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The purpose of this study was to assess self-reported infection prevention processes and their effect on businesses of chiropractic doctors (DCs) and licensed massage therapists (LMTs) in Mississippi during the COVID-19 pandemic.We developed a survey that was electronically delivered to all licensed DCs and LMTs in Mississippi between August and September 2020. Assessments were made using Qualtrics software, with data management and subsequent analysis including Pearson's χResponses were based on 32 of 323 DCs and 69 of 934 LMTs that were still seeing patients through the pandemic (n = 101, response rate 8%). The DC and LMT practitioners (94%) used treatment table and/or surface sanitizing (91.8%) and hand washing and/or sanitizing (89.8%) between all patients. Female practitioners reported practicing handwashing for at least 20 seconds, whereas male practitioners reported practicing handwashing for at least 15 seconds (Most respondents had moderate to high compliance with guidelines on recommended infection prevention processes during fall 2020 of the COVID-19 pandemic. This assessment of compliance may be used to help guide future health education and promotion research of disease prevention and mitigation as well as physical and economic burdens faced by DCs and LMTs in Mississippi during a pandemic.

Objectives The aims of the study were (1) to determine the frequency of neck pain in patients diagnosed with mild traumatic brain injury (mTBI) or concussion in a pediatric level 1 trauma center emergency department (ED), (2) to identify variables associated with neck pain in this population, and (3) to report on aspects of care received in the ED including imaging and medication use. Methods This is a retrospective chart review of 652 patients presenting to a pediatric ED with diagnosis of concussion/mTBI. Charts were reviewed for the following information: baseline demographic information, mechanism of injury, cause of mTBI, presence or absence of neck pain, point tenderness in the neck on physical examination, and whether the patient followed up within our health system in the 6 months after injury. Charts were also reviewed for other concussion-related symptoms, medication given in the ED, imaging performed in the ED, cervical spine clearance in the ED, and referrals made. For those patients who did have follow-up appointments within our system, additional chart review was performed to determine whether they sought follow-up treatment for symptoms related to concussion/neck pain and the duration of follow-up. Statistical analyses focused on the prevalence of neck pain in the sample. We subsequently explored the degree to which neck pain was associated with other collected variables. Results Of 652 patients, 90 (13.8%) reported neck pain. Acceleration/deceleration injury and motor vehicle accident were predictive of neck pain. Neck pain was less common in those reporting nausea and vomiting. Direct impact of the head against an object was associated with reduced odds of neck pain, but after adjusting for other variables, this was no longer statistically significant. Patients with neck pain were older than those without neck pain. Patients with neck pain were more likely to receive ibuprofen or morphine and undergo imaging of the spine. They were also more likely to receive a referral and follow-up with neurosurgery. There was no significant difference between groups with respect to concussion-related follow-up visits or follow-up visits to a dedicated concussion clinic. Conclusions Neck pain is a common symptom in pediatric patients with mTBI, although it was more likely in older patients and those presenting with acceleration/deceleration mechanisms. Although patients with neck pain were more likely to receive a referral and follow-up with neurosurgery, they were not more likely to have concussion-related follow-up visits. Indeed, most patients had no follow-up visits related to their concussion, which supports the notion that concussion is a self-limiting condition.

