Flying-focus pulses promise to revolutionize laser-driven secondary sources by decoupling the trajectory of the peak intensity from the native group velocity of the medium over distances much longer than a Rayleigh range. Previous demonstrations of the flying focus have either produced an uncontrolled trajectory or a trajectory that is engineered using chromatic methods that limit the duration of the peak intensity to picosecond scales. Here we demonstrate a controllable ultrabroadband flying focus using a nearly achromatic axiparabola-echelon pair. Spectral interferometry using an ultrabroadband superluminescent diode was used to measure designed super- and subluminal flying-focus trajectories and the effective temporal pulse duration as inferred from the measured spectral phase. The measurements demonstrate that a nearly transform- and diffraction-limited moving focus can be created over a centimeter-scale-an extended focal region more than 50 Rayleigh ranges in length. This ultrabroadband flying-focus and the novel axiparabola-echelon configuration used to produce it are ideally suited for applications and scalable to >100 TW peak powers.

Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021

OBJECTIVE

To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021.

DESIGN

Descriptive multi-country secondary data analysis.

SETTING

Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021.

POPULATION

Liveborn infants.

METHODS

Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study.

RESULTS

Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%).

CONCLUSIONS

Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Calibration of the sub-aperture backscatter system on OMEGA EP

The sub-aperture backscatter (SABS) diagnostic on the OMEGA EP Laser System [Waxer et al., Opt. Photonics News 16, 30 (2005)] is a diagnostic that is used to measure the backscattered and sidescattered light during laser-plasma interaction experiments [W. L. Kruer, The Physics of Laser Plasma Interactions, Frontiers in Physics Vol. 73, edited by D. Pines (Addison-Wesley, Redwood City, CA, 1988) and Myatt et al., Phys. Plasmas 21, 055501 (2014)] that are relevant to high-energy-density physics and inertial confinement fusion. The diagnostic collects stimulated Brillouin scattering (SBS) UV light at around 351 nm and stimulated Raman scattering (SRS) in the visible-light regime in the 420-720-nm-wavelength range and provides spectrally and temporally resolved information. Five 1-in. light collectors, composed of a lens, ground glass diffuser, and coupling into a 300-μm fiber, are positioned behind the last steering mirror on one of the four beamlines to catch a portion of the beam cross section (∼1.5%) of the emission that is scattered into the beamline. The SRS light is collected in two light collectors, combined, and transported via graded index fibers to a streaked spectrometer. The SABS-SRS streak spectrometer has a temporal and spectral resolution of 100 ps and 1 nm, respectively. Three other light collectors collect, combine, and transport the SBS signal to a Hamamatsu high-voltage photodiode, where an oscilloscope digitizes the data, providing a time resolution of better than 1 ns. To obtain an absolute energy calibration of SRS measurements, light signals of known energy and wavelength were injected into the light collectors one at a time. The resulting counts on the streak camera charge-coupled device for SRS are then correlated with the incident fluence of scattered light at the light collector in order to allow a quantitative assessment of streak camera sensitivity to determine the energy of the scattered light during experiments. The measurements were performed in situ from the light collectors to the detectors. Additional offline measurements provided the transmission of the optics between the target chamber center and the light collectors.

Inverse Bremsstrahlung Absorption

Inverse bremsstrahlung absorption was measured based on transmission through a finite-length plasma that was thoroughly characterized using spatially resolved Thomson scattering. Expected absorption was then calculated using the diagnosed plasma conditions while varying the absorption model components. To match data, it is necessary to account for (i) the Langdon effect; (ii) laser-frequency (rather than plasma-frequency) dependence in the Coulomb logarithm, as is typical of bremsstrahlung theories but not transport theories; and (iii) a correction due to ion screening. Radiation-hydrodynamic simulations of inertial confinement fusion implosions have to date used a Coulomb logarithm from the transport literature and no screening correction. We anticipate that updating the model for collisional absorption will substantially revise our understanding of laser-target coupling for such implosions.

Measurement of laser absorption in underdense plasmas using near-field imaging of the incident and transmitted beams

Measurements of laser absorption in high-temperature, underdense plasmas produced at the Omega Laser Facility are made using two near-field imaging detectors that diagnose the spatial profile and energy of the port P9 beam before and after it transmits through the plasma. The incident beam is sampled using a partial reflection from a full-aperture, (30 cm-diam) uncoated wedge pickoff located before the target chamber vacuum window and final focus lens assembly. A concave mirror reduces the reflected beam size, allowing it to be recorded directly using a charged-coupled device (CCD) camera. The P9 transmitted beam diagnostic (P9TBD) characterizes the transmitted light by terminating the expanded beam on a semi-transparent diffuser and imaging the illuminated surface using a lens and CCD camera. The P9TBD samples a numerical aperture twice as large as the input beam, allowing the energy of transmitted beams with moderate levels of beam spray to be measured accurately. Calibration shots with no plasma provide a path to infer absorption without absolute photometric calibration of either detector. The cross-calibration between the two detectors was measured to remain stable at ±200 ppm, enabling measurements of total beam absorption below 1% with ±0.07% error.

