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Hydrogen is expected to play a key role in the global energy transition to net zero emissions in many scenarios. However, fugitive emissions of hydrogen into the atmosphere during its production, storage, distribution and use could reduce the climate benefit and also have implications for air quality. Here we explore the atmospheric composition and climate impacts of increases in atmospheric hydrogen abundance using the UKESM1 chemistry-climate model. We find that increases in hydrogen result in increases in methane, tropospheric ozone and stratospheric water vapour, resulting in a positive radiative forcing. However, some of the impacts of hydrogen leakage are partially offset by potential reductions in emissions of methane, carbon monoxide, nitrogen oxides and volatile organic compounds from the consumption of fossil fuels. We derive a new methodology for determining indirect Global Warming Potentials from steady-state simulations which is applicable to both shorter-lived species and those with intermediate and longer lifetimes, such as hydrogen. Using this methodology, we determine a 100-year Global Warming Potential for hydrogen of 12 ± 6. To maximise the benefit of hydrogen as an energy source, emissions associated with hydrogen leakage and emissions of the ozone precursor gases need to be minimised.

Introduction Hospital-acquired thrombosis (HAT) is defined as any venous thromboembolism (VTE)-related event during a hospital admission or occurring up to 90 days post discharge, and is associated with significant morbidity, mortality and healthcare-associated costs. Although surgery is an established risk factor for VTE, operations with a short hospital stay (, National Institute for Health Research (NIHR) NIHR133776

Laser wakefield accelerators generate ultrashort electron bunches with the capability to produce γ-rays. Here, we produce focused laser wakefield acceleration electron beams using three quadrupole magnets. Electron beams are then focused into a 3 mm lead converter to generate intense, focused bremsstrahlung γ beams. Experimental results demonstrate the generation and propagation of focused γ beams to a best focus spot size of 2.3 ± 0.1 × 2.7 ± 0.2 mm2 using a copper stack calorimeter. Monte Carlo simulations conducted using GEANT4 are in good agreement with experimental results and enable detailed examination of γ-ray generation. Simulations indicate that the focused γ beams contained 2.6 × 109 photons in the range of 100 keV to 33 MeV with an average energy of 6.4 MeV. A γ-ray intensity of 7 × 1010 W/cm2 was estimated from simulations. The generation of focused bremsstrahlung γ-ray sources can have important applications in medical imaging applications and laboratory astrophysics experiments.

We report a novel method to profile intrcellular oxygen concentration (icO2) during in vitro mammalian oocyte and preimplantation embryo development using a commercially available multimodal phosphorescent nanosensor (MM2). Abattoir-derived bovine oocytes and embryos were incubated with MM2 in vitro. A series of inhibitors were applied during live-cell multiphoton imaging to record changes in icO2 associated with mitochondrial processes. The uncoupler carbonyl cyanide-p-trifluoromethoxyphenylhydrazone (FCCP) uncouples mitochondrial oxygen consumption to its maximum, while antimycin inhibits complex III to ablate mitochondrial oxygen consumption. Increasing oxygen consumption was expected to reduce icO2 and decreasing oxygen consumption to increase icO2. Use of these inhibitors quantifies how much oxygen is consumed at basal in comparison to the upper and lower limits of mitochondrial function. icO2 measurements were compared to mitochondrial DNA copy number analysed by qPCR. Antimycin treatment increased icO2 for all stages tested, suggesting significant mitochondrial oxygen consumption at basal. icO2 of oocytes and preimplantation embryos were unaffected by FCCP treatment. Inner cell mass icO2 was lower than trophectoderm, perhaps reflecting limitations of diffusion. Mitochondrial DNA copy numbers were similar between stages in the range 0.9–4 × 106 copies and did not correlate with icO2. These results validate the MM2 probe as a sensitive, non-toxic probe of intracellular oxygen concentration in mammalian oocytes and preimplantation embryos.