The US Army Corps of Engineers (USACE)'s Engineering With Nature® (EWN®) initiative consistently promotes the use of collaboration for identifying innovative, nature-based solutions (NBS) that lead to more resilient communities and water-based infrastructure. In recent years, EWN researchers, in partnership with landscape architects (LAs) affiliated with the Dredge Research Collaborative (DRC), have championed an innovative, collaborative strategy that offers traditional planners an opportunity to participate in visioning exercises during the initial phases of coastal storm risk management projects. This has resulted in the identification, development, and incorporation of design concepts that prioritize NBS and the placement of natural and nature-based features (NNBF). These concepts, and their development process, have been documented in reports for the use of both the participating planners and other audiences interested in innovative NNBF. Upon observing these favorable outcomes, it has become clear that the integration of disciplines-landscape architecture, applied science, and engineering-has increased our ability to process, utilize, and communicate complex information. Both groups (i.e., DRC's LAs and EWN engineers and scientists) have considerable experience related to infrastructure design and performance; they elucidate ways to achieve functional engineering criteria while also maximizing ecological value and/or promoting more recreational opportunities. However, this partnership also produces a complementary set of uniquely acquired skills and expertise, which advances the development of NBS through accelerated and more meaningful communications. This study will offer insight into the partnership, collaborative techniques, and resulting products that have fostered innovation as well as advocacy for more sustainable infrastructure. Integr Environ Assess Manag 2021;00:1-7. © 2021 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Damaging storm events frequently impact the Texas coast. In response, the US Army Corps of Engineers Galveston District (SWG) has undertaken the Sabine-to-Galveston (S2G) Coastal Storm Risk Management (CSRM) Project. This approximately $3.9B project includes numerous measures across several counties of the upper Texas coast, including levees, floodwalls, and pump stations. In June 2019, SWG leadership enlisted a team including the paper authors to integrate Engineering With Nature (EWN) strategies into this infrastructure project. EWN strategies intentionally align natural and engineering processes to efficiently and sustainably deliver economic, environmental, and social benefits through collaboration. The first step in this process was to develop potentially relevant EWN strategies. A collaborative workshop included visits to project sites and working sessions where the project team reviewed challenges associated with each site, generated an array of EWN strategies, and began to test design concepts based on those strategies through collaborative drawing sessions. Afterward, prioritized ideas were refined and evaluated in terms of property acquisition, estimated cost, logistics, stakeholder and sponsor interest, constructability, aesthetics, recreational opportunities, and ecological benefit. Design concepts considered feasible for integration into the broader S2G project included horizontal levees, inland floodwater storage areas that double as wildlife habitat, and strategic placement of sediment berms to reduce storm impacts and provide marsh substrate. All these concepts should achieve intended CSRM outcomes while enhancing environmental and social benefits. This assimilation of EWN strategies and landscape architecture techniques into a large CSRM study illustrates a method for expanding overall project value and producing infrastructure that benefits coastal communities. Integr Environ Assess Manag 2022;18:63-73. © 2021 SETAC.

Background context The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. Study design This is a guideline summary review. Methods This guideline is the product of the Low Back Pain Work Group of NASS’ Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. Results Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. Conclusions The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx

Following Kaplanian tradition, this chapter calls both pure indexicals like ‘I’ and demonstratives like ‘she’ and ‘that’ indexicals. Though these expressions all have uses in which they are used to talk about particular people and objects, as Nunberg (1993) pointed out, they also have uses in which they allow the sentences they occur in to convey claims that in some sense don’t seem to be about particular people and objects: 1. (uttered by Tracey to Glenn, who she just let in the door, explaining why she didn’t answer the door sooner) ‘You could have been a murderer!’ 2. (uttered pointing at the Pope) ‘He is usually Italian.’ 3. (uttered by a condemned prisoner) ‘I am traditionally allowed to order whatever I like for my last meal.’ This chapter gives an account of how these readings of 1–3 arise.

In cases of felicitous underspecification, instead of having a unique semantic value in context, the relevant expression is associated with a range of candidate semantic values in context. I formulate an account of the mechanism that associates this range of candidate semantic values in context with the relevant expression. I argue that it is the same mechanism that associates expressions with unique semantic values in context in “normal” cases.

It is arguable that the word ‘I’ has a context invariant meaning that suffices to secure semantic values for it in context. Set ‘I’ in a context and its context invariant meaning secures the speaker of the context as its semantic value in that context (at least if there is one). Consider the class of contextually sensitive expressions whose context invariant meanings arguably do ...

Some underspecified expressions are felicitous and some aren’t. To explain this, I formulate the notion of a context being appropriate for a sentence (LF). I show that if a sentence is felicitous in a context, that context is appropriate for the sentence.