A partnership approach to supporting the health and wellbeing of the Charedi (Orthodox Jewish) community in London

BACKGROUND

There is a need for a specific programme of engagement around COVID-19 vaccination with the Charedi Orthodox Jewish community in Stamford Hill, London, UK. We co-produced a live event for women on COVID-19 safety and vaccination and wider health topics to support vaccine uptake and improve awareness of health and wellbeing issues.

METHODS

For this qualitative analysis, we organised an event that was designed and delivered by a local community organisation in partnership with regional and local health partners and community groups. The event was for Charedi women aged 16 years and older, and provided information on COVID-19, childhood immunisations, oral health and dental hygiene, childhood respiratory infections, and mental health. The event included health stalls, a panel session, co-designed culturally competent physical information, and the opportunity to speak with health professionals. We evaluated the event using attendees' feedback forms, collected in person at the end of the event, and a thematic analysis of semi-structured interviews with organisers from community and statutory organisations. The evaluation was informed by a co-produced logic model and outcomes framework.

FINDINGS

More than 100 women attended the event on March 28, 2022. Feedback suggested the focus on wider health issues was valued, and a greater number of more targeted events (eg on health for women older than 40) would be beneficial. Dental health, COVID-19 vaccination, and childhood immunisations were identified as the most important topics by participants. 16 (55%) of 29 respondents stated they would attend a similar event again, 12 (41%) stated they were unsure, and one (3%) said they would not attend again. Informal feedback from the community highlighted that the event was useful and acted as a basis for further engagement and collaboration with the community.

INTERPRETATION

Our findings emphasised the need to work in partnership with a lead community organisation to identify and address principal health challenges within communities, to share community-specific insights, and to promote community events through community communication channels. Statutory institutions should engage with local community organisations to support and facilitate public health interventions to increase relevant vaccine uptake and to improve awareness around wider health and wellbeing issues and services.

FUNDING

None.

Instrument design for an inertial confinement fusion ion temperature imager

A mix of contaminant mass is a known, performance-limiting factor for laser-driven inertial confinement fusion (ICF). It has also recently been shown that the contaminant mass is not necessarily in thermal equilibrium with the deuterium-tritium plasma [B. M. Haines et al., Nat. Commun. 11, 544 (2020)]. Contaminant mass temperature is one of the dominant uncertainties in contaminant mass estimates. The MixIT diagnostic is a new and potentially transformative diagnostic, capable of spatially resolving ion temperature. The approach combines principles of neutron time-of-flight and neutron imaging diagnostics. The information from the MixIT diagnostic can be used to optimize ICF target and laser drive designs as well as provide key constraints on ICF radiation-hydrodynamic simulations that are critical to contaminant mass estimates. This work details the design and optimization of the major components of the MixIT diagnostic: the neutron aperture, the neutron detector (scintillator), and the recording system.

Scattered-light uniformity imager for diagnosing laser absorption asymmetries on OMEGA

Light scattered from a target is the most-direct measurement for diagnosing laser absorption in a direct-drive implosion. Observations from OMEGA implosions show much larger scattered-light asymmetries than predictions. A new instrument has been developed to absolutely measure the scattered-light intensity and nonuniformity for the purpose of diagnosing the asymmetry. The scattered-light uniformity imager (SLUI) diagnostic records the variation in scattered-light intensity over a transmission diffuser using a charge-coupled device (CCD)/lens assembly. At the standard operating position, an 11.3° (f/2.5) cone of light is collected. A stray light baffle, debris shield, and antireflection absorbing filter are also incorporated into the diagnostic payload inserted into the target chamber. The imaging parts of the diagnostic (light baffle, vacuum window, filters, lens, and CCD camera) are located outside the target chamber. Five SLUIs have been built and deployed in OMEGA's ten-inch manipulator diagnostic ports, covering almost 5% of the emission surface, enabling an absolute scattered-light measurement should be within a few percent of the global average. Each SLUI system is calibrated offline, providing absolute scattered-light intensity measurements. Based on the measured point spread function, each diffuser plate image contains over 20 000 independent scattered-light absolute-intensity measurements of the variation over the collection cone. SLUI provides a platform to study scattered light and absorption asymmetries, and their possible sources.

The phase-2 particle x-ray temporal diagnostic for simultaneous measurement of multiple x-ray and nuclear emission histories from OMEGA implosions (invited)

Electron-temperature (T_e) measurements in implosions provide valuable diagnostic information, as T_e is negligibly affected by residual flows and other non-thermal effects unlike ion-temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of T_e(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The newly implemented phase-2 Particle X-ray Temporal Diagnostic (PXTD) utilizes four fast-rise (∼15 ps) scintillator-channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons (DTn) from OMEGA Cryo-DT implosions. High quality data have been collected from warm implosions at OMEGA. These data have been used to infer spatially integrated T_e(t) with <10% uncertainty at peak emission. Nuclear and x-ray emission histories are measured with 10 ps relative timing uncertainty for x rays and DTn and 12 ps for x rays and deuterium-He3 protons (D³Hep). A future upgrade to the system will enable spatially integrated T_e(t) with 40 ps time-resolution from cryogenic DT implosions.