Sub-micron defects represent a well-known fundamental problem in manufacturing since they can significantly affect performance and lifetime of virtually any high-value component. Positron annihilation lifetime spectroscopy is arguably the only established method capable of detecting defects down to the sub-nanometer scale but, to date, it only works for surface studies, and with limited resolution. Here, we experimentally and numerically show that laser-driven systems can overcome these well-known limitations, by generating ultra-short positron beams with a kinetic energy tuneable from 500 keV up to 2 MeV and a number of positrons per shot in a 50 keV energy slice \color{black} of the order of $10^3$. Numerical simulations of the expected performance of a typical mJ-scale kHz laser demonstrate the possibility of generating MeV-scale narrow-band and ultra-short positron beams with a flux exceeding $10^5$ positrons/s, of interest for fast volumetric scanning of materials at high resolution., Submitted to PRAB

Bioenergetic algorithms and mercury (Hg) mass balance approaches are combined into a single modeling framework (BioHg) to investigate sensitivity of methylmercury (MeHg) levels in Sacramento blackfish ( Orthodon microlepidotus ), a planktivorous cyprinid, as a function of dissolved water column concentrations of methylmercury ( DMeHg ). Boundary condition DMeHg are defined using observed Carson River contributions to Lahontan Reservoir, Nevada (USA). Influxes of DMeHg have a seasonal mean of 0.65 ± 0.21 ng/L (January) to 2.48 ± 1.53 ng/L (August) and blackfish concentrations in Lahontan Reservoir exceed health criterion for human consumption of MeHg by nearly three-fold. Model parameterization relies on laboratory and field data specific to the blackfish to calibrate allometric coefficients related to consumption, respiration, specific dynamic action, egestion, excretion, and spawning. Actual consumption is reliant on feeding strategies, prey selectivity, filtering efficiency, and prey availability. BioHg is able to capture trends in observed growth and wet weight MeHg concentrations in blackfish. MeHg concentrations are obtained in the first year and maintained throughout the lifespan of the fish, with growth dilution an important processes limiting continued increases in MeH g concentrations through time. Model results indicate that coupling dynamic DMeHg influxes with periods of maximum plankton growth and maximum fish consumption rates increases fish concentrations by 50% and is a better predictor of observed concentrations in comparison to a constant DMeHg condition. Additionally, peak MeHg concentration in fish is directly correlated to maximum DMeHg . Simulated phase shifts in DMeHg decouples modeled processes and MeHg fish concentration estimates decrease by 50%. BioHg highlights that both the magnitude and timing of DMeHg are important predictors of MeHg accumulation in a planktivourous fish.

We present a global methane modelling study assessing the sensitivity of Arctic atmospheric CH4 mole fractions, δ13C-CH4 and δD-CH4 to uncertainties in Arctic methane sources. Model simulations include methane tracers tagged by source and isotopic composition and are compared with atmospheric data at four northern high-latitude measurement sites. We find the model's ability to capture the magnitude and phase of observed seasonal cycles of CH4 mixing ratios, δ13C-CH4 and δD-CH4 at northern high latitudes is much improved using a later spring kick-off and autumn decline in northern high-latitude wetland emissions than predicted by most process models. Results from our model simulations indicate that recent predictions of large methane emissions from thawing submarine permafrost in the East Siberian Arctic Shelf region could only be reconciled with global-scale atmospheric observations by making large adjustments to high-latitude anthropogenic or wetland emission inventories.

Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct identification and treatment of patients who are likely to benefit from receptor radioligand therapy.There are a multitude of treatment modalities available for the treatment of prostate cancer and these therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and should ideally also involve a palliative/pain specialist, a dietician and a psychologist.Treatment with