I consider the results of embedding sentences containing felicitous underspecified expressions in certain environments. In particular, I consider embeddings under negation, and verbs of propositional attitude. These cases give rise to a new possibility for update. The update rule from Chapter 3 is shown to handle these embedded cases.

Many examples of felicitous underspecification are given. In each case, how conversational participants update the context in response to accepting a sentence containing an instance of felicitous underspecification is described.

Having given many examples of felicitous underspecification in the previous chapter and saying how we update the context in such cases, I provide an update rule that correctly predicts these updates. I also argue that the update rule has good intuitive backing. I consider a case in the literature discussed by Kai von Fintel and Anthony Gillies that superficially looks like a case of underspecification and argue that it isn’t. Finally, I argue that no existing update rule such as diagonalization makes correct predications about updating in cases of felicitous underspecification.

This book illustrates some of the current challenges and hazards experienced by military installations, and the content highlights activities at seven military installations to achieve increased resilience through natural infrastructure.

To deliver infrastructure that sustain our communities, economy, and environment, we must innovate, modernize, and even revolutionize our approach to infrastructure development. Change takes courage, but as one starts down the path of innovation, what was once novel becomes more familiar, more established. The U.S. Army Corps of Engineers (USACE) is walking this path with our partners through the Engineering With Nature (EWN) Initiative, integrating human engineering with natural systems. The International Guidelines on Natural and Nature-Based Features for Flood Risk Management are the next step toward revolutionary infrastructure development—a set of real-world guidelines to help familiarize us with what was once novel. USACE and collaborators around the world have been building, learning, and documenting the best practices for constructing Natural and Nature-Based Features (NNBF) for decades. The consolidation of these lessons into a single guidance document gives decision-makers and practitioners a much-needed resource to pursue, consider, and apply NNBF for flood risk management while expanding value through infrastructure. Relationships and partnerships are vital ingredients for innovation and progress. The NNBF Guidelines was achieved because of the strong relationships in the nature-based engineering community. The magnitude and diversity of contributors to the NNBF Guidelines have resulted in a robust resource that provides value beyond a single agency, sector, or nation. Similarly, the work of incorporating NNBF into projects will require us to strengthen our relationships across organizations, mandates, and missions to achieve resilient communities. I hope you are inspired by the collaborative achievement of the NNBF Guidelines and will draw from this resource to develop innovative solutions to current and future flood risk management challenges. There is a lot we can achieve together along the path of revolutionary infrastructure development.

A preliminary neutron reflector material selection and feasibility study of an inexpensive reflector replacement for the neutron beam-port at the 200 kW Missouri University of Science and Technology Research Reactor (MSTR) was conducted using Monte-Carlo techniques. The Monte-Carlo N-Particle transport code (MCNP6.1) was used to model the neutron beam-port of the Missouri S&T Reactor in order to study the effects of adding different reflector materials, in terms of the neutron flux reaching the radiography/tomography facility in front of MSTR’s neutron beam-port. Aluminum, beryllium, titanium, nickel, nickel-58, lead, bismuth, tungsten and stainless steel reflectors were modeled to find the best neutron reflector for the beam-port. After examining reflector materials, it was concluded that none of them were an improvement over the current design. Experimental thermal flux was measured to be 1.0 × 107 ± 3.16 × 103 cm−2 s−1 at the exit of beam port for current version of beam-port. The current ratio of beam port inlet and outlet obtained from simulations was found to be 3.37 × 104. The flux of beam port inlet was determined on the order of 1.0 × 1011 cm−2 s−1 which is consistent with previous findings.