Direct Measurement of the Return Current Instability in a Laser-Produced Plasma

Measurements were made of the return current instability growth rate, demonstrating its concurrence with nonlocal transport. Thomson scattering was used to measure a maximum growth rate of 5.1×10^{9}  Hz, which was 3 times less than classical Spitzer-Härm theory predicts. The measured plasma conditions indicate the heat flux was nonlocal, and Vlasov-Fokker-Planck simulations that account for nonlocality reproduce the measured growth rates. Furthermore, the threshold for the return current instability was measured (δ_{T}=0.017±0.002) to be in good agreement with previous theoretical models.

Increased odds ratio for erectile dysfunction in COVID-19 patients

PURPOSE

Erectile dysfunction and COVID-19 share similar risk factors, including vascular disruption of integrity, cytokine release, cardiovascular disease, diabetes and obesity. The aim of this study was to investigate the association between erectile dysfunction and COVID-19 patients.

METHODS

Odds ratio for erectile dysfunction in patients with a history of COVID-19 with and without comorbidities were calculated using a patients' registry platform i2b2. ICD-10 diagnoses codes were accessed for queries and data were analyzed using logistic regression.

RESULTS

Patients with COVID-19 were 3.3 times more likely to have erectile dysfunction with 95% CI (2.8, 3.8). The association became stronger with odds ratio 4.8 (95% CI (4.1, 5.7)) after adjusting for age groups. The odds ratio remained the same after adjusting for smoking status with 3.5 (95% CI (3.0, 4.1)). After adjusting for race, COVID-19 patients were 2.6 (95% CI (2.2, 3.1)) times more likely to have erectile dysfunction. The odds ratio were 1.6, 1.8, 1.9 and 2.3 after adjusting for respiratory disease, obesity, circulatory disease and diabetes, respectively.

CONCLUSION

COVID-19 and erectile dysfunction are strongly associated even after adjustment for known risk factors and demographics.

Quantitative assessment of fitting errors associated with streak camera noise in Thomson scattering data analysis

Thomson scattering measurements in high energy density experiments are often recorded using optical streak cameras. In the low-signal regime, noise introduced by the streak camera can become an important and sometimes the dominant source of measurement uncertainty. In this paper, we present a formal method of accounting for the presence of streak camera noise in our measurements. We present a phenomenological description of the noise generation mechanisms and present a statistical model that may be used to construct the covariance matrix associated with a given measurement. This model is benchmarked against simulations of streak camera images. We demonstrate how this covariance may then be used to weight fitting of the data and provide quantitative assessments of the uncertainty in the fitting parameters determined by the best fit to the data and build confidence in the ability to make statistically significant measurements in the low-signal regime, where spatial correlations in the noise become apparent. These methods will have general applicability to other measurements made using optical streak cameras.

Novel design for a polarizing DUV spectrometer using a Wollaston prism and its application as a diagnostic for measuring Thomson scattering data in the presence of strong self-emission backgrounds

We present a novel design for an optical spectrometer for use in ultraviolet Thomson scattering measurements of plasma parameters in high energy density (HED) inertial confinement fusion experiments on large-scale high-energy laser facilities. In experiments investigating high-Z plasmas, the fidelity of measurements is commonly limited by signal/background ratios approaching or exceeding unity. An alpha barium borate Wollaston prism can provide both spectral dispersion and polarization channel separation, allowing simultaneous measurement of both the Thomson scattering signal and plasma self-emission along a single line of sight and in a single experiment, which should greatly improve data quality and reduce the opportunity cost of taking high quality measurements. We present a basic discussion of the design and a worked example of an instrument designed to take fourth harmonic electron plasma wave measurements in HED experiments at the OMEGA laser facility.

Placental miR-3940-3p Is Associated With Maternal Insulin Resistance in Late Pregnancy

CONTEXT

An increase in maternal insulin resistance (IR) during pregnancy is essential for normal fetal growth. The mechanisms underlying this adaptation are poorly understood. Placental factors are believed to instigate and maintain these changes, as IR decreases shortly after delivery. Methylation of placental gene loci that are common targets for miRNAs are associated with maternal IR.

OBJECTIVE

We hypothesized that placental miRNAs targeting methylated loci are associated with maternal IR during late pregnancy.

METHODS

We collected placentas from 132 elective cesarean sections and fasting blood samples at delivery to estimate maternal homeostasis model assessment of insulin resistance (HOMA-IR). Placental miRNA expression was measured via whole genome small-RNA sequencing in a subset of 40 placentas selected by maternal pre-gravid body mass index (BMI) and neonatal adiposity. Five miRNAs correlated with maternal HOMA-IR and previously identified as targeting methylated genes were selected for validation in all 132 placenta samples via RT-qPCR. Multiple regression adjusted for relevant clinical variables.

