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Summary Massive power failures are induced frequently by natural disasters. A fundamental challenge is how recovery can be resilient to the increasing severity of disruptions in a changing climate. We conduct a large-scale study on recovery from 169 failure events at two operational distribution grids in the states of New York and Massachusetts. Guided by unsupervised learning from non-stationary data, our analysis finds that under the widely adopted prioritization policy favoring large failures, recovery exhibits a scaling property where a majority ( ∼ 90%) of customers recovers in a small fraction ( ∼ 10%) of total downtime. However, recovery degrades with the severity of disruptions: large failures that cannot recover rapidly increase by ∼ 30% from the moderate to extreme events. Prolonged small failures dominate entire recovery processes. Further, our analysis demonstrates the promise of mitigating the degradation by enhancing recovery of a small fraction of large failures through distributed generation and storage.

Plasma-facing materials in future large-scale fusion reactors must be designed to withstand high heat fluxes from extreme off-normal events such as edge localized modes and unmitigated plasma disruptions. The erosion rates of possible tungsten-alternative materials are tested under high heat flux conditions at the DIII-D National Fusion Facility. High-purity β-3C CVD silicon carbide was exposed alongside MAX phase ceramic Ti3SiC2 to both L- and H-mode plasma discharges in the DIII-D divertor. Samples survived average heat fluxes ranging from 2–10 MW/m2 over 16 s. A new micro-trench erosion measurement technique was successfully implemented and measured Ti3SiC2 and SiC erosion rates of 0–9 nm/s and 27–73 nm/s, respectively. Additionally, average ion impact angle estimates for an incident B-field angle of ∼1.5° from surface parallel were made using micro-trench impact patterns. Measurements ranged from θ = 24o–34o with respect to Bt and ϕ = 51.5o–55o below the surface normal.

Silicon carbide (SiC) represents a promising but largely untested plasma-facing material (PFM) for next-step fusion devices. In this work, an analytic mixed-material erosion model is developed by calculating the physical (via SDTrimSP) and chemical (via empirical scalings) sputtering yield from SiC, Si, and C. The Si content in the near-surface SiC layer is predicted to increase during D plasma bombardment due to more efficient physical and chemical sputtering of C relative to Si. Silicon erosion from SiC thereby occurs primarily from sputtering of the enriched Si layer, rather than directly from the SiC itself. SiC coatings on ATJ graphite, manufactured via chemical vapor deposition, were exposed to repeated H-mode plasma discharges in the DIII-D tokamak to test this model. The qualitative trends from analytic modeling are reproduced by the experimental measurements, obtained via spectroscopic inference using the S/XB method. Quantitatively the model slightly under-predicts measured erosion rates, which is attributed to uncertainties in the ion impact angle distribution, as well as the effect of edge-localized modes. After exposure, minimal changes to the macroscopic or microscopic surface morphology of the SiC coatings were observed. Compositional analysis reveals Si enrichment of about 10%, in line with expectations from the erosion model. Extrapolating to a DEMO-type device, an order-of-magnitude decrease in impurity sourcing, and up to a factor of 2 decrease in impurity radiation, is expected with SiC walls, relative to graphite, if low C plasma impurity content can be achieved. These favorable erosion properties motivate further investigations of SiC as a low-Z, non-metallic PFM., 17 pages, 15 figures

New studies identify the critical parameters and physics governing disruptive neoclassical tearing mode (NTM) onset. An m/n = 2/1 mode in DIII-D that begins to grow robustly after a seeding event (edge localized mode ELM or sawtooth precursor and crash) causes the mode rotation to drop close to the plasma’s E r = 0 rest frame; this condition opens the stabilizing ion-polarization current ‘gate’ and destabilizes an otherwise marginally stable NTM. Our new experimental and theoretical insights and novel toroidal theory-based modeling are benchmarked and scalable to ITER and other future experiments. The nominal ITER rotation at q = 2 is found to be stabilizing (‘gate closed’) except for MHD-induced transients that could ‘open the gate’. Extrapolating from the DIII-D ITER baseline scenario (IBS) discharges, MHD transients are much more likely to destabilize problematic robustly growing 2/1 NTMs in ITER; this makes predictions of seeding and control of both ELMs and sawteeth imperative for more than just minimizing divertor pulsed-heat loading.

