Search

A sequence of magnetized target fusion devices built by General Fusion has compressed magnetically confined deuterium plasmas inside imploding aluminum liners. Here we describe the best-performing compression experiment, PCS-16, which was the fifth of the most recent experiments that compressed a spherical tokamak plasma configuration. In PCS-16, the plasma remained axisymmetric with $\delta B_\textrm{pol}/B_\textrm{pol} \lt 20\%$ to a high radial compression factor ( $C_\mathrm R \gt 8$ ) with significant poloidal flux conservation (77% up to $C_\mathrm R = $ 1.7, and ${\approx}30\%$ up to $C_\mathrm R = 8.65$ ) and a total compression time of 167 $\mu\mathrm{s}$ . Magnetic energy of the plasma increased from 0.96 kJ poloidal and 17 kJ toroidal to a peak of 1.14 kJ poloidal and 29.9 kJ toroidal during the compression, while the thermal energy was in the range of 350 ± 25 J. Plasma equilibrium was a low- β state with $\beta_\textrm{tor} \approx 4\%$ and $\beta_\textrm{pol} \approx 15\%$ . Ingress of impurities from the lithium-coated aluminum wall was not the dominant effect. Neutron yield from D-D fusion increased significantly during compression. Thermodynamics during the early phase of compression ( $C_\mathrm R \lt 1.7$ ) were consistent with increasing Ohmic heating of the electrons due to a geometric increase in the current density at near-constant resistivity, and with increasing ion cooling that approximately matched ion compression heating power. Ion cooling by electrons was significant because the electrons were much cooler than the ions ( $T_\mathrm e = 200\,\mathrm{eV}, T_\mathrm i = 600\,\mathrm{eV}$ ). Magnetohydrodynamic simulations were used to model the emergence of instabilities that increase electron thermal transport in the final phase of compression. Conditions for ideal stability were actively maintained during compression through a current ramp applied to the central shaft and, after this current ramp reached its peak two-thirds of the way through compression, we measured a transition in plasma behavior across multiple diagnostics.

Abstract Introduction Variants of uncertain significance (VUS) are commonly reported in cancer with the widespread adoption of diagnostic massive parallel sequencing. The rate of reclassification of VUS in patients with haematological malignancy is not known and we evaluated this retrospectively. We also investigated whether re‐evaluating VUS in 12–24 months or greater than 24 months post‐initial classification was significant. Method A retrospective audit of patients with haematological malignancies referred to the Molecular Medicine Department at the John Hunter Hospital in Newcastle, Australia between September 2018 and December 2021. Data was analysed for VUS, which was then re‐analysed in standard software using current somatic variant guidelines. Proportions of VUS at baseline were compared to post‐re‐analysis. Results The most common diagnoses in the patient cohort (n = 944) were acute myelogenous leukaemia (41%), myelodysplastic syndrome (31%), and chronic myelomonocytic leukaemia (7%). A total of 210 VUS were re‐analysed. The most common VUS were in the TET2 (20%), RUNX1 (10%) and DNMT3A (9%) genes. A total of 103 were re‐analysed at 24–39 months post‐initial classification and 107 variants were re‐analysed between 12 and 24 months post‐initial classification. Of these, 33 (16%) of VUS were re‐classified at 24–39 months and 12 (11%) were re‐classified at 12–24 months post‐initial classification. The most common variants that were re‐classified in both groups were CSF3R (32%), TET2 (29%), ASXL1 (11%) and ZRSR2 (11%). Conclusion This study on reclassification of VUS in blood cancers demonstrated that one in seven VUS were re‐classified 12 months post initial classification. This can inform practice guidelines and potentially impact the prognosis, diagnosis and treatment of haematological malignancies.

Evidence is needed about how to effectively support health care providers in implementing screening for social risks (adverse social determinants of health) and providing related referrals meant to address identified social risks. This need is greatest in underresourced care settings. The authors tested whether an implementation support intervention (6 months of technical assistance and coaching study clinics through a five-step implementation process) improved adoption of social risk activities in community health centers (CHCs). Thirty-one CHC clinics were block-randomized to six wedges that occurred sequentially. Over the 45-month study period from March 2018 to December 2021, data were collected for 6 or more months preintervention, the 6-month intervention period, and 6 or more months postintervention. The authors calculated clinic-level monthly rates of social risk screening results that were entered at in-person encounters and rates of social risk-related referrals. Secondary analyses measured impacts on diabetes-related outcomes. Intervention impact was assessed by comparing clinic performance based on whether they had versus had not yet received the intervention in the preintervention period compared with the intervention and postintervention periods. In assessing the results, the authors note that five clinics withdrew from the study for various bandwidth-related reasons. Of the remaining 26, a total of 19 fully or partially completed all 5 implementation steps, and 7 fully or partially completed at least the first 3 steps. Social risk screening was 2.45 times (95% confidence interval [CI], 1.32-4.39) higher during the intervention period compared with the preintervention period; this impact was not sustained postintervention (rate ratio, 2.16; 95% CI, 0.64-7.27). No significant difference was seen in social risk referral rates during the intervention or postintervention periods. The intervention was associated with greater blood pressure control among patients with diabetes and lower rates of diabetes biomarker screening postintervention. All results must be interpreted considering that the Covid-19 pandemic began midway through the trial, which affected care delivery generally and patients at CHCs particularly. Finally, the study results show that adaptive implementation support was effective at temporarily increasing social risk screening. It is possible that the intervention did not adequately address barriers to sustained implementation or that 6 months was not long enough to cement this change. Underresourced clinics may struggle to participate in support activities over longer periods without adequate resources, even if lengthier support is needed. As policies start requiring documentation of social risk activities, safety-net clinics may be unable to meet these requirements without adequate financial and coaching/technical support.

Climate change is increasing the frequency and severity of extreme precipitation events, requiring new ways of managing stormwater, particularly in urban areas. Nature-based solutions (NBS) have become increasingly popular to provide distributed stormwater storage while supporting urban biodiversity and access to nature. However, long-term monitoring of the hydrological performance of NBS is limited. To date most literature has focused on monitoring methodologies for specific sites and types of NBS, use of remote sensing and modeling for large-scale assessments, or measuring benefits of NBS for urban heat mitigation. More comprehensive and consistent measurement strategies are needed to understand the effects of distributed NBS on urban hydrology at the regional scale, and improve the design, maintenance, and adoption for community-centered stormwater management. To address these gaps, we review available literature on measurement methods, summarize these methods and provide specific recommendations for instrumentation and in situ monitoring of common types and scales of urban NBS. Based on our findings on performance monitoring for individual NBS sites, we extend recommendations for consistent hydrological assessment of distributed NBS at regional scale and the efficacy of NBS in reducing community flooding impacts. These recommendations are particularly applicable for municipalities, researchers and community-based organizations who are now leading the planning and implementation of community-centered NBS systems in many areas.