RESULTS

Median maternal age was 27.5 years, with median pre-pregnancy BMI of 24.7 kg/m2, and median HOMA-IR of 2.9. Among the 5 selected miRNA, maternal HOMA-IR correlated with the placental expression of miRNA-371b-3p (r = 0.25; P = 0.008) and miRNA-3940-3p (r = 0.32; P = 0.0004) across the 132 individuals. After adjustment for confounding variables, placental miRNA-3940-3p expression remained significantly associated with HOMA-IR (β = 0.16; P = 0.03).

CONCLUSION

Placental miRNA-3940-3p was associated with maternal IR at delivery. This placental miRNA may have an autocrine or paracrine effect-regulating placental genes involved in modulating maternal IR.

Nonuniform Absorption and Scattered Light in Direct-Drive Implosions Driven by Polarization Smoothing

Laser-direct-drive symmetric implosions on OMEGA illuminate a target with 60 laser beams and are designed to produce spherical implosions. Each beam is smoothed using orthogonal polarizations obtained by passing the laser beams through distributed polarization rotators (DPRs). Observations of light scattered from OMEGA implosions do not show the expected symmetry and have much larger variation than standard predictions. For the first time, we have quantified the scattered-light nonuniformity from individual beams and identified the DPRs as the source of the enhanced nonuniformity. An instrument was invented that isolated and measured the variation in the intensity and polarization of the light scattered from each OMEGA beam. The asymmetric intensity and polarization measurements are explained when the on-target offsets between the two orthogonal polarizations produced by the DPRs are modeled using a 3D cross-beam energy transfer (CBET) code that tracks the polarizations of each beam. The time-integrated nonuniformity in laser absorption and scattered light due to CBET and the DPR polarization offsets during high-performance OMEGA implosions is predicted to be significant and dominated by low spherical harmonic mode numbers. The nonuniformity is predicted to be greatly reduced by replacing the DPRs with new optics that create smaller offsets.

Measurements of Non-Maxwellian Electron Distribution Functions and Their Effect on Laser Heating

Electron velocity distribution functions driven by inverse bremsstrahlung heating are measured to be non-Maxwellian using a novel angularly resolved Thomson-scattering instrument and the corresponding reduction of electrons at slow velocities results in a ∼40% measured reduction in inverse bremsstrahlung absorption. The distribution functions are measured to be super-Gaussian in the bulk (v/v_{th}<3) and Maxwellian in the tail (v/v_{th}>3) when the laser heating rate dominates over the electron-electron thermalization rate. Simulations with the particle code quartz show the shape of the tail is dictated by the uniformity of the laser heating.

Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia

OBJECTIVE

To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM).

DESIGN

A cohort study with a delayed treatment arm used as a comparator.

SETTING

Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada.

SUBJECTS

Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire.

METHODS

Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period (n = 9). HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks. Safety was evaluated by the frequency and severity of adverse effects reported by patients. Feasibility was assessed by recruitment, retention, and HBOT compliance rates. Both groups were assessed at baseline, after HBOT intervention, and at 3 months' follow-up. Validated assessment tools were used to evaluate pain, psychological variables, fatigue, and sleep quality.

RESULTS

A total of 17 patients completed the study. One patient withdrew after randomization. HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients. The efficacy of HBOT was evident in most of the outcomes in both groups. This improvement was sustained at 3-month follow-up assessment.

CONCLUSION

HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment.

Unabsorbed light beamlets for diagnosing coronal density profiles and absorption nonuniformity in direct-drive implosions on OMEGA

Laser light scattered from a target is the most-direct measurement for diagnosing laser absorption in a direct-drive implosion. The 3ω gated optical imager beamlets diagnostic images unabsorbed light from all 60 OMEGA beams as distinct "beamlet" spots for each beam. The implosion can be diagnosed using the position and intensity of these beamlets. The position of each beamlet in the image is determined by refraction and can be used to fit the coronal plasma density profile of the implosion. The inferred plasma density profiles are comparable to the profiles predicted by the 1D hydrodynamics code LILAC but suggest that the predictions underestimate the density farther out in the corona. The intensity of light in each spot depends on the cumulative effects of absorption and cross-beam energy transfer along the beamlet's path through the corona. The measured variation in intensity and polarization between similar spots indicates that absorption during OMEGA implosions is less uniform than previously known.

A transmitted-beam diagnostic for the wavelength-tunable UV drive beam on OMEGA

A transmitted-beam diagnostic (P9TBD) was developed as part of a new experimental platform used to study laser-plasma interactions on OMEGA. Located in the opposing port to the wavelength-tunable (350 nm to 353 nm) UV drive beam, the P9TBD characterizes the beam after it propagates through an undersense plasma. The instrument consists of a large-aperture window that allows light to exit the target chamber and project onto a thin sheet of semi-transparent diffuser material. Light transmitted through the diffuser is recorded using a time-integrated camera and a fiber-optically coupled streaked spectrometer, providing measurements of the energy, power, fluence, polarization, and spectrum of the transmitted beam. The diagnostic enables direct observation of a variety of cross-beam energy transfer phenomena, such as wavelength detuning, polarization effects, and gain saturation.