We provide the first explicit example of a universal Hilbert set${\Ncal S}$having asymptotic density 1 in the set of integers. More precisely, the number of integersnotin${\Ncal S}$with absolute value ≤Xis bounded byX/(logX)δ, where δ = 1 − (1 + loglog 2)/(log 2) = 0.086071. . ..

Edge localized modes (ELMs) are triggered using deuterium pellets injected into plasmas with ITER-relevant low collisionality pedestals, and the resulting peak ELM energy fluence is reduced by approximately 25%–50% relative to natural ELMs destabilized at similar pedestal pressures. Cryogenically frozen deuterium pellets are injected from the low-field side of the DIII-D tokamak at frequencies lower than the natural ELM frequency, and heat flux is measured by infrared cameras. Ideal MHD pedestal stability calculations show that without pellet injection, these low collisionality pedestals were limited by their current density (peeling-limited) rather than their pressure gradient (ballooning-limited). ELM triggering success correlates strongly with pellet mass, consistent with the theory that a large pressure perturbation is required to trigger an ELM in low collisionality discharges that are far from the ballooning stability boundary. For sufficiently large pellets, both instantaneous and time-integrated ELM energy deposition measured by infrared cameras is reduced with respect to naturally occurring ELMs at the inner strike point, which is the position where it is largest for natural ELMs. Energy fluence at the outer strike point is less effected. Cameras observing both heat flux and D-alpha emission often find significant toroidally asymmetric striations in the outboard far scrape-off layer resulting from ELMs that are triggered by pellets. Toroidal asymmetries at the inner strike point are similar between natural and pellet-triggered ELMs, suggesting that the reduction in peak heat flux and total fluence at that location is robust for the conditions reported here.

3D nonlinear, as well as 2D linear M3D-C1 simulations are used to model ELM triggering by small pellets in DIII-D discharges in the ITER relevant, peeling-limited pedestal stability regime. A critical pellet size threshold is found in both experiment and modeling depending on pedestal conditions, pellet velocity and injection direction. Using radial injection at the outboard midplane, the threshold is determined by M3D-C1 for multiple time slices of a DIII-D low-collisionality discharge that has pellet ELM triggering. Experimental observations show that a larger pellet size than the standard 1.3 mm diameter is necessary for ELM triggering; 1.8 mm pellets triggered several ELMs in cases where a smaller pellet failed. The M3D-C1 simulations are in good agreement with these observations. While the 2D linear simulations give insight into the change of growth rates for various toroidal modes with pellet size, the 3D nonlinear simulations apply a pellet ablation model that mimics the actual injection with good match to the experiment. The 3D nonlinear simulation confirms the pellet ELM triggering for a pellet size larger than the threshold found by the linear simulations.

The contributions of deuterium molecular emission to the total deuterium radiation was assessed in DIII-D ohmically-confined plasmas in high-recycling divertor conditions. Radial profiles of the deuterium Ly-α line intensity across the low-field side divertor leg were obtained with the recently installed divertor Survey Poor Resolution, Extended Spectrometer [1]. A high-resolution spectrometer was used to measure the poloidal profiles of the deuterium Balmer-α and the deuterium Fulcher-α band intensity in the visible wavelength range. The scrape-off layer plasma and neutral distributions were simulated using the edge fluid EDGE2D-EIRENE [2], and the numerical solutions constrained utilizing Thomson scattering and Langmuir probe measurements at the low-field side midplane and the divertor target plate. The studies show that for these conditions molecular emission plays a negligible role in the total radiative power balance of the low-field side divertor, but molecular processes are important when evaluating deuterium Balmer-α line intensity for code-experiment validation. Keywords: Deuterium atomic and molecular emission, Lyman-Werner and Fulcher band, DIII-D, Divertor edge fluid simulations, EDGE2D-EIRENE, EIRENE

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Coherence Imaging Spectroscopy (CIS) has emerged as a powerful tool for investigating complex ion phenomena in the boundary of magnetically confined plasma devices. The combination of Fourier-transform interferometry and high-resolution fast-framing cameras has made it possible to make sensitive velocity measurements that are also spatially resolved. However, this sensitivity makes the diagnostic vulnerable to environmental effects including thermal drifts, vibration, and magnetic fields that can influence the velocity measurement. Additionally, the ability to provide an absolute calibration for these geometries can be impacted by differences in the light-collection geometry between the plasma and reference light source, spectral impurities, and the presence of thin-films on in-vessel optics. This paper discusses the mitigation of these effects and demonstration that environmental effects result in less than 0.5 km/s error on the DIII-D CIS systems. A diagnostic comparison is used to demonstrate agreement between CIS and traditional spectroscopy once tomographic artifacts are accounted for.

