Pulsed power generators create high-energy-density conditions by rapidly delivering an immense pulse of electrical current to a compact imploding load. Accurately measuring the shape and amplitude of ...this load current pulse is essential to understanding the behavior of all pulsed power experiments. At the Z Pulsed Power Facility, the closest-in load current measurements are provided by velocimetry techniques such as VISAR (velocity interferometer system for any reflector) and PDV (photonic Doppler velocimetry). Here, fiber-coupled interferometers measure the velocity history of an exploding metallic flyer plate that is embedded in the vertical walls of the current return can. The flyer plate is driven outward by the magnetic pressure from the load current such that magnetohydrodynamic modeling can be used to determine the load current waveform from the measured velocity history. In this paper, we present the first load current velocimetry measurements to be made from the horizontal top flyer plate that carries current radially inward from the return can to the load. These spatially resolved measurements, which span R=5–9 mm, are enabled by a transformative new velocimetry diagnostic—a line-imaging velocity interferometer called Z Line VISAR (ZLV)—whose optical performance overcomes the measurement challenges presented by the steep velocity gradients encountered on the top flyer plate. To validate ZLV’s capabilities, a 14-MA, 100-ns experiment was conducted to losslessly couple current up the return can and radially inward across the top flyer plate. Comparisons between the ZLV data obtained from this experiment and two-dimensional magnetohydrodynamic simulations driven with the current measured on the return can indicate that the current delivery across the top flyer plate is indeed lossless to within the few-percent uncertainty of the ZLV data. Given that the current coupling is lossless, the experimental results are used to demonstrate that one-dimensional current unfold techniques can be applied to generate a radially resolved load current map from the ZLV velocity data. This analysis provides a template for how to use the ZLV diagnostic to determine the efficacy of current delivery in future experiments where losses may occur in close proximity to the load.
To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19.
On October 26, 2022, a systematic ...search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization.
Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio OR, 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82).
During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians.
AHOD commenced ...enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods.
Forty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related.
As far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population.
One hundred patients with acne vulgaris applied adapalene (Differin®) 0·1% gel to one side of their face and tretinoin 0·025% cream to the other once a day for 4 weeks; the side of application was ...determined by randomization code. Patient tolerance (assessed as the side of the face least irritated by drug application) was recorded weekly and patient preference (assessed as the preparation more easily spread, absorbed more quickly, smelled better, felt best on the skin and least greasy to the feel) at completion of the study. The investigator measured skin irritation weekly, scoring erythema, skin dryness, desquamation and burning/stinging on a 10‐point scale.
After each week of treatment, 64–68% of patients found adapalene 0·1% gel more tolerable than tretinoin 0·025% cream (P < 0·05). At study completion, 65% of patients preferred adapalene 0·1% gel over tretinoin 0·025% cream (P = 0·003). An overall assessment showed adapalene 0·1% gel was significantly less irritating to the skin in terms of producing erythema, dryness, desquamation and burning/stinging, at Visits 2, 3 and 4 (P < 0·02).
Thirty‐two patients experienced mild to moderately severe adverse events; three had adverse events considered to be drug related (two with skin discomfort; one with skin dryness). One patient stopped using the study drugs because of dry skin.
This study showed that a majority of patients preferred adapalene 0·1% gel over tretinoin 0·025% cream and that it caused significantly less skin irritation.
Abstract 217
HCT is used with curative intent in children with cancer at risk for relapse. Improvements in transplantation strategies have contributed to increments in survival approximating 10% per ...decade. Adult HCT survivors are at increased risk for chronic health conditions (Sun, Blood 2010). The magnitude of risk of these conditions in childhood HCT survivors compared with the general population is not defined. Furthermore, while children treated with conventional therapy carry a substantial burden of morbidity (Oeffinger, N Engl J Med 2006), little data exists regarding the added impact of HCT-related conditioning and GvHD on the prevalence of chronic health conditions and functional status.
Participants were drawn from two studies: BMTSS and CCSS. BMTSS examined long-term outcomes in individuals undergoing HCT between 1976 and 1998 at City of Hope or University of Minnesota. Participants were ≤21 years of age at diagnosis of AML, ALL, HL, and NHL, had survived at least 5 yrs from primary diagnosis and 2 yrs from myeloablative HCT. CCSS is a multi-institutional cohort of five-year survivors of childhood cancer diagnosed between 1970 and 1986, and their siblings. For the current study, participation was limited to those treated conventionally with the same diagnoses as BMTSS. Participants for both studies had completed a questionnaire covering the following areas: presence of physical health conditions (endocrinopathies; central nervous system compromise; cardiopulmonary dysfunction; gastrointestinal sequelae; musculoskeletal abnormalities; and subsequent malignancies); chronic GvHD (BMTSS); and sociodemographics. Responses obtained from BMTSS were compared to conventionally treated childhood cancer survivors and sibling controls enrolled in CCSS. Chronic physical health conditions were graded using CTCAE v 3.0 (grade 1–4, ranging from mild to life-threatening/ disabling). Relative risk regression was used to identify risk of health conditions (RR) and 95% confidence interval (CI).