Cross-Beam Energy Transfer Saturation by Ion Heating

We measure cross-beam energy transfer (CBET) saturation by ion heating in a gas-jet plasma characterized using Thomson scattering. A wavelength-tunable ultraviolet (UV) probe laser beam interacts with four intense UV pump beams to drive large-amplitude ion-acoustic waves. For the highest-intensity interactions, the power transfer to the probe laser drops, demonstrating ion-acoustic wave saturation. Over this time, the ion temperature is measured to increase by a factor of 7 during the 500-ps interaction. Particle-in-cell simulations show ion trapping and a subsequent ion heating consistent with measurements. Linear kinetic CBET models are found to agree well with the observed energy transfer when the measured plasma conditions are used.

A multi-channel x-ray temporal diagnostic for measurement of time-resolved electron temperature in cryogenic deuterium-tritium implosions at OMEGA

Electron-temperature (T_e) measurements in implosions provide valuable diagnostic information, as T_e is unaffected by residual flows and other non-thermal effects unlike ion temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of T_e(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The proposed diagnostic utilizes five fast-rise (∼15 ps) scintillator channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10 keV-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons. Initial data collected using a prototype nosecone on the existing neutron temporal diagnostic demonstrate the validity of this diagnostic technique. The proposed system will be capable of measuring spatially integrated T_e(t) with 20 ps time resolution and <10% uncertainty at peak emission in cryogenic DT implosions.

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.

Requirements for a 4ω Thomson scattering system on megajoule scale laser facilities

With the arrival of megajoule class laser facilities, the features of laser-produced plasmas are evolving toward unprecedented high electron temperatures reached in the environment of a cm-scale indirect-drive Hohlraum for a few tens of nanoseconds. In this context, the need for in situ experimental characterization of the plasma parameters becomes critical in order to test hydrodynamics simulations in these novel conditions. Taking advantage of the progress achieved in the last 40 years, Thomson scattering has become a classic diagnostic in the characterization of laser produced plasmas. However, the many beam configuration of the megajoule scale experiments makes the measurements increasingly complex because the Thomson scattering signals produced by the 351 nm heaters themselves dominate the plasma emission around 263 nm, a wavelength range typically of interest when a 4ω Thomson probe is used. This paper reviews the requirements for and the potential of a 4ω Thomson scattering system to be operated on such 351 nm megajoule scale facilities in order to characterize the hot (T_e > 3 keV) plasmas produced in the indirect-drive irradiation of a Hohlraum. It is found that the configuration of the diagnostic could be optimized in order to enable the detection of the ion acoustic resonances over a large domain of plasma parameters. The results for the electron plasma wave resonances are also given.

Visual Function and Visual Acuity in An Urban Adult Population

In this survey, 6,850 Baltimore residents aged 40 and older were interviewed about activities they had difficulty doing or could no longer do because of poor vision. One-fourth of the sample reported limitations in activities, most frequently reading and other near-vision tasks, because of poor vision. In addition to poor vision, general health status, educational level, and time since the last eye care visit were associated with the loss of visual function.

OP0071 PREDICTING PERSISTENT HIGH-DOSE OPIOID USE AFTER TOTAL KNEE REPLACEMENT

Background:

Patients undergoing total knee replacement (TKR) are at increased risk of persistent opioid use and dependence

Objectives:

To identify patients with persistent high-dose opioid use after TKR using group-based trajectory models (GBTM) and determine predictors of persistent high-dose opioid users using pre-TKR patient characteristics

Methods:

Using US Medicare claims (2010-2014), we identified patients aged ≥65 years who underwent a TKR and had no history of cancer or high-dose opioid use (>25 mean morphine equivalents (MME)/day) in the year prior. All patients were continuously enrolled in Medicare for ≥360 days prior to and ≥30 days after the TKR. To determine opioid filling patterns after the surgery, patients were followed up to 360 days from the day of TKR. We modeled 12 monthly indicators of opioid prescription fills as a continuous (MME/day) variable using a censored normal GBTM and categorized patients into 4 groups. The primary outcome was persistent high-dose opioid use defined as patients in trajectory Group 3 (38.8 MME/day) or Group 4 (22.4 MME/day). We split the data into training (2010-2013 data) and test (2014 data) sets and used logistic regression to predict high-dose opioid use vs low-dose opioid use (Groups 1 and 2) as a binary outcome utilizing pre-TKR patient characteristics as candidate predictors using the least absolute shrinkage and selection operator (LASSO) regression for variable selection. A reduced model with only 10 pre-specified variables readily available for clinical use was also considered

Results:

The final study cohort included 142,089 patients. The GBTM identified 4 distinct trajectories (Group 1- Short-term, low-dose, Group 2- long-term, low-dose, Group 3- medium-term, high-dose, Group 4-long-term, high-dose) of opioid use in the year after TKR(Figure). Using logistic regression and LASSO, we predicted the probability of persistent high-dose opioid use (N=17,171) (vs. low-dose opioid use) in the training set (N=101,810) for an AUC=0.80. The AUC in the test set (N=40,279) predicting high opioid use (N=5,893) was 0.77. The final model selected 33 variables and identified baseline history of opioid use as the strongest positive predictor of high-dose persistent opioid use. The reduced model with only ten predictors also performed equally well (AUC=0.77)(Table).