Fast, accurate three dimensional reconstructions of plasma equilibria, crucial for physics interpretation of fusion data generated within confinement devices like stellarators/ tokamaks, are computationally very expensive and routinely require days, even weeks, to complete using serial approaches. Here, we present a parallel implementation of the three dimensional plasma reconstruction code, V3FIT. A formal analysis to identify the performance bottlenecks and scalability limits of this new parallel implementation, which combines both task and data parallelism, is presented. The theoretical findings are supported by empirical performance results on several thousands of processor cores of a Cray XC30 supercomputer. Parallel V3FIT is shown to deliver over 40X speedup, enabling fusion scientists to carry out three dimensional plasma equilibrium reconstructions at unprecedented scales in only a few hours (instead of in days/weeks) for the first time.

Large, spontaneous m/n = 1/1 helical cores are predicted in tokamaks with extended regions of low- or reversed-magnetic shear profiles in a region within the q = 1 surface and an onset condition determined by constant (dp/dρ)/Bt2 along the threshold. These 3D modes occurred frequently in Alcator C-Mod during ramp-up when slow current penetration results in a reversed shear q-profile. The onset and early development of a helical core in C-Mod were simulated using a new 3D time-dependent equilibrium reconstruction, based on the ideal MHD equilibrium code VMEC. The reconstruction used the experimental density, temperature, and soft-X-ray fluctuations. The pressure profile can become hollow due to an inverted, hollow electron temperature profile caused by molybdenum radiation in the plasma core during the current ramp-up phase before the onset of sawteeth, which may also occur in ITER with tungsten. Based on modeling, it is found that a reverse shear q-profile combined with a hollow pressure profile reduces the onset condition threshold, enabling helical core formation from an otherwise axisymmetric equilibrium.Large, spontaneous m/n = 1/1 helical cores are predicted in tokamaks with extended regions of low- or reversed-magnetic shear profiles in a region within the q = 1 surface and an onset condition determined by constant (dp/dρ)/Bt2 along the threshold. These 3D modes occurred frequently in Alcator C-Mod during ramp-up when slow current penetration results in a reversed shear q-profile. The onset and early development of a helical core in C-Mod were simulated using a new 3D time-dependent equilibrium reconstruction, based on the ideal MHD equilibrium code VMEC. The reconstruction used the experimental density, temperature, and soft-X-ray fluctuations. The pressure profile can become hollow due to an inverted, hollow electron temperature profile caused by molybdenum radiation in the plasma core during the current ramp-up phase before the onset of sawteeth, which may also occur in ITER with tungsten. Based on modeling, it is found that a reverse shear q-profile combined with a hollow pressure profile reduces ...

It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI).Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients ≥75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital. Emergency coronary angiography was performed if fibrinolysis failed; otherwise, angiography was performed 6 to 24 hours after randomization. The primary end point was a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary end point occurred in 116 of 939 patients (12.4%) in the fibrinolysis group and in 135 of 943 patients (14.3%) in the primary PCI group (relative risk in the fibrinolysis group, 0.86; 95% confidence interval, 0.68 to 1.09; P=0.21). Emergency angiography was required in 36.3% of patients in the fibrinolysis group, whereas the remainder of patients underwent angiography at a median of 17 hours after randomization. More intracranial hemorrhages occurred in the fibrinolysis group than in the primary PCI group (1.0% vs. 0.2%, P=0.04; after protocol amendment, 0.5% vs. 0.3%, P=0.45). The rates of nonintracranial bleeding were similar in the two groups.Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.).