Background Patients with long term conditions (LTC) such as COPD have a higher incidence of depression and anxiety compared to the general population.1 This patient group often have a high usage of healthcare services. Cognitive Behavioural Therapy (CBT) has been shown to improve welfare, although access to these services can be delayed and non-specific.2 Aim To see if improving access to Psychological Therapy services for patients with long term respiratory conditions could reduce healthcare costs and improve patient wellbeing. Methods A tailored approach of fast accessible therapy was set up locally – Improved Access to Psychological Therapy (IAPT). Patients were referred via Respiratory Specialist Nurses, Healthcare professionals or self-referral. This group was compared to patients with registered LTC’s assigned to general psychological therapy (PT). Healthcare usage was assessed 3 months prior to and post referral date and psychological scores recorded using WSAS (Work and Social Adjustment scale). Results Within IAPT 45% of patients had a diagnosis of COPD and 32.3% had more than one LTC (20.2% in the PT group). In the IAPT group there was a 70.6% reduction in A&E attendances for those that completed treatment compared to 13.3% in PT group and a 59.1% versus 18.7% reduction in non-elective hospital admissions. In the IAPT group, for CSRI (Client Service Receipt Inventory) paired responses taken before and immediately after treatment there was a 15.4% reduction in ambulance callout and a 27.3% reduction in GP appointments. For those in paid employment total days lost due to ill health reduced by 64% post treatment, with an average saving of £852.50 per person in the three months post treatment completion. Conclusions There was a significant reduction in cost, non-elective hospital admissions and wider healthcare activity in the IAPT group. Patient perception of their functional impairment also improved. Further development of fast accessible therapy tailored towards the breathless patient is required to improve outcomes in patients with long term respiratory conditions. References Anxiety and depression in patients with COPD. A review. Mikkelsen RL, et al. Nord J Psychiatry. 2004;58(1):65–70 Mind. We still need to talk. A report on access to talking therapies. 2013;4–5

The fast-paced development of laser-wakefield electron acceleration has recently culminated in the generation of electron beams with extreme characteristics, including femtosecond-scale duration, mrad divergence, and high-energy. It is now customary to attain tens to hundreds of pC of charge with an energy of hundreds of MeV per particle with small-scale commercial laser systems, with multi-GeV electron beams being demonstrated from cm-scale accelerators. The interaction of such electron beams with either a solid target or the focus of a second high-power laser can result in the generation of high-quality positron beams and MeV-photon beams. The unrivalled properties of these secondary sources make them ideal for both fundamental and practical applications. In the present article, some of their main characteristics will be discussed, with particular emphasis on their potential applications in fundamental and applied physics. A discussion of potential future developments enabled by near-term laser facilities will also be presented.

Background Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost-effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers. Methods This was a within-trial cost-utility analysis with a 1-year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality-adjusted life-year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health-related quality of life, and per protocol. Results After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost-effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost-effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost-effective. Conclusion Early treatment of superficial reflux is highly likely to be cost-effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com).

In this work, two-dimensional (2D) hydrodynamic simulations of a variable length gas cell were performed using the open source fluid code OpenFOAM. The gas cell was designed to study controlled injection of electrons into a laser-driven wakefield at the Astra Gemini laser facility. The target consists of two compartments: an accelerator and an injector section connected via an aperture. A sharp transition between the peak and plateau density regions in the injector and accelerator compartments, respectively, was observed in simulations with various inlet pressures. The fluid simulations indicate that the length of the down-ramp connecting the sections depends on the aperture diameter, as does the density drop outside the entrance and the exit cones. Further studies showed, that increasing the inlet pressure leads to turbulence and strong fluctuations in density along the axial profile during target filling, and consequently, is expected to negatively impact the accelerator stability.

We present a design for a pixelated scintillator based gamma-ray spectrometer for non-linear inverse Compton scattering experiments. By colliding a laser wakefield accelerated electron beam with a tightly focused, intense laser pulse, gamma-ray photons up to 100 MeV energies and with few femtosecond duration may be produced. To measure the energy spectrum and angular distribution, a 33 × 47 array of cesium-iodide crystals was oriented such that the 47 crystal length axis was parallel to the gamma-ray beam and the 33 crystal length axis was oriented in the vertical direction. Using an iterative deconvolution method similar to the YOGI code, modeling of the scintillator response using GEANT4 and fitting to a quantum Monte Carlo calculated photon spectrum, we are able to extract the gamma ray spectra generated by the inverse Compton interaction.