The current study included 145 BMTSS participants, 4,020 siblings, and 7,207 CCSS cancer survivors. Median age at participation – BMTSS: 24 yrs; childhood cancer survivors: 24.6 yrs; siblings: 26.6; time from diagnosis – BMTSS: 11.9 yrs; CCSS: 15.6 yrs. 79.3% of BMTSS participants reported at least one condition (grades 1–4); 59.3% multiple (≥2); and 25.5% severe or life-threatening conditions (grade 3–4). Prevalence and severity of these conditions was significantly greater for BMTSS when compared with cancer survivors or siblings (Figure). BMTSS vs. Siblings: After adjustment for age at questionnaire, gender, and ethnicity, BMTSS participants were significantly more likely than sibling controls to report chronic health conditions: grades 1–4: RR=2.7 (95% CI, 2.4–3.0, p<0.01); grades 3–4: RR=6.4 (4.6-8.8, p<0.01); multiple conditions: RR=5.9 (5.0-7.0, p<0.01). In addition, BMTSS participants were significantly more likely to report compromised functional status: adverse general health: RR=3.4 (2.1-5.3, p<0.01); activity limitations: RR=6.8 (5.0-9.3, p<0.01); and functional impairment: RR=7.8 (5.1-12.0, p<0.01). BMTSS vs. CCSS cancer survivors: After adjustment for age, follow-up, gender, ethnicity/race, diagnosis, pre-HCT therapeutic exposures (dose-specific chemotherapy, radiation), and treatment era, BMTSS participants were 1.5 (1.3-1.7, p<0.01) times as likely as conventionally treated patients to report a chronic condition; 2.3 (1.5-3.5, p<0.01) times as likely to report severe/ life-threatening conditions; and 2.2 (1.7-2.8, p<0.01) times as likely to report multiple conditions. Allogeneic HCT recipients with a history of chronic GvHD were at a modestly higher risk of reporting multiple chronic health conditions (Table).
Display omitted
RR (95% CI) Grades 1-4RR (95% CI) Grade 3 or 4RR (95% CI) Multiple (≥2) ConditionsConventionally treated (CCSS)1.01.01.0Autologous HCT (BMTSS)1.3 (1.0–1.7)1.7 (0.7–3.9)1.5 (0.9–2.2)Allogeneic HCT, no GvHD (BMTSS)1.5 (1.2–1.7)2.5 (1.6–3.9)2.2 (1.7–2.8)Allogeneic HCT, GvHD (BMTSS)1.7 (1.4–2.0)2.7 (1.3–5.3)2.9 (2.1–3.9)
Childhood HCT survivors carry a significantly higher burden of morbidity when compared with the general population, as well as children treated with conventional therapy, providing evidence for a critical need for close monitoring of this high-risk population.
No relevant conflicts of interest to declare.
This fresh look at southern politics clarifies the recent and dramatic development of party competition in the South. Southern politics has changed dramatically during the past half century. While ...new developments have touched virtually every aspect of the region's politics, change has been especially marked in the South's political party and electoral systems. Southern Parties and Elections explores the contemporary developments in party realignment and examines the relationship between regional party change and electoral behavior and the larger patterns in national politics. The collection's first group of essays examines some of the key legal issues in contemporary southern politics: the legal battle over majority-minority districting, the electoral consequences of such districting, the practice-fairly widespread in the South-of separating presidential elections from state and local elections, and the connections between the electorate and party change. The second section of essays focuses on nominations, elections, and partisan developments in the South, including the recent surge of voter participation in southern Republican primaries, the comparative importance of the South and selected states with large blocks of electoral votes in presidential election outcomes, and the southern contribution to patterns of voting in Congress. The final two chapters examine changes in southern state legislatures-one a case study of the Virginia General Assembly and the other an analysis of state legislatures in the region as a whole. Collectively these essays add important pieces to the enduring puzzle of "southern politics."
One hundred patients with acne vulgaris applied adapalene (Differin) 0.1% gel to one side of their face and tretinoin 0.025% cream to the other once a day for 4 weeks; the side of application was ...determined by randomization code. Patient tolerance (assessed as the side of the face least irritated by drug application) was recorded weekly and patient preference (assessed as the preparation more easily spread, absorbed more quickly, smelled better, felt best on the skin and least greasy to the feel) at completion of the study. The investigator measured skin irritation weekly, scoring erythema, skin dryness, desquamation and burning/stinging on a 10-point scale. After each week of treatment, 64-68% of patients found adapalene 0.1% gel more tolerable than tretinoin 0.025% cream (P < 0.05). At study completion, 65% of patients preferred adapalene 0.1% gel over tretinoin 0.025% cream (P = 0.003). An overall assessment showed adapalene 0.1% gel was significantly less irritating to the skin in terms of producing erythema, dryness, desquamation and burning/stinging, at Visits 2, 3 and 4 (P < 0.02). Thirty-two patients experienced mild to moderately severe adverse events; three had adverse events considered to be drug related (two with skin discomfort; one with skin dryness). One patient stopped using the study drugs because of dry skin. This study showed that a majority of patients preferred adapalene 0.1% gel over tretinoin 0.025% cream and that it caused significantly less skin irritation.
To assess the aggregate burden of infectious disease in New Zealand in terms of mortality and hospital admissions.
New Zealand mortality records for the years 1980-1998, and hospital discharges for ...the period 1988-2000, were re-analysed using a recoding of ICD-9 codes to estimate the aggregate burden of infectious disease. The recoding scheme was modified, as in an earlier analysis, from that developed by Centers for Disease Control and Prevention.
Following recoding, the proportion of deaths attributable to infectious disease increased from 0.7% of deaths to 6.6% of deaths. Likewise recoding of hospital discharges showed an increase in the proportion due to infectious disease from 2.2% to 12.6%, second only to "complications of pregnancy, childbirth and the puerperium". Over the study period infectious disease mortality rates have showed little decline, and there has been a nearly 60% increase in infectious disease hospital discharge rates.
The findings confirm and extend those of an earlier study, indicating the substantial burden of disease that is still attributable to infectious disease in New Zealand. The burden remains inequitable.
PDF