Conclusion:

In this cohort of older patients with no history of cancer or high-dose opioid use at baseline, 16.2% became high dose (28.1 MME/day) opioid users during the year after TKR. Our prediction model with 10 readily available clinical factors may help identify patients at high risk of future adverse outcomes from persistent opioid use and dependence after TKR

Figure.

 Trajectories of opioid use patterns after TKR

Table.

Predictors of persistent high-dose opioid use in the reduced mode

VariableMultivariable Odds Ratio (95% CI)Predicting High dose vs.Low dose opioid useP-valueAge (in years)0.94 (0.93-0.94)<0.001Females (Ref=Males)0.99 (0.93-1.06)0.78White race (Ref=Other)1.25 (1.04-1.50)0.02Baseline opioid use (MME/day)1.22 (1.22-1.23)<0.001Substance use (Yes/No)1.10 (1.02-1.20)0.02Benzodiazepine use (Yes/No)1.22 (1.12-1.32)<0.001Anxiolytic use (Yes/No)1.30 (1.19-1.43)<0.001Anticonvulsant use (Yes/No)0.94 (0.87-1.03)0.19Antidepressant use (Yes/No)1.03 (0.96-1.11)0.36NSAID use (Yes/No)1.07 (1.00-1.14)0.04

Disclosure of Interests:

Chandrasekar Gopalakrishnan: None declared, Jessica Franklin: None declared, Yinzhu Jin: None declared, Daniel Solomon Grant/research support from: Funding from Abbvie and Amgen unrelated to this work, Jeffrey Katz Grant/research support from: Dr Katz reported receiving grants from Samumed and Flexion Therapeutics outside the submitted work., Yvonne Lee Shareholder of: Cigna-Express Scripts, Grant/research support from: Pfizer, Consultant of: Highland Instruments, Inc., Patricia Franklin: None declared, Joyce Lii: None declared, Rishi J Desai Grant/research support from: Dr. Desai reported receiving grants from Bayer, Novartis, and Vertex Pharmaceuticals outside the submitted work., Seoyoung Kim Grant/research support from: Seoyoung C Kim has received research grants from AbbVie, Roche, Bristol-Myers Squibb and Pfizer.

Measurement of Kinetic-Scale Current Filamentation Dynamics and Associated Magnetic Fields in Interpenetrating Plasmas

We present the first local, quantitative measurements of ion current filamentation and magnetic field amplification in interpenetrating plasmas, characterizing the dynamics of the ion Weibel instability. The interaction of a pair of laser-generated, counterpropagating, collisionless, supersonic plasma flows is probed using optical Thomson scattering (TS). Analysis of the TS ion-feature revealed anticorrelated modulations in the density of the two ion streams at the spatial scale of the ion skin depth c/ω_{pi}=120  μm, and a correlated modulation in the plasma current. The inferred current profile implies a magnetic field amplitude ∼30±6  T, corresponding to ∼1% of the flow kinetic energy, indicating that magnetic trapping is the dominant saturation mechanism.

Plasma Collision in a Gas Atmosphere

We present a study on the impact of a gas atmosphere on the collision of two counterpropagating plasmas (gold and carbon). Imaging optical Thomson scattering data of the plasma collision with and without helium in between have been obtained at the Omega laser facility. Without gas, we observed large scale mixing of colliding gold and carbon ions. Once ambient helium is added, the two plasmas remain separated. The difference in ionic temperature is consistent with a reduction of the maximum Mach number of the flow from M=7 to M=4. It results in a reduction of a factor ∼10 of the counterstreaming ion-ion mean free path. By adding a low-density ambient gas, it is possible to control the collision of two high-velocity counterstreaming plasma, transitioning from an interpenetrating regime to a regime in agreement with a hydrodynamic description.

Evolution of the Electron Distribution Function in the Presence of Inverse Bremsstrahlung Heating and Collisional Ionization

The picosecond evolution of non-Maxwellian electron distribution functions was measured in a laser-produced plasma using collective electron plasma wave Thomson scattering. During the laser heating, the distribution was measured to be approximately super-Gaussian due to inverse bremsstrahlung heating. After the heating laser turned off, collisional ionization caused further modification to the distribution function while increasing electron density and decreasing temperature. Electron distribution functions were determined using Vlasov-Fokker-Planck simulations including atomic kinetics.

Predictors of Post-operative Pain and Opioid Consumption in Patients Undergoing Liver Surgery

BACKGROUND

Post-operative pain management is a critical component of perioperative care. Patients at risk of poorly controlled post-operative pain may benefit from early measures to optimize pain management. We sought to identify risk factors for post-operative pain and opioid consumption in patients undergoing liver resection.

METHODS

This is a multi-institutional prospective nested cohort study of patients undergoing open liver resection. Opioid consumption and pain scores were collected following surgery. To estimate the effects of patient factors on opioid consumption (oral morphine equivalents-OME) and on pain scores (NRS-11), we used generalized linear models and multivariable linear regression model, respectively.

