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BackgroundA lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. ObjectiveThis study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. MethodsPotential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. ResultsThe mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. ConclusionsElderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. Trial RegistrationClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864

This study assessed adolescent females' self-reported attraction and interest in dating adolescent male bullies and victims of bullying. Thirty-six 9th and 10th grade female adolescents (mean age = 15 years; 69.2% White; 30.8% Non-white) from a city high school in the Mid-Atlantic United States examined three photographs and listened to a verbal account portraying two adolescent males in an episode of physical and verbal bullying. Participants were significantly more likely to be attracted and interested in dating a male victim of bullying than a male bully. [ABSTRACT FROM AUTHOR]

The role of the private sector in the provision of publicly funded healthcare services has become the subject of increasing debate and discussion at the heart of the New Labour Government. The present paper reports the findings from an empirical study regarding the attitude of public-sector managers towards public-private partnerships in the healthcare arena. It reveals a growing awareness amongst managers of both the positive and negative consequences of stepping into the market place to purchase services. However, in the context of the ongoing ideological debate within the Government regarding the role of both the private sector and markets within healthcare, public sector managers are unlikely to receive the practical advice that will enable them to reap the benefits of working with the private sector and avoid the pitfalls. [ABSTRACT FROM AUTHOR]

BackgroundPatient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. ObjectiveOur goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. MethodsPatient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. ResultsThe MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. ConclusionsIncluding patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.

Indirect Drive Inertial Confinement Fusion Experiments on the National Ignition Facility (NIF) have achieved a burning plasma state with neutron yields exceeding 170 kJ, roughly 3 times the prior record and a necessary stage for igniting plasmas. The results are achieved despite multiple sources of degradations that lead to high variability in performance. Results shown here, for the first time, include an empirical correction factor for mode-2 asymmetry in the burning plasma regime in addition to previously determined corrections for radiative mix and mode-1. Analysis shows that including these three corrections alone accounts for the measured fusion performance variability in the two highest performing experimental campaigns on the NIF to within error. Here we quantify the performance sensitivity to mode-2 symmetry in the burning plasma regime and apply the results, in the form of an empirical correction to a 1D performance model. Furthermore, we find the sensitivity to mode-2 determined through a series of integrated 2D radiation hydrodynamic simulations to be consistent with the experimentally determined sensitivity only when including alpha-heating., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

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.

Obtaining a burning plasma is a critical step towards self-sustaining fusion energy 1 . A burning plasma is one in which the fusion reactions themselves are the primary source of heating in the plasma, which is necessary to sustain and propagate the burn, enabling high energy gain. After decades of fusion research, here we achieve a burning-plasma state in the laboratory. These experiments were conducted at the US National Ignition Facility, a laser facility delivering up to 1.9 megajoules of energy in pulses with peak powers up to 500 terawatts. We use the lasers to generate X-rays in a radiation cavity to indirectly drive a fuel-containing capsule via the X-ray ablation pressure, which results in the implosion process compressing and heating the fuel via mechanical work. The burning-plasma state was created using a strategy to increase the spatial scale of the capsule 2,3 through two different implosion concepts 4-7 . These experiments show fusion self-heating in excess of the mechanical work injected into the implosions, satisfying several burning-plasma metrics 3,8 . Additionally, we describe a subset of experiments that appear to have crossed the static self-heating boundary, where fusion heating surpasses the energy losses from radiation and conduction. These results provide an opportunity to study α-particle-dominated plasmas and burning-plasma physics in the laboratory., (© 2022. The Author(s).)