Significance High-resolution microcomputed tomography with benchtop X-ray sources requires long scan times because of the heat load limitation on the anode. We present an alternative, high-brightness plasma-based X-ray source that does not suffer from this restriction. A demonstration of tomography of a centimeter-scale complex organism achieves equivalent quality to a commercial scanner. We will soon be able to record such scans in minutes, rather than the hours required by conventional X-ray tubes., In the field of X-ray microcomputed tomography (μCT) there is a growing need to reduce acquisition times at high spatial resolution (approximate micrometers) to facilitate in vivo and high-throughput operations. The state of the art represented by synchrotron light sources is not practical for certain applications, and therefore the development of high-brightness laboratory-scale sources is crucial. We present here imaging of a fixed embryonic mouse sample using a compact laser–plasma-based X-ray light source and compare the results to images obtained using a commercial X-ray μCT scanner. The radiation is generated by the betatron motion of electrons inside a dilute and transient plasma, which circumvents the flux limitations imposed by the solid or liquid anodes used in conventional electron-impact X-ray tubes. This X-ray source is pulsed (duration 1010 photons per pulse), small (diameter 15 keV. Stable X-ray performance enabled tomographic imaging of equivalent quality to that of the μCT scanner, an important confirmation of the suitability of the laser-driven source for applications. The X-ray flux achievable with this approach scales with the laser repetition rate without compromising the source size, which will allow the recording of high-resolution μCT scans in minutes.

In this paper we report the experimental implementation of a theoretically-proposed technique for creating a photoionized plasma in the laboratory using X-ray line radiation. Using a Sn laser-plasma to irradiate an Ar gas target, the photoionization parameter, \xi = 4{\pi}F/Ne, reached values of order 50 erg cm/s, where F is the radiation flux in erg/cm2/s. The significance of this is that this technique allows us to mimic effective spectral radiation temperatures in excess of 1 keV. We show that our plasma starts to be collisionally dominated before the peak of the X-ray drive. However, the technique is extendable to higher energy laser systems to create plasmas with parameters relevant to benchmarking codes used to model astrophysical objects., Comment: 10 pages; 8 figures; Physical Review E, in press

International audience; The experimental study of the dynamics of neutral electron–positron beams is an emerging area of research, enabled by the recent results on the generation of this exotic state of matter in the laboratory. Electron–positron beams and plasmas are believed to play a major role in the dynamics of extreme astrophysical objects such as supermassive black holes and pulsars. For instance, they are believed to be the main constituents of a large number of astrophysical jets, and they have been proposed to significantly contribute to the emission of gamma-ray bursts and their afterglow. However, despite extensive numerical modelling and indirect astrophysical observations, a detailed experimental characterisation of the dynamics of these objects is still at its infancy. Here, we will report on some of the general features of experiments studying the dynamics of electron–positron beams in a fully laser-driven setup.

The dynamics of energetic particles in strong electromagnetic fields can be heavily influenced by the energy loss arising from the emission of radiation during acceleration, known as radiation reaction. When interacting with a high-energy electron beam, today's lasers are sufficiently intense to explore the transition between the classical and quantum radiation reaction regimes. We report on the observation of radiation reaction in the collision of an ultra-relativistic electron beam generated by laser wakefield acceleration ($\varepsilon > 500$ MeV) with an intense laser pulse ($a_0 > 10$). We measure an energy loss in the post-collision electron spectrum that is correlated with the detected signal of hard photons ($��$-rays), consistent with a quantum (stochastic) description of radiation reaction. The generated $��$-rays have the highest energies yet reported from an all-optical inverse Compton scattering scheme, with critical energy $\varepsilon_{\rm crit} > $ 30 MeV., 11 pages, 9 figures, accepted for publication in PRX

44th EPS Conference on Plasma Physics, Belfast, Northern Ireland, 26 Jun 2017 - 30 Jun 2017; Plasma physics and controlled fusion 60(1), 014022 (2018). doi:10.1088/1361-6587/aa8f0e, We report on the evaluation of the performance of self-guiding over extended distances with $f/20$ and $f/40$ focussing geometries. Guiding over $39\,\mathrm{mm}$ or more than 100 Rayleigh ranges was observed with the $f/20$ optic at ${n}_{e}=1.5\times {10}^{18}\,{\mathrm{cm}}^{-3}$. Analysis of guiding performance found that the extent of the exiting laser spatial mode closely followed the matched spot size predicted by 3D nonlinear theory. Self-guiding with an $f/40$ optic was also characterised, with guided modes observed for a plasma length of $90\,\mathrm{mm}$ and a plasma density of ${n}_{e}=9.5\times {10}^{17}\,{\mathrm{cm}}^{-3}$. This corresponds to self-guided propagation over 53 Rayleigh ranges and is similar to distances obtained with discharge plasma channel guiding., Published by IOP Publ., Bristol