The article of record as published may be found at http://dx.doi.org/10.2514/1.G003816 The agility of a rigid-body spacecraft can be expressed in terms of a geometric, three-dimensional, solid called the agilitoid. Originally developed as a means for explaining the concept of “hidden agility” made visible through the use of optimal control techniques, a modified agilitoid called an agility envelope is presented here that is compatible with conventional eigenaxis maneuvers. This paper demonstrates how the agility envelope can be applied to size an attitude control system (ACS) and/or assess the capability of an existing design. Analysis of the James Webb Space Telescope (JWST) ACS shows that the agility envelope accurately predicts the true capability of the ACS: a 90 deg maneuver can actually be completed 15% faster than the conventional back-of-the-envelope slew-sizing equations suggest. The utility of the agility envelope is further illustrated by showing how an alternative control allocation scheme can reduce the JWST torque and momentum requirements by 40%. The otherwise hidden agility can be recovered to enhance the slew performance of the JWST or allow the reaction wheel array to be reduced from six to five wheels, while meeting existing maneuver requirements. The agility envelope allows such design trades to be studied without the need to perform detailed simulations of the attitude control system.

Coastal Louisiana (USA) continues to sustain immense land and habitat losses due to subsidence, sea-level rise, and storm events. Approximately 65 million m3 (85 million cubic yards) of sediment is dredged annually from Gulf Coast federal navigation channels to maintain safe waterway passage. The beneficial use of these sediments continues to increase, and now this sediment is recognized as a critical resource in large-scale (estimated multibillion dollar) ecosystem restoration efforts to mitigate land and habitat losses along the US Gulf Coast. However, the documentation of restoration benefits where dredged sediments are the primary resource is lacking, which limits the potential for future applications. Therefore, this study documents the progress to restore marsh habitat and the resultant benefits in West Bay, Louisiana, and investigates how the restoration practices align with principles of the US Army Corps of Engineers (USACE) Engineering with Nature® (EWN®) and UN Sustainable Development Goals (UNSDGs). West Bay, a 4964-ha subdelta adjacent to the Mississippi River, typifies risks of coastal land loss that also threatens the integrity of the adjacent federal navigation channel. To help restore coastal marsh habitat on a large spatial and temporal scale, the USACE constructed an uncontrolled diversionary channel from the Mississippi River and with subsequent direct and strategic placement of dredged sediment. Restoration performance was assessed through remotely sensed methods using data spanning approximately 70 years. To date, placement of dredged sediment in the bay has facilitated the creation of over 800 ha of new land in the formerly open waters of West Bay. The West Bay restoration project aligns with the principles of the EWN initiative, which supports more sustainable practices to deliver economic, environmental, and social benefits through collaborative processes and meaningfully integrates 10 of the UN SDGs designed to achieve a better and more sustainable future. Integr Environ Assess Manag 2021;00:1-12. Published 2021. This article is a U.S. Government work and is in the public domain in the USA.

Many philosophers believe that there is a kind of thought about an object that is in some sense particularly directly about the object. The chapter will use the terms de re or singular thought for thoughts of this sort. It outlines a broadly Russellian approach to singular thought on which to have a singular thought about an object o is to have a thought whose content is a singular proposition having o as a constituent. It then explores some of the consequences of this view. It also critically discusses recent attempts by Francois Recanati and Robin Jeshion to explicate the notion of singular thought by means of the notion of a mental file.

A LEU-fueled space reactor would avoid the security concerns inherent with Highly Enriched Uranium (HEU) fuel and could be attractive to signatory countries of the Non-Proliferation Treaty (NPT) or commercial interests. The HEU-fueled Kilowatt Reactor Using Stirling Technology (KRUSTY) serves as a basis for a similar reactor fueled with LEU fuel. Based on MCNP6™ neutronics performance estimates, the size of a 5 kWe reactor fueled with 19.75 wt% enriched uranium-10 wt% molybdenum alloy fuel is adjusted to match the excess reactivity of KRUSTY. Then, zirconium hydride moderator is added to the core in four different configurations (a homogeneous fuel/moderator mixture and spherical, disc, and helical fuel geometries) to reduce the mass of uranium required to produce the same excess reactivity, decreasing the size of the reactor. The lowest mass reactor with a given moderator represents a balance between the reflector thickness and core diameter needed to maintain the multiplication factor equal to 1.035, with a H/D ratio of 1.81. All three heterogeneous geometries yield a minimum mass reactor using a moderator/fuel ratio of 80 wt%. The lifetime is directly proportional to the initial amount of fissile material in the core in all the cases. Based on the small differences in estimated masses, but large difference in estimated lifetimes between the 60 wt% and 80 wt% moderated reactors, the 60 wt% moderated systems with disc or helical fuel geometries represent the best balance between total mass and operating lifetime.