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

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

The Crystal Backlighter Imager (CBI) is a quasi-monochromatic, near-normal incidence, spherically bent crystal imager developed for the National Ignition Facility (NIF), which will allow inertial confinement fusion capsule implosions to be radiographed close to stagnation. This is not possible using the standard pinhole-based area-backlighter configuration, as the self-emission from the capsule hotspot overwhelms the backlighter signal in the final stages of the implosion. The CBI mitigates the broadband self-emission from the capsule hot spot by using the extremely narrow bandwidth inherent to near-normal-incidence Bragg diffraction. Implementing a backlighter system based on near-normal reflection in the NIF chamber presents unique challenges, requiring the CBI to adopt novel engineering and operational strategies. The CBI currently operates with an 11.6 keV backlighter, making it the highest energy radiography diagnostic based on spherically bent crystals to date. For a given velocity, Doppler shift is proportional to the emitted photon energy. At 11.6 keV, the ablation velocity of the backlighter plasma results in a Doppler shift that is significant compared to the bandwidth of the instrument and the width of the atomic line, requiring that the shift be measured to high accuracy and the optics aligned accordingly to compensate. Experiments will be presented that used the CBI itself to measure the backlighter Doppler shift to an accuracy of better than 1 eV. These experiments also measured the spatial resolution of CBI radiographs at 7.0 μm, close to theoretical predictions. Finally, results will be presented from an experiment in which the CBI radiographed a capsule implosion driven by a 1 MJ NIF laser pulse, demonstrating a significant (>100) improvement in the backlighter to self-emission ratio compared to the pinhole-based area-backlighter configuration.

Measurements of hydrodynamic instability growth for a high-density carbon ablator for indirectly driven inertial confinement fusion implosions on the National Ignition Facility are reported. We observe significant unexpected features on the capsule surface created by shadows of the capsule fill tube, as illuminated by laser-irradiated x-ray spots on the hohlraum wall. These shadows increase the spatial size and shape of the fill tube perturbation in a way that can significantly degrade performance in layered implosions compared to previous expectations. The measurements were performed at a convergence ratio of ∼2 using in-flight x-ray radiography. The initial seed due to shadow imprint is estimated to be equivalent to ∼50-100 nm of solid ablator material. This discovery has prompted the need for a mitigation strategy for future inertial confinement fusion designs as proposed here.

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

Advances in experimental, high-speed techniques can be used to explore the processes occurring within energetic materials. This review describes techniques used to study a wide range of processes: hot-spot formation, ignition thresholds, deflagration, sensitivity and finally the detonation process. As this is a wide field the focus will be on small-scale experiments and quantitative studies. It is important that such studies are linked to predictive models, which inform the experimental design process. The stimuli range includes, thermal ignition, drop-weight, Hopkinson Bar and Plate Impact studies. Studies made with inert simulants are also included as these are important in differentiating between reactive response and purely mechanical behaviour.

The degree of surface roughness and clarity with which a surface in a brittle material can be formed via fracture is known to be related to the speed of the propagating crack. Cracks traversing a brittle material at low speed produce very smooth surfaces, while those propagating faster create less reflective and rough surfaces (Buehler MJ, Gao H. 2006 Nature 439, 307-310 (doi:10.1038/nature04408)). The elastic wave speeds (c(l)≈18 000 m s(-1), c(s)≈11 750 m s(-1)) in diamond are fast (Willmott GR, Field JE. 2006 Phil. Mag. 86, 4305-4318 (doi:10.1080/14786430500482336)) and present a particular problem in creating smooth surfaces during the cleaving of diamond-a routine operation in the fashioning of diamonds for gemstone purposes--as the waves are reflected from the boundaries of the material and can add a tensile component to the propagating crack tip causing the well-known cleavage steps observed on diamond surfaces (Field JE. 1971 Contemp. Phys. 12, 1-31 (doi:10.1080/00107517108205103); Field JE. 1979 Properties of diamond, 1st edn, Academic Press; Wilks EM. 1958 Phil. Mag. 3, 1074-1080 (doi:10.1080/14786435808237036)). Here we report an analysis of two diamonds, having large dimensions and high aspect ratio, which from a gemological analysis are shown to have been cleaved from the same 200 carat specimen. A methodology for their manufacture is calculated by an analysis of a model problem. This takes into account the effect of multiple reflections from the sample boundaries. It is suggested that the lapidary had an intuitive guide to how to apply the cleavage force in order to control the crack speed. In particular, it is shown that it is likely that this technique caused the fracture to propagate at a lower speed. The sacrifice of a large diamond with the intention of creating thin plates, rather than a faceted gemstone, demonstrates how symbolism and beliefs associated with gemstones have changed over the centuries (Harlow GE. 1998 The nature of diamonds, Cambridge University Press). The scientific insights gained by studying these gemstones suggest a method of producing macroscale atomically flat and stress-free surfaces on other brittle materials.