The ability to sustain magnetically confined plasma in a state of stable equilibrium is crucial for optimal and cost-effective operations of fusion devices like tokamaks and stellarators. The Variational Moments Equilibrium Code (VMEC) is the de-facto serial application used by fusion scientists to compute magnetohydrodynamics (MHD) equilibria and study the physics of three dimensional plasmas in confined configurations. Modern fusion energy experiments have larger system scales with more interactive experimental workflows, both demanding faster analysis turnaround times on computational workloads that are stressing the capabilities of sequential VMEC. In this paper, we present PARVMEC, an efficient, parallel version of its sequential counterpart, capable of scaling to thousands of processors on distributed memory machines. PARVMEC is a non-linear code, with multiple numerical physics modules, each with its own computational complexity. A detailed speedup analysis supported by scaling results on 1,024 cores of a Cray XC30 supercomputer is presented. Depending on the mode of PARVMEC execution, speedup improvements of one to two orders of magnitude are reported. PARVMEC equips fusion scientists for the first time with a state-of-the-art capability for rapid, high fidelity analyses of magnetically confined plasmas at unprecedented scales.

Severe weather events frequently result in large-scale power failures, affecting millions of people for extended durations. However, the lack of comprehensive, detailed failure and recovery data has impeded large-scale resilience studies. Here, we analyse data from four major service regions representing Upstate New York during Super Storm Sandy and daily operations. Using non-stationary spatiotemporal random processes that relate infrastructural failures to recoveries and cost, our data analysis shows that local power failures have a disproportionally large non-local impact on people (that is, the top 20% of failures interrupted 84% of services to customers). A large number (89%) of small failures, represented by the bottom 34% of customers and commonplace devices, resulted in 56% of the total cost of 28 million customer interruption hours. Our study shows that extreme weather does not cause, but rather exacerbates, existing vulnerabilities, which are obscured in daily operations. Power grids often fail during extreme weather events such as hurricanes, leaving millions of customers without electricity. A large-scale analysis of the operation of power grids in an extended geographical area now reveals that such events exacerbate vulnerabilities that are obscured during normal operation.

New evidence indicates that there is significant 3D variation in density fluctuations near the boundary of weakly 3D tokamak plasmas when resonant magnetic perturbations are applied to suppress transient edge instabilities. The increase in fluctuations is concomitant with an increase in the measured density gradient, suggesting that this toroidally localized gradient increase could be a mechanism for turbulence destabilization in localized flux tubes. Two-fluid magnetohydrodynamic simulations find that, although changes to the magnetic field topology are small, there is a significant 3D variation of the density gradient within the flux surfaces that is extended along field lines. This modeling agrees qualitatively with the measurements. The observed gradient and fluctuation asymmetries are proposed as a mechanism by which global profile gradients in the pedestal could be relaxed due to a local change in the 3D equilibrium. These processes may play an important role in pedestal and scrape-off layer transport in ITER and other future tokamak devices with small applied 3D fields.

Intense Langmuir-probe measurements were carried out in the toroidal low-temperature plasma of the torsatron TJ-K in order to investigate the origin and dynamics of intermittent transport events, so-called blobs, at the transition from closed to open field lines. The statistical properties of the fluctuations at the plasma boundary agree with observations made in fusion edge plasmas. Blobs were found to be generated locally through a change in turbulence drive across the separatrix. The non-linear spectral energy transfer from small-scale fluctuations into large-scale flows was measured with a 128-probe array. The results point to the transfer being a key loss channel for turbulence energy leading to a reduction in turbulent transport. Earlier observations [M.A. Pedrosa et al., Phys. Rev. Lett. 100, 215003 (2008)] of enhanced long-range correlations in the plasma potential through externally induced shear flows in TJ-II stellarator were verified. The newly measured correlation of zonal vorticity and Reynolds stress at induced flow shear indicates an enhancement of zonal-flow drive (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Small 3D perturbations to the magnetic field in DIII-D ( δB/B∼2×10−4) result in large modulations of density fluctuation amplitudes in the pedestal, which are shown using Doppler backscattering measurements to vary by a factor of 2. Helical perturbations of equilibrium density within flux surfaces have previously been observed in the pedestal of DIII-D plasmas when 3D fields are applied and were correlated with density fluctuation asymmetries in the pedestal. These intra-surface density and pressure variations are shown through two fluid MHD modeling studies using the M3D-C1 code to be due to the misalignment of the density and temperature equilibrium iso-surfaces in the pedestal region. This modeling demonstrates that the phase shift between the two iso-surfaces corresponds to the diamagnetic direction of the two species, with the mass density surfaces shifted in the ion diamagnetic direction relative to the temperature and magnetic flux iso-surfaces. The resulting pedestal density, potential, and turbulence asymmetries within flux surfaces near the separatrix may be at least partially responsible for several poorly understood phenomena that occur with the application of 3D fields in tokamaks, including density pump out and the increase in power required to transition from L- to H-mode.Small 3D perturbations to the magnetic field in DIII-D ( δB/B∼2×10−4) result in large modulations of density fluctuation amplitudes in the pedestal, which are shown using Doppler backscattering measurements to vary by a factor of 2. Helical perturbations of equilibrium density within flux surfaces have previously been observed in the pedestal of DIII-D plasmas when 3D fields are applied and were correlated with density fluctuation asymmetries in the pedestal. These intra-surface density and pressure variations are shown through two fluid MHD modeling studies using the M3D-C1 code to be due to the misalignment of the density and temperature equilibrium iso-surfaces in the pedestal region. This modeling demonstrates that the phase shift between the two iso-surfaces corresponds to the diamagnetic direction of the two species, with the mass density surfaces shifted in the ion diamagnetic direction relative to the temperature and magnetic flux iso-surfaces. The resulting pedestal density, potential, and turbul...

