Toward a 21st-century health care system: Recommendations for health care reform

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges

LDRD final report on confinement of cluster fusion plasmas with magnetic fields.

Two versions of a current driver for single-turn, single-use 1-cm diameter magnetic field coils have been built and tested at the Sandia National Laboratories for use with cluster fusion experiments at the University of Texas in Austin. These coils are used to provide axial magnetic fields to slow radial loss of electrons from laser-produced deuterium plasmas. Typical peak field strength achievable for the two-capacitor system is 50 T, and 200 T for the ten-capacitor system. Current rise time for both systems is about 1.7 {mu}s, with peak current of 500 kA and 2 MA, respectively. Because the coil must be brought to the laser, the driver needs to be portable and drive currents in vacuum. The drivers are complete but laser-plasma experiments are still in progress. Therefore, in this report, we focus on system design, initial tests, and performance characteristics of the two-capacitor and ten-capacitors systems. The questions of whether a 200 T magnetic field can retard the breakup of a cluster-fusion plasma, and whether this field can enhance neutron production have not yet been answered. However, tools have been developed that will enable producing the magnetic fields needed to answer these questions. These are a two-capacitor, 400-kA system that was delivered to the University of Texas in 2010, and a 2-MA ten-capacitor system delivered this year. The first system allowed initial testing, and the second system will be able to produce the 200 T magnetic fields needed for cluster fusion experiments with a petawatt laser. The prototype 400-kA magnetic field driver system was designed and built to test the design concept for the system, and to verify that a portable driver system could be built that delivers current to a magnetic field coil in vacuum. This system was built copying a design from a fixed-facility, high-field machine at LANL, but made to be portable and to use a Z-machine-like vacuum insulator and vacuum transmission line. This system was sent to the University of Texas in Austin where magnetic fields up to 50 T have been produced in vacuum. Peak charge voltage and current for this system have been 100 kV and 490 kA. It was used this last year to verify injection of deuterium and surrogate clusters into these small, single-turn coils without shorting the coil. Initial test confirmed the need to insulate the inner surface of the coil, which requires that the clusters must be injected through small holes in an insulator. Tests with a low power laser confirmed that it is possible to inject clusters into the magnetic field coils through these holes without destroying the clusters. The university team also learned the necessity of maintaining good vacuum to avoid insulator, transmission line, and coil shorting. A 200-T, 2 MA system was also constructed using the experience from the first design to make the pulsed-power system more robust. This machine is a copy of the prototype design, but with ten 100-kV capacitors versus the two used in the prototype. It has additional inductance in the switch/capacitor unit to avoid breakdown seen in the prototype design. It also has slightly more inductance at the cable connection to the vacuum chamber. With this design we have been able to demonstrate 1 MA current into a 1 cm diameter coil with the vacuum chamber at air pressure. Circuit code simulations, including the additional inductance with the new design, agree well with the measured current at a charge voltage of 40 kV with a short circuit load, and at 50 kV with a coil. The code also predicts that with a charge voltage of 97 kV we will be able to get 2 MA into a 1 cm diameter coil, which will be sufficient for 200 T fields. Smaller diameter or multiple-turn coils will be able to achieve even higher fields, or be able to achieve 200-T fields with lower charge voltage. Work is now proceeding at the university under separate funding to verify operation at the 2-MA level, and to address issues of debris mitigation, measurement of the magnetic field, and operation in vacuum. We anticipate operation at full current with single-turn, magnetic field coils this fall, with 200 T experiments on the Texas Petawatt laser in the spring of 2012

LDRD final report on confinement of cluster fusion plasmas with magnetic fields.

Two versions of a current driver for single-turn, single-use 1-cm diameter magnetic field coils have been built and tested at the Sandia National Laboratories for use with cluster fusion experiments at the University of Texas in Austin. These coils are used to provide axial magnetic fields to slow radial loss of electrons from laser-produced deuterium plasmas. Typical peak field strength achievable for the two-capacitor system is 50 T, and 200 T for the ten-capacitor system. Current rise time for both systems is about 1.7 {mu}s, with peak current of 500 kA and 2 MA, respectively. Because the coil must be brought to the laser, the driver needs to be portable and drive currents in vacuum. The drivers are complete but laser-plasma experiments are still in progress. Therefore, in this report, we focus on system design, initial tests, and performance characteristics of the two-capacitor and ten-capacitors systems. The questions of whether a 200 T magnetic field can retard the breakup of a cluster-fusion plasma, and whether this field can enhance neutron production have not yet been answered. However, tools have been developed that will enable producing the magnetic fields needed to answer these questions. These are a two-capacitor, 400-kA system that was delivered to the University of Texas in 2010, and a 2-MA ten-capacitor system delivered this year. The first system allowed initial testing, and the second system will be able to produce the 200 T magnetic fields needed for cluster fusion experiments with a petawatt laser. The prototype 400-kA magnetic field driver system was designed and built to test the design concept for the system, and to verify that a portable driver system could be built that delivers current to a magnetic field coil in vacuum. This system was built copying a design from a fixed-facility, high-field machine at LANL, but made to be portable and to use a Z-machine-like vacuum insulator and vacuum transmission line. This system was sent to the University of Texas in Austin where magnetic fields up to 50 T have been produced in vacuum. Peak charge voltage and current for this system have been 100 kV and 490 kA. It was used this last year to verify injection of deuterium and surrogate clusters into these small, single-turn coils without shorting the coil. Initial test confirmed the need to insulate the inner surface of the coil, which requires that the clusters must be injected through small holes in an insulator. Tests with a low power laser confirmed that it is possible to inject clusters into the magnetic field coils through these holes without destroying the clusters. The university team also learned the necessity of maintaining good vacuum to avoid insulator, transmission line, and coil shorting. A 200-T, 2 MA system was also constructed using the experience from the first design to make the pulsed-power system more robust. This machine is a copy of the prototype design, but with ten 100-kV capacitors versus the two used in the prototype. It has additional inductance in the switch/capacitor unit to avoid breakdown seen in the prototype design. It also has slightly more inductance at the cable connection to the vacuum chamber. With this design we have been able to demonstrate 1 MA current into a 1 cm diameter coil with the vacuum chamber at air pressure. Circuit code simulations, including the additional inductance with the new design, agree well with the measured current at a charge voltage of 40 kV with a short circuit load, and at 50 kV with a coil. The code also predicts that with a charge voltage of 97 kV we will be able to get 2 MA into a 1 cm diameter coil, which will be sufficient for 200 T fields. Smaller diameter or multiple-turn coils will be able to achieve even higher fields, or be able to achieve 200-T fields with lower charge voltage. Work is now proceeding at the university under separate funding to verify operation at the 2-MA level, and to address issues of debris mitigation, measurement of the magnetic field, and operation in vacuum. We anticipate operation at full current with single-turn, magnetic field coils this fall, with 200 T experiments on the Texas Petawatt laser in the spring of 2012