RESULTS

One hundred and fifty-three patients who underwent open liver resection between 2013 and 2016 were included in the study. The mean patient age was 62.2 years, and 43.3% were female. Younger patients were significantly more likely to use more opioids in the early post-operative period (16.7 OME/10 years, p < 0.001). Patient factors that were significantly associated with increased NRS-11 pain scores also included younger patient age (difference in pain score of 0.3/10 years with cough and 0.2/10 years at rest, p < 0.01 for both) as well as a history of analgesic use (difference in pain score of 0.9 with cough and 0.6 at rest, p < 0.01 and p = 0.07, respectively).

CONCLUSION

Younger patients and those with a history of analgesic use are more likely to report higher post-operative pain and require higher doses of opioids. Early identification of these patients, and measures to better manage their pain, may contribute to optimal perioperative care.

Picosecond Thermodynamics in Underdense Plasmas Measured with Thomson Scattering

The rapid evolutions of the electron density and temperature in a laser-produced plasma were measured using collective Thomson scattering. Unprecedented picosecond time resolution, enabled by a pulse-front-tilt compensated spectrometer, revealed a transition in the plasma-wave dynamics from an initially cold, collisional state to a quasistationary, collisionless state. The Thomson-scattering spectra were compared with theoretical calculations of the fluctuation spectrum using either a conventional Bhatnagar-Gross-Krook (BGK) collision operator or the rigorous Landau collision terms: the BGK model overestimates the electron temperature by 50% in the most-collisional conditions.

Oral hygiene, prevalence of gingivitis, and associated risk factors among pregnant women in Sarlahi District, Nepal

BACKGROUND

The oral health status of pregnant women in low-resource communities such as Nepal has not been well characterized. This sub-population is also of specific interest given associations between poor oral health and adverse pregnancy outcomes previously documented in other settings. We explored relationships between gingivitis and risk factors among pregnant women in rural Nepal.

METHODS

The design was a community-based, cross-sectional study in a sub-area of Sarlahi District, Nepal. Pregnant women < 26 weeks gestation underwent clinical periodontal exams conducted by community-based oral health workers. Exams included a full mouth assessment measuring bleeding on probing (BOP), probing depth (PD) (six sites per tooth), and gingival recession, the distance from the cemento-enamel junction to the free gingival margin (two direct sites per tooth). Data on participant risk factors were collected through household surveys, including demographic characteristics, oral health behaviors, care seeking, and health attitudes. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors.

RESULTS

We enrolled 1452 participants, of which 40% (n = 582) had signs of clinical gingivitis and 60% (n = 870) clinical health. Average participant age was 23. Most participants (88%) had never received oral health care. Participants averaged 10% of sites with BOP with most (79%) having ≥1 site with BOP. Nine percent of participants had ≥1 site with PD ≥4 mm, although very few participants (0.7%) had sites with PD ≥5 mm. Few participants (13%) had any recession (≥1 mm). In the final adjusted model, odds of gingivitis increased by 3% for each year of age (aOR 1.03, 95% CI 1.00, 1.06) and were higher for women of short maternal stature (< 150 cm) (aOR 1.43, 95% CI: 1.14, 1.79) and among women reporting cost to be a barrier to seeking dental care (aOR 2.13, 95% CI: 1.09, 4.15).

CONCLUSIONS

Gingivitis was common and associated with age, maternal stature, self-reported high cost of dental care, and other risk factors among pregnant women in rural Nepal.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).

Influenza Activity - United States, September 30-December 1, 2018

Influenza activity in the United States was low during October 2018, and, although it increased slowly during November, activity remains low across most of the country.* During the week ending December 1, 2018, the percentage of outpatient visits for influenza-like illness^† (ILI) was equal to the national baseline^§ (Figure) and was at or slightly above the region-specific baseline in four of the 10 U.S. Department of Health and Human Services regions^¶ (Regions 4 and 7–9). The majority of jurisdictions experienced minimal or low ILI activity since September 30; however, two experienced moderate ILI activity, and two experienced high ILI activity** during the week ending December 1. The percentage of deaths attributed to pneumonia and influenza remains below the epidemic threshold,^†† and the rate of influenza-associated hospitalizations remains low. Five laboratory-confirmed, influenza-associated pediatric deaths occurring since September 30 have been reported to CDC. During the week ending December 1, the majority of jurisdictions (40 states, the District of Columbia, Puerto Rico, and U.S. Virgin Islands) reported sporadic or local geographic spread of influenza activity, nine states reported regional activity, and one state reported widespread activity.^§§

Update: Influenza Activity - United States and Worldwide, May 20-October 13, 2018