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.

Recent experimental observations have found turbulent fluctuation structures that are non-axisymmetric in a tokamak with applied 3D fields. In this paper, two fluid resistive effects are shown to produce changes relevant to turbulent transport in the modeled 3D magnetohydrodynamic (MHD) equilibrium of tokamak pedestals with these 3D fields applied. Ideal MHD models are insufficient to reproduce the relevant effects. By calculating the ideal 3D equilibrium using the VMEC code, the geometric shaping parameters that determine linear turbulence stability, including the normal curvature and local magnetic shear, are shown to be only weakly modified by applied 3D fields in the DIII-D tokamak. These ideal MHD effects are therefore not sufficient to explain the observed changes to fluctuations and transport. Using the M3D-C1 code to model the 3D equilibrium, density is shown to be redistributed on flux surfaces in the pedestal when resistive two fluid effects are included, while islands are screened by rotation in this region. The redistribution of density results in density and pressure gradient scale lengths that vary within pedestal flux surfaces between different helically localized flux tubes. This would produce different drive terms for trapped electron mode and kinetic ballooning mode turbulence, the latter of which is expected to be the limiting factor for pedestal pressure gradients in DIII-D.

This paper presents the first fully 3-dimensional (3D) equilibrium reconstruction of a helical core in a tokamak device. Using a new parallel implementation of the Variational Moments Equilibrium Code (PARVMEC) coupled to V3FIT, 3D reconstructions can be performed at resolutions necessary to produce helical states in nominally axisymmetric tokamak equilibria. In a flux pumping experiment performed on DIII-D, an external n = 1 field was applied while a 3/2 neoclassical tearing mode was suppressed using ECCD. The externally applied field was rotated past a set of fixed diagnostics at a 20 Hz frequency. The modulation, observed to be strongest in the core SXR and MSE channels, indicates a localized rotating 3D structure locked in phase with the applied field. Signals from multiple time slices are converted to a virtual rotation of modeled diagnostics adding 3D signal information. Starting from an axisymmetric equilibrium reconstruction solution, the reconstructed broader current profile flattens the q-profile, resulting in an m = 1, n = 1 perturbation of the magnetic axis that is similar to 50x larger than the applied n = 1 deformation of the edge. Error propagation confirms that the displacement of the axis is much larger than the uncertainty in the axis position validating the helical equilibrium.

Background— In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Methods and Results— Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients ( P =0.49; risk ratio, 1.13; 95% confidence interval, 0.79–1.62). Cardiac mortality rates were similar as well (4.0% versus 4.1%, P =0.93; risk ratio, 0.98; 95% confidence interval, 0.62–1.54). Overall, only 34 patients died between day 30 and 1 year, 20 in the PI arm and 14 in the pPCI arm, of whom 20 died of noncardiac reasons (13 in the PI and 7 in the pPCI arm). There was no significant difference in 1-year all-cause mortality between the 2 groups among the prespecified key subgroups. Conclusions— At 1 year, mortality rates in the PI and pPCI arms were similar in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset and unable to undergo pPCI within 1 hour. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00623623.