Two-dimensional radiographs of imploding fusion capsules are obtained at the National Ignition Facility by projection through a pinhole array onto a time-gated framing camera. Parallax among images in the image array makes it possible to distinguish contributions from the capsule and from the backlighter, permitting correction of backlighter non-uniformities within the capsule radiograph. Furthermore, precise determination of the imaging system geometry and implosion velocity enables combination of multiple images to reduce signal-to-noise and discover new capsule features.

In an indirectly driven implosion, non-radial translational motion of the compressed fusion capsule is a signature of residual kinetic energy not coupled into the compressional heating of the target. A reduction in compression reduces the peak pressure and nuclear performance of the implosion. Measuring and reducing the residual motion of the implosion is therefore necessary to improve performance and isolate other effects that degrade performance. Using the gated x-ray diagnostic, the x-ray Bremsstrahlung emission from the compressed capsule is spatially and temporally resolved at x-ray energies of >8.7 keV, allowing for measurements of the residual velocity. Here details of the x-ray velocity measurement and fitting routine will be discussed and measurements will be compared to the velocities inferred from the neutron time of flight detectors.

First measurements of the in-flight shape of imploding inertial confinement fusion (ICF) capsules at the National Ignition Facility (NIF) were obtained by using two-dimensional x-ray radiography. The sequence of area-backlit, time-gated pinhole images is analyzed for implosion velocity, low-mode shape and density asymmetries, and the absolute offset and center-of-mass velocity of the capsule shell. The in-flight shell is often observed to be asymmetric even when the concomitant core self-emission is round. A ∼ 15 μm shell asymmetry amplitude of the Y(40) spherical harmonic mode was observed for standard NIF ICF hohlraums at a shell radius of ∼ 200 μm (capsule at ∼ 5× radial compression). This asymmetry is mitigated by a ∼ 10% increase in the hohlraum length.

Diamond is an exciting material with many outstanding properties; see, for example Field J E (ed) 1979 The Properties of Diamond (London: Academic) and Field J E (ed) 1992 The Properties of Natural and Synthetic Diamond (London: Academic). It is pre-eminent as a gemstone, an industrial tool and as a material for solid state research. Since natural diamonds grew deep below the Earth's surface before their ejection to mineable levels, they also contain valuable information for geologists. The key to many of diamond's properties is the rigidity of its structure which explains, for example, its exceptional hardness and its high thermal conductivity. Since 1953, it has been possible to grow synthetic diamond. Before then, it was effectively only possible to have natural diamond, with a small number of these found in the vicinity of meteorite impacts. Techniques are now available to grow gem quality synthetic diamonds greater than 1 carat (0.2 g) using high temperatures and pressures (HTHP) similar to those found in nature. However, the costs are high, and the largest commercially available industrial diamonds are about 0.01 carat in weight or about 1 mm in linear dimension. The bulk of synthetic diamonds used industrially are 600 µm or less. Over 75% of diamond used for industrial purposes today is synthetic material. In recent years, there have been two significant developments. The first is the production of composites based on diamond; these materials have a significantly greater toughness than diamond while still maintaining very high hardness and reasonable thermal conductivity. The second is the production at low pressures by metastable growth using chemical vapour deposition techniques. Deposition onto non-diamond substrates was first demonstrated by Spitsyn et al 1981 J. Cryst. Growth 52 219-26 and confirmed by Matsumoto et al 1982 Japan J. Appl. Phys. 21 L183-5. These developments have added further to the versatility of diamond. Two other groups of materials based on carbon, namely the fullerenes and graphines have been identified in recent years and are now the subject of intense research.

The first examples of circularly polarized luminescence from chiral bridged triarylamine-based heterohelicene molecules are reported. The luminescence dissymmetry factors are approximately |0.001|.