During May 20-October 13, 2018,* low levels of influenza activity were reported in the United States, with a mix of influenza A and B viruses circulating. Seasonal influenza activity in the Southern Hemisphere was low overall, with influenza A(H1N1)pdm09 predominating in many regions. Antigenic testing of available influenza A and B viruses indicated that no significant antigenic drift in circulating viruses had emerged. In late September, the components for the 2019 Southern Hemisphere influenza vaccine were selected and included an incremental update to the A(H3N2) vaccine virus used in egg-based vaccine manufacturing; no change was recommended for the A(H3N2) component of cell-manufactured or recombinant influenza vaccines. Annual influenza vaccination is the best method for preventing influenza illness and its complications, and all persons aged ≥6 months who do not have contraindications should receive influenza vaccine, preferably before the onset of influenza circulation in their community, which often begins in October and peaks during December-February. Health care providers should offer vaccination by the end of October and should continue to recommend and administer influenza vaccine to previously unvaccinated patients throughout the 2018-19 influenza season (1). In addition, during May 20-October 13, a small number of nonhuman influenza "variant" virus infections^† were reported in the United States; most were associated with exposure to swine. Although limited human-to-human transmission might have occurred in one instance, no ongoing community transmission was identified. Vulnerable populations, especially young children and other persons at high risk for serious influenza complications, should avoid swine barns at agricultural fairs, or close contact with swine.^§.

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.

Supersonic gas-jet characterization with interferometry and Thomson scattering on the OMEGA Laser System

A supersonic gas-jet target platform has been activated on the OMEGA Laser System. An analytic model for gas dynamics in a supersonic nozzle was used to predict gas-plume parameters and to design nozzles for use in laser-plasma experiments. The gas-jet system was analyzed with a Mach-Zehnder interferometer to study neutral density and with Thomson scattering to study plasma parameters on the OMEGA Laser System. These initial measurements demonstrate the capabilities of the OMEGA gas jet as a platform for future laser-plasma interaction science.

Unabsorbed light beamlets for diagnosing cross-beam energy transfer

A new diagnostic has been fielded on OMEGA to diagnose cross-beam energy transfer (CBET) during direct-drive implosions. Unabsorbed light from each OMEGA laser beam is imaged as a distinct "spot" onto a gated optical imager. Each spot is in essence the endpoint of a beamlet of light that originates from different regions of each beam profile and follows a path determined by refraction. The intensity of light in the beamlet varies along its path as a result of absorption and CBET with other beamlets. This diagnostic allows the investigation of the effects of CBET on laser energy from specific locations of the beam profile. The diagnostic records images in two 200-ps time windows and includes a Wollaston prism to split each beamlet into two orthogonal polarizations recorded on separate images, allowing the absolute polarization of each beamlet to be determined. This diagnostic has provided the first evidence of polarization rotation caused by CBET during direct-drive implosions.

Observation of Nonlocal Heat Flux Using Thomson Scattering

Nonlocal heat flux was measured in laser-produced coronal plasmas using a novel Thomson scattering technique. The measured heat flux was smaller than the classical values inferred from the measured plasma conditions in regions with large temperature gradients and agreed with classical values for weak gradients. Vlasov-Fokker-Planck simulations self-consistently calculated the electron distribution functions used to reproduce the measured Thomson scattering spectra and to determine the heat flux. Multigroup nonlocal simulations overestimated the measured heat flux.

Ionization Waves of Arbitrary Velocity

Flying focus is a technique that uses a chirped laser beam focused by a highly chromatic lens to produce an extended focal region within which the peak laser intensity can propagate at any velocity. When that intensity is high enough to ionize a background gas, an ionization wave will track the intensity isosurface corresponding to the ionization threshold. We report on the demonstration of such ionization waves of arbitrary velocity. Subluminal and superluminal ionization fronts were produced that propagated both forward and backward relative to the ionizing laser. All backward and all superluminal cases mitigated the issue of ionization-induced refraction that typically inhibits the formation of long, contiguous plasma channels.

Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: a qualitative study

BACKGROUND

Oral health behavior and attitudes of pregnant women in low-income countries are rarely examined, yet should be considered when designing preventative or therapeutic studies to reduce burden of oral diseases. We aimed to understand dental care-seeking behavior, as well as oral health knowledge and attitudes of oral health among pregnant women in rural Nepal.

METHODS

Semi-structured in-depth interviews (n = 16) and focus group discussions (3 groups, n = 23) were conducted among pregnant and recently-delivered women in Sarlahi, Nepal. Transcripts were translated from the local language to English then analyzed using a hybrid approach to thematic coding with Atlas.ti version 7.

RESULTS

Women felt confident describing the signs and symptoms of tooth decay and gum disease, but were not knowledgeable about where to receive care for tooth and/or gum pain and relied heavily on the knowledge of their community. Some women used a toothbrush and toothpaste at least once a day to clean their teeth, but many reported the traditional use of a branch of a local shrub or tree as their teeth cleaning instrument. Women suggested a willingness to consider using an oral rinse throughout pregnancy, perceiving that it might have a positive impact on infant health.

CONCLUSIONS

Future studies should focus on providing adequate and sustainable resources for pregnant women in Nepal and other low income settings to engage in good oral health behaviors (possibly supported through community-based workers), to maintain dental hygiene, and to access qualified dentists as a means of improving their oral health.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study) and NCT02788786 (Pilot Trial).