A technique for tokamak equilibrium reconstructions is used for multiple DIII-D discharges, including L-mode and H-mode cases when weakly 3D fields ( δ B / B ∼ 10 − 3 ) are applied. The technique couples diagnostics to the non-linear, ideal MHD equilibrium solver VMEC, using the V3FIT code, to find the most likely 3D equilibrium based on a suite of measurements. It is demonstrated that V3FIT can be used to find non-linear 3D equilibria that are consistent with experimental measurements of the plasma response to very weak 3D perturbations, as well as with 2D profile measurements. Observations at DIII-D show that plasma rotation larger than 20 krad s−1 changes the relative phase between the applied 3D fields and the measured plasma response. Discharges with low averaged rotation (10 krad s−1) and peaked rotation profiles (40 krad s−1) are reconstructed. Similarities and differences to forward modeled VMEC equilibria, which do not include rotational effects, are shown. Toroidal phase shifts of up to 30 ° are found between the measured and forward modeled plasma responses at the highest values of rotation. The plasma response phases of reconstructed equilibra on the other hand match the measured ones. This is the first time V3FIT has been used to reconstruct weakly 3D tokamak equilibria.

Using multi-tipped Langmuir probes in the edge of the HSX stellarator, the radial electric field and parallel flows are found to deviate from the values calculated by the neoclassical transport code PENTA for the optimized quasi-helically symmetric (QHS) configuration. To understand whether Reynolds stress might explain the discrepancy, fluctuating floating potential measurements are made at two locations in the torus corresponding to the low field and high field sides of the device. The measurements at the two locations show clear evidence of a gradient in the Reynolds stress. However, the resulting flow due to the gradient in the stress is found to be large and in opposite directions for the two locations. This makes an estimation of the flux surface average using a small number of measurement locations impractical from an experimental perspective. These results neither confirm nor rule out whether Reynolds stress plays an important role for the QHS configuration. Measurements made in configurations with the quasi-symmetry degraded show even larger flows and greater deviations from the neoclassically calculated velocity profiles than the QHS configuration while the fluctuation magnitudes are reduced. Therefore, for these configurations in particular, the Reynolds stress is most likely not responsible for the additional momentum.

One of the most important aspects of the recent mass migrations of Latin Americans into previously remote regions of the hemisphere is the impact these have had on areas cut by international boundaries. With the exception of the United States-Mexico border, however, historical examination of the process is still in its infancy. And few observers have developed a satisfactory theoretical basis explaining an admittedly complex process.One exception was Cuban historian Jorge Mañach, who spoke of “balanced” and “unbalanced” frontiers, largely in the context of the United States-Mexican boundary. He believed that power distribution between nations determined the degree to which their frontier interrelationships were equal or unequal. In Mañach's view, when a politically or economically weaker nation shares a boundary with one that is stronger, overall communication is sacrificed and the stronger power inevitably “spills over” into the neighboring region, economically and culturally.

Background: Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-elevation myocardial infarction (STEMI) provided it is performed in a timely fashion at an expert 24/7 facility. Fibrinolysis is a well-accepted alternative, especially in patients presenting early after symptom onset. The STREAM study will provide novel information on whether prompt fibrinolysis at first medical contact, followed by timely catheterization or rescue coronary intervention in STEMI patients presenting within 3 hours of symptom onset, represents an appropriate alternative strategy to primary PCI. Methods: Acute STEMI patients presenting early after symptom onset are eligible if PCI is not feasible within 60 minutes of first medical contact. This is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. Patients are randomized to fibrinolysis combined with enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6 to 24 hours or rescue coronary intervention if reperfusion fails within 90 minutes of fibrinolysis versus PCI performed according to local guidelines. Composite efficacy end points at 30 days include death, shock, heart failure, and reinfarction. Safety end points include ischemic stroke, intracranial hemorrhage, and major nonintracranial bleeding. Follow-up is extended to 1 year and includes all-cause mortality. Discussion: Continuing delays in achieving timely PCI remain a difficult issue. Many patients fail to achieve the desired reperfusion times of 90 to 120 minutes after first medical contact. The STREAM results will provide useful additional data on which to base informed therapeutic decisions. © 2010, Mosby, Inc. All rights reserved.