Nanoporous material-based sensors promise easier integration into portable devices. Here, we use a nanoporous layer (∼130 nm thick) fabricated on a cover glass as a planar waveguide and integrated sensing surface. A combination of custom-built planar waveguiding experiments and the Zemax ray tracing model confirmed that the nanoporous surface produced an increased in-plane waveguide signal output in backscattering mode. Also, by addition of a fluorophore (coumarin 6) on the surface, the nanoporous glass showed increased interactions between the dye and in-plane waveguided light, resulting in 4–6× higher emission. Utilizing the nanoporous glass as an integrated chemical and mechanical surface, we report a fluorescent planar waveguide-based oxygen sensor that is operational in backscattering mode. We showed an 11× improvement in the sensing signal upon using an appropriate filter and a ∼2× overall improvement for the nanoporous glass over plain glass in oxygen sensing. The Stern–Volmer (SV) plot confirmed a...

The ability to create nuclear weapons from 235U and 239Pu makes it imperative to closely account for these materials as they progress through a nuclear fuel cycle. Improved measurement syst...

SafeGuards Analysis (SGA) is a toolbox developed to allow engineers and scientists to create detailed simulations of safeguards material control and accountability simulations. SGA accepts material flow data from an external material flow model and can be used with any existing fuel cycle or material control code. This paper examines some new developments to the SGA code that allow the code to consider material losses over long time frames. The first scenario described in this paper examined an enrichment facility consisting of two material balance areas (MBAs). Cumulative sum and basic control chart tests were evaluated for a case involving a loss of material from both MBAs simultaneously and a case in which material is removed from the facility over a timescale of double the one that the tests were calibrated to detect. A second scenario represents an entire fuel cycle consisting of four MBAs and two materials of interest (low-enriched uranium and plutonium). This scenario evaluated the calibrat...

Cervical artery dissection (CAD) has been associated with spinal manipulative therapy (SMT). Although uncommonly reported, SMT-associated CADs hold devastating neurological consequences, warranting further exploration. We endeavored to investigate this association through the comparison of all CAD etiologies at a single academic medical center.A retrospective chart review was conducted of patients diagnosed with CAD or transferred to our institution for primary management of CAD during the 10-year period from 2010 to 2020 (n = 578). Patients were divided into SMT-associated (within 1 month of presentation), spontaneous, traumatic, and iatrogenic cohorts.SMT-associated dissections represented 23/578 (4%) of all dissections and 5.9% of vertebral artery dissections specifically. These patients were generally younger than those in the spontaneous (p = .004) and iatrogenic groups (p .001), and more often non-smokers or former smokers compared to the spontaneous (p = .009), traumatic (p = .001), and iatrogenic (p = .008) groups. Additionally, the SMT group had a higher mean low-density lipoprotein (LDL) than the spontaneous (p = .009) and traumatic (p = .003) types. SMT-associated CADs were more often vertebral and bilateral, compared to the spontaneous (p = .003; p .001), traumatic (p = .047; p = .004), and iatrogenic (p = .002; p = .002) groups. Outcomes including infarct (p = .112), medical treatment (p = .523), intervention (p = .47), and length of stay (p = .512) were similar between the SMT and spontaneous groups.In this unique study comparing SMT-associated CADs with other dissection etiologies, SMT-associated CADs were uncommon and not associated with worse clinical outcomes. However, SMT-associated CADs were more likely to be bilateral and affected the vertebral arteries in young, non-smoking patients with high LDL.