Wastewater treatment plants are common point sources of nutrients to streams. Excess loading of nutrients, particularly nitrogen (N), can result in significant water quality degradation. Where stream loading cannot be increased by water quality trading with other point or nonpoint sources, stream restoration may be an alternative means for point sources to increase loading while maintaining or improving stream health by increasing in-stream N removal via denitrification. However, the primary drivers of nitrogen removal are currently not well understood and thus optimizing restoration efforts is difficult. A two-storage zone transport model with Michaelis–Menten uptake kinetics was applied to a river system based on the Truckee River of Nevada to simulate N removal for multiple restoration scenarios and different types of nitrogen loading. Rates of N removal were found to be most sensitive to the size of the hyporheic zone (AHTS) and maximum denitrification rate in the hyporheic zone (U′max,HTS), followed by the half-saturation concentration for denitrification (Km,HTS). Graphs that incorporate the ranges of these three parameters indicate the potential effectiveness of restoration activities for increasing N removal. Combining restoration targets (e.g., increasing AHTS, sinuosity, width-to-depth ratio, etc.) provided more N removal than the sum of N removal from the individual targets. The relative fractions of the three nitrogen species (dissolved organic-N, total ammonia-N, and nitrate-N) was found to significantly affect a stream's potential to remove N. Together, these results can be used to help guide stream restoration activities to increase a stream’s N removal capacity.

The main channel (MC), surface transient storage (STS), and hyporheic transient storage (HTS) zones provide unique habitats in streams. Most nutrient spiraling studies use models that aggregate the influence of the various transient storage zones on uptake and retention. This may explain contradictory results on drivers of nutrient cycling in streams. Here, a new two-storage zone transport model with Michaelis–Menten uptake kinetics was developed to quantify the relative role of the three stream compartments on the physical and biological transport of solutes and compared with a dynamic nutrient spiraling method (tracer additions for spiraling curve characterization). Both approaches are applied to coinjected conservative and reactive tracer tests in a stream with mean annual discharge >1.0 m3 s−1. The relative influence of the three stream compartments on in-stream uptake of NO3-N varied between reaches; each stream compartment dominated overall nitrate uptake in at least one subreach. HTS zones generally had greater influence on nitrate concentrations than STS zones because of longer residence times and faster uptake rates. However, a combination of geomorphology, MC-transient storage connectivity, residence time, compartment size, and uptake rate controls overall nutrient uptake capacity of a stream. Overall reach and compartment-specific uptake and uptake efficiency benefit from the upstream action of the transient storage zones during nutrient addition experiments, but STS and HTS contribute in different ways. Physical retention and biological uptake in STS zones contributed equally to overall reach uptake, but biological uptake in HTS zones overshadowed physical retention.

We report on the first experimental observation of a current-driven instability developing in a quasineutral matter-antimatter beam. Strong magnetic fields (amp;gt;= 1 T) are measured, via means of a proton radiography technique, after the propagation of a neutral electron-positron beam through a background electron-ion plasma. The experimentally determined equipartition parameter of epsilon(B) approximate to 10(-3) is typical of values inferred from models of astrophysical gamma-ray bursts, in which the relativistic flows are also expected to be pair dominated. The data, supported by particle-in-cell simulations and simple analytical estimates, indicate that these magnetic fields persist in the background plasma for thousands of inverse plasma frequencies. The existence of such long-lived magnetic fields can be related to analog astrophysical systems, such as those prevalent in lepton-dominated jets. Funding Agencies|EPSRC [EP/N022696/1, EP/N027175/1, EP/L013975/1, EP/N002644/1, EP/P010059/1]; DOE [DE-NA0002372]; ARO [W911NF-16-1-0044]

The generation of high-quality relativistic positron beams is a central area of research in experimental physics, due to their potential relevance in a wide range of scientific and engineering areas, ranging from fundamental science to practical applications. There is now growing interest in developing hybrid machines that will combine plasma-based acceleration techniques with more conventional radio-frequency accelerators, in order to minimise the size and cost of these machines. Here we report on recent experiments on laser-driven generation of high-quality positron beams using a relatively low energy and potentially table-top laser system. The results obtained indicate that current technology allows to create, in a compact setup, positron beams suitable for injection in radio-frequency accelerators.