Experimental febrile seizures can be evoked in epileptic chicks by elevation of their body temperature. Both competitive N-methyl-D-aspartate (NMDA) receptor antagonists [(3-(±)2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP), DL-2-amino-7-phosphosphonoheptanoic acid (APH), DL-2-amino-5-phosphonovaleric acid (APV), D-α-aminoadipic acid (AAA), and DL-α,ε-diaminopimelic acid (DAP)] and the noncompetitive NMDA antagonist (+)-5-methyl-10,11-dihydro-5H-dibenzo [a,d] cyclohepten-5,10-imine maleate (MK-801) produced dose-dependent increases in latency to the onset of seizures. Of the drugs tested, MK-801 had the highest potency followed in order by CPP = APH > APV [Formula: see text] AAA > DAP. There was a high correlation (r = 0.995) between the dose capable of doubling seizure latency and the affinity of the competitive NMDA antagonists for the NMDA receptor as determined by in vitro binding assays. These data suggest that NMDA receptor mediated mechanisms may be involved in the production of seizures in response to hyperthermia.Key words: seizures, NMDA antagonists, epileptic chickens, anticonvulsant activity, receptors.

The objective of this study was to confirm that the efficacy and safety of percutaneous coronary intervention (PCI) in diabetic patients are not compromised by a bivalirudin-based antithrombotic strategy.Previous studies have shown a survival benefit with use of platelet glycoprotein (GP) IIb/IIIa inhibitors in diabetic patients undergoing PCI. The Randomized Evaluation in Percutaneous Coronary Intervention Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial showed the non-inferiority of a strategy of bivalirudin with provisional GP IIb/IIIa inhibition compared with routine GP IIb/IIIa inhibition. The relative efficacy of these two strategies in diabetic patients has not been studied.We evaluated the diabetic patients enrolled in the REPLACE-2 trial to assess the impact of these antithrombotic strategies on the short- and long-term outcome after PCI.The REPLACE-2 trial enrolled 1,624 diabetic patients and 4,368 non-diabetic patients. Compared with non-diabetic patients, diabetic patients had similar short-term outcome but higher mortality at 1 year (3.06% vs. 1.85%, p = 0.004). There was no difference in short-term or long-term ischemic events among the diabetic patients randomized to the two arms. Specifically, the 1-year mortality rate was non-significantly lower in the bivalirudin arm, suggesting no differential survival impact of the two strategies (2.3% vs. 3.9%). There was less minor bleeding in the bivalirudin arm in diabetic patients (12.6% vs. 24.4%, p0.001), whereas no difference was seen in the incidence of major bleeding (3.0% vs. 3.3%, p = 0.69).Compared with routine GP IIb/IIIa inhibition, the use of bivalirudin with provisional GP IIb/IIIa inhibitors in diabetic patients is associated with no differences in clinical outcomes at 30 days, a trend toward lesser mortality at 1 year, and a reduction in minor bleeding.

We studied the outcome of diabetics enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) V trial to assess whether the combination of half-dose reteplase and abciximab provides any propitious benefits over standard fibrinolytic therapy in diabetic patients.Diabetics with acute ST-segment elevation myocardial infarction (MI) have a worse outcome compared with nondiabetics. Higher-risk patients are usually more likely to benefit from advances in medical therapy.We analyzed diabetic patients enrolled in the GUSTO V trial to assess the outcome of those randomized to the combination of half-dose reteplase and abciximab versus those randomized to reteplase. We also evaluated whether any differences existed in presentation and outcome of MI among the diabetics versus the nondiabetics enrolled in the study.The trial enrolled 13782 nondiabetics and 2633 diabetics. Compared to nondiabetics, diabetics had a significantly higher mortality at 30 days (8.5% vs. 5.1%, p0.001) and at 1 year (12.7% vs. 7.5%, p0.001). Among the diabetic subset, no significant difference existed in the incidence of 30-day (8.8% vs. 8.2%, p = 0.52) or 1-year mortality (13.0% vs. 12.4%, p = 0.62) among patients randomized to reteplase compared to those receiving combination of abciximab and reteplase. The incidence of reinfarction (2.5% vs. 4.3%, p = 0.013), recurrent ischemia (11.8% vs. 14.9%, p = 0.017), and urgent revascularization (10.9% vs. 13.3%, p = 0.055) at seven days was lower in diabetics treated with the combination therapy.Compared to nondiabetics, diabetics continue to have a worse outcome with MI. Although combination therapy did not provide a survival benefit, nonfatal ischemic outcomes, including reinfarction, recurrent ischemia, and urgent revascularization, were substantially reduced.