SafeGuards Analysis (SGA) is a computational toolbox able to simulate different safeguards scenarios across a number of different fuel cycles and at many different scales within the MATLAB Simulink framework. SGA functions by simulating Material Balance Areas (MBAs) under safeguards materials control and accountability and allows the user to define the uncertainty parameters of the associated flow and inventory measurements. The simulated safeguard system uses the uncertain measurement estimates to calculate a mass-balance across the MBA. This mass balance is then evaluated by one of a number of different statistical tests to determine if a significant amount of material has been removed from the MBA. This paper describes the design of SGA, the results of testing each element of the toolbox, and a number of single MBA example scenarios. In all of the test cases, SGA performed as expected and produced acceptable results from the single MBA scenario.

There is an increasing awareness, interest and acceptance of the biopsychosocial (BPS) model by all health care professionals involved with patient care. The areas of spine care and pain medicine are no exception, and in fact, these areas of health care are a major centerpiece of the movement from the traditional biomedical model to a BPS model of patient assessment and delivery of care. The chiropractic approach to health care has a history that is grounded in key aspects of the BPS model. The profession has inherently implemented certain features of the BPS model throughout its history, perhaps without a full understanding or realization. The purpose of this paper is to present an overview of the BPS model, its relationship with spine care and pain management, and to discuss the BPS model, particularly psychosocial aspects, in the context of its historical relationship with chiropractic. We will also provide recommendations for the chiropractic profession as it relates to successful adoption of a full integration of the BPS model.

To validate an MCNP5 model of the Missouri S&T Research Reactor (MSTR), temperature and void effects on reactivity experiments were simulated and performed. We compared the keff of the modeled reactor mirroring the position of all control rods to the actual critical reactor (keff = 1.00000). In the simulation we modeled three different scenarios. In the first two scenarios, the reactor is modeled as isothermal at two different temperatures (measured experimentally near the core), and in the third scenario, we split the core into bottom and top parts and used interpolated values for the temperatures of both halves. The model predicted keff’s for the “critical reactor” between 1.00234 and 1.00248 (±0.00018) when using as temperature the experimental thermocouple readings at the top of the core and keff’s between 1.00296 to 1.00383 (±0.00018) when using the temperature of thermocouple readings at the bottom of the core. In the third experiment, a linear vertical temperature profile was included in th...

The average nuclear power plant produces twenty metric tons of used nuclear fuel per year, containing approximately 95 wt% uranium, 1 wt% plutonium, and 4 wt% fission products and transuranic elements. Fast reactors are a preferred option for the transmutation of plutonium and minor actinides; however, an optimistic deployment time of at least 20 years indicates a need for a nearer-term solution. This study considers a method for plutonium and minor actinide transmutation in existing light water reactors and evaluates a variety of transmutation fuels to provide a common basis for comparison and to determine if any single target fuel provides superior transmutation properties. A model developed using the NEWT module in the SCALE 6.1 code package provided performance data for the burnup of the target fuel rods in the present study. The target fuels (MOX, PuO 2 , Pu 3 Si 2 , PuN, PuUZrH, PuZrH, PuZrHTh, and PuZrO 2 ) are evaluated over a 1400 Effective Full Power Days (EFPD) interval to ensure each assembly remained critical over the entire burnup period. The MOX (5 wt% PuO 2 ), Pu 0.31 ZrH 1.6 Th 1.08 , and PuZrO 2 MgO (8 wt% Pu) fuels result in the highest rate of plutonium transmutation with the lowest rate of curium-244 production. This study selected eleven different burnable absorbers (B 4 C, CdO, Dy 2 O 3 , Er 2 O 3 , Eu 2 O 3 , Gd 2 O 3 , HfO 2 , In 2 O 3 , Lu 2 O 3 , Sm 2 O 3 , and TaC) for evaluation as spectral shift absorber coatings on the outside of the fuel pellets to determine if an absorber coating can improve the transmutation properties of the target fuels. The PuZrO 2 MgO (8 wt% Pu) target fuel with a coating of Lu 2 O 3 resulted in the highest rate of plutonium transmutation with the greatest reduction in curium-244 production.