Summary Hyporheic storage accounts for a significant fraction of solute residence time in small streams and has been shown to have a large effect on the transport of solutes. It is not clear whether this characteristic is preserved in larger streams and rivers, as increased discharge and decreased slope may reduce overall exchange between the channel and subsurface, and the size of surface storage zones may increase. Conservative tracer tests conducted in the Truckee River, a stream with mean annual discharge >0.5 m3 s−1, were simulated with both one (1-SZ) and two-storage zone (2-SZ) transport models to quantify the relative role of surface transient storage (STS) and hyporheic transient storage (HTS) on the physical transport of solutes in a large stream. Tracer injections were conducted at two different discharge levels in two reaches with distinct geomorphic characteristics. STS was the dominant storage mechanism for all reaches and discharge levels and surface storage accounted for a larger fraction of median transport time ( F MED 200 ) than hyporheic storage in all but one case. Increased discharge significantly reduced the influence of the HTS (primarily) and STS zones on median transport time at the study site. Comparisons with studies of discharge and geomorphic effects on TS characteristics in other streams indicated differing physical controls on STS and HTS zones. Therefore, measurements such as slope, sinuosity, width, depth, and gross gains and losses of discharge need to be considered along with discharge. This work adds to the growing sentiment that up-scaling and prediction of stream storage characteristics based on discharge and channel properties is far from straightforward. Since biogeochemical processing occurs differently in the HTS and STS, two-zone storage models provide necessary representations of transport in river systems for studies focused on aspects of water quality. Extra parameters are required for model optimization but simple cross-section surveys (area and velocity) provide enough information to ensure enhanced parameter reliability.

Introduction NAC has been used for downsizing of the tumour in breast and axilla to allow more conservative surgery. In the NAC setting, intraoperative assessment of sentinel lymph node(s) (SLN) is still considered necessary1. Current awareness of the prognostic value for axillary nodal down-staging has renewed interest in analysis of SLN post-NAC. In this study we want to examine the clinical utility of OSNA (based on CK19 mRNA detection) as a method of intra-operative analysis of SLN to assist real-time decision-making for axillary surgery post-NAC in early breast cancer (EBC). Methods Retrospective analysis of prospective data on 399 consecutive patients with EBC who received NAC followed by breast surgery with SLN biopsy (408 axillae) and assessment by OSNA, from September 2011 to January 2018 at the Royal Marsden Hospital (UK). OSNA readouts from the Sysmex RD-100i were collected separate to and blinded from clinico-pathological data. A negative or benign pre-treatment axillary ultrasound scan or indeterminate ultrasound with negative or benign axillary cytology/histology prior to NAC was considered cN0. Univariate analysis (significance at p Results The median age at diagnosis was 49 years, median BMI 26, 41 EBC (10%) were screen-detected, 292 (72%) were grade 3 and the most frequent phenotype was receptor triple negative (n=132, 32%). Of 408 axillae, 248 (60%) were initially cN0, of which 113 (46%) had a pathological complete response (pCR) in the breast. SLN in 54 (22%) cN0 patients were positive on OSNA, of which only 6 (9%) had further involved axillary nodes all 6 of which were ER+ Her2-. The remaining 160 (40%) axillae were cN1 of which 87 (54%) had conversion to ypN0 including 55 (34%) with both ypT0ypN0. Axillary lymphadenectomy (AL) was performed in 79 (19%) patients overall, of which n=22 (28%) were cN0 and 57 (72%) were cN1. Of these, 30 (53%) of the cN1 and 6 of 22 (45%) of cN0 had at least 1 additional positive AL node. Overall 59 (14.4%) patients relapsed. A significantly worse rate of relapse was observed in cN1 compared to cN0 patients (37/159 (23.3%) versus 22/244 (9%), p The mean of both the single highest node tumour load (and total nodal tumour load), as measured by CK19mRNA copies/ul on OSNA, were significantly higher at 90,000 (98,300) for those who relapsed versus 23,100 (25,100) for those without relapse (p=0.027). Conclusions The OSNA assay is an accurate tool for axillary SLN analysis in patients after NAC and was helpful in intra-operative axillary management. OSNA reduces the need for a second surgery for AL in 20% of breast cancer patients with a positive-SLN after NAC and might offer additional prognostic value. Reference 1. NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology Breast Cancer.2016.Version 2.2016. Citation Format: Muscara F, Christaki G, Richardson C, O'Connell R, Padmanabhan P, Warwick J, Lee Y, Smith I, Nerurkar A, Osin P, Krupa K, Rusby J, Roche N, Gui G, MacNeil F, Barry P. Clinical utility of one-step nucleic acid amplification (OSNA) in axillary surgery after neoadjuvant chemotherapy (NAC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-14.

This review summarizes the literature regarding venous thromboembolism and examines the prophylaxis guidelines with relation to hand, wrist and elbow surgery. We performed an extensive literature search identifying any relevant case reports or outcome studies. Of 680 potential articles, only four contained data relevant to thrombosis after elbow, wrist and hand surgery. No isolated deep vein thromboses and only nine pulmonary embolisms were identified suggesting that the rate of venous thromboembolism is extremely low following this subset of upper limb surgery. We identified nine guidelines, of which only two (the British Society for Surgery of the Hand and the National Institute of Health and Clinical Excellence) addressed the upper limb. We present a set of recommendations based on the results of this review.

For direct drive inertial confinement fusion, a capsule is imploded by directly illuminating the surface with laser light. Beam smoothing and uniformity of illumination affect the seeding of instabilities at the ablation front. We have developed a technique for studying the imprint of a laser beam on a thin foil using an x-ray laser as an extreme ultraviolet (XUV) backlighter. We use multilayer XUV optics to relay the x-ray laser onto the directly driven foil, and then to image the foil modulation onto a charged coupled device camera. This technique allows us to measure small fractional variations in the foil thickness. We have measured the modulation due to imprint from a low intensity 0.35 mu m drive beam incident on a 3 mu m Si foil using an yttrium x-ray laser on Nova. We present results from a similar technique to measure the imprinted modulation due to a low intensity 0.53 mu m drive beam incident on a 2 mu m Al foil using a germanium x-ray laser at the Vulcan facility. (C) 1997 American Institute of Physics.

Lake Taihu, China's third largest freshwater lake, exemplifies the severity of eutrophication problems in rapidly developing regions. We used long term land use, water quality, and hydrologic data from 26 in-lake and 32 tributary locations to describe the spatiotemporal patterns in nutrient loads, nutrient concentration, algal biomass, measured as chlorophyll a (Chl-a), in Lake Taihu. Point and nonpoint sources, as determined by chemical oxygen demand, contributed approximately 75 and 25% of the total nutrient loads to the lake, respectively. Spatial patterns in total phosphorus (TP) and total nitrogen (TN) concentrations in Lake Taihu strongly corresponded with observed loads from adjoining rivers with high concentrations proximate to densely populated areas. Chl-a concentrations exhibited spatial patterns similar to TP and TN concentrations. Generally, nutrient and Chl-a concentrations were highest in the northwestern region of the lake and lowest in the southeastern region of the lake. Seasona...

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

Background Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014–19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through ‘managed transition’, ethics of transitioning and the training of health care professionals. Methods Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Discussion Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. Trial registration “MILESTONE study” registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017. Electronic supplementary material The online version of this article (10.1186/s12888-018-1758-z) contains supplementary material, which is available to authorized users.

This study examined the effects of uncertain model boundary conditions on dissolved oxygen (DO) predictions for the lower Truckee River, Nevada using an augmented version of the EPA’s Water Quality Analysis Simulation Program Version 5 (WASP5) that included periphyton, or attached algae, in eutrophication kinetics. Uncertainty analyses were performed on selected organic nitrogen (ON) and carbonaceous biochemical oxygen demand boundary conditions using Monte Carlo techniques. The stochastic model was run using boundary concentrations assigned from observed probability distributions. Ranges of simulated values were used to construct confidence intervals, the magnitudes of which indicated the uncertainty associated with model predictions. Uncertainty in agricultural ditch return concentrations had minimal effects on in-stream model predictions, as predicted values of daily minimum and maximum DOs, daily average ON, and periphyton biomass all failed to show significant variability as a result of ditch concent...