A self-insulating, high-power, microwave source

We present first predictions for the performance of a novel, mildly relativistic (500keV, 2kA), X-band Cherenkov oscillator, nominally a variant of the backward-wave oscillator. The source operates with no externally-applied magnetic insulation, relying only on the self-fields of the electron beam for propagation. This significantly reduces the overall energy requirements for operation, along with the complexity; conventional (magnetically insulated) sources of this type typically require magnetic field strengths of 1 – 2T for efficient beam propagation, translating to a relatively large solenoid and associated power-supply. By eliminating this factor, the overall-efficiency of the source is tightly coupled to the conversion-efficiency between the beam and the wave. Conversion efficiencies in excess of 30% have been predicted for the source, when driven by a high-quality electron beam; the parameters of which were determined via numerical modelling of the electron gun. A tolerance study of variation in the beam parameters shows the efficiency remains better than ∼25% over the variation in critical control parameters expected in experiment, with clean excitation of the intended TM01 operating mode achieved at a stable output frequency of ~9.4GHz. The resonant frequency of the source was found to be insensitive to variation in the electron energy over an extended range (400-600keV)

A high-power Ka-band free electron maser, defined by a 2D – 1D Bragg lasing cavity

One of the on-going research programs, at the University of Strathclyde, involves the development of high-power, pulsed, Free-Electron Masers (FEMs) with the lasing cavity defined using periodic corrugations on the drift-tube walls 1-4 . These corrugations form 1D and 2D Bragg resonators, whose reflection bands determine the dominant resonance of the maser 5 . Proper selection of the FEM undulator magnetic field strength, allows for efficient extraction of energy from a mildly relativistic (400 - 500 keV) electron beam at the resonant frequency of the lasing cavity, leading to monochromatic output at power levels of several tens of megawatts and pulse durations of ~150ns (determined primarily by the pulse duration of the driving power supply of ~250ns)

Linear plasma experiment for non-linear microwave interaction experiments

As a non-linear medium, plasma can exhibit diverse dynamics when excited bymultiple EM waves. Electromagnetic waves are vital to the introduction of energyin laser plasma interactions and the heating of magnetically confined fusion reactors.In laser plasma applications Raman coupling via a Langmuir oscillation or Brillouinscattering mediated by ion-acoustic waves are of interest. Signals with normalisedintensities approaching those used in some recent laser plasma interactions can begenerated using powerful and flexible microwave amplifiers, interacting in relativelytenuous, cool and accessible plasma. Other multi-wave interactions are interesting formagnetic confinement fusion plasmas, for example beat-wave interactions betweentwo microwave signals coupling to cyclotron motion of the ions and electrons or thelower hybrid oscillations may be useful in heating the plasmas or for driving currents.A linear plasma experiment is being built to test such multifrequency microwaveinteraction in plasma, based on prior research on geophysical cyclotron wave emissionand propagation [1,2]. The main section of the plasma will be magnetised at up to0.05T, with the plasma created by an RF helicon source to generate a dense, large,cool plasma with a high ionisation fraction. A range of frequency-flexible sources willprovide microwave beams to enable multi-wave coupling experiments. The paper willpresent progress on this apparatus and experiments.The authors gratefully acknowledge support from the EPSRC, MBDA UK Ltd andTMD Technologies Ltd.[1] Ronald K., Speirs D.C., McConville S.L., Phelps A.D.R., Robertson C.W., WhyteC.G., He W., Gillespie K.M., Cross A.W., Bingham R., 2008, Phys. Plasmas, 15,art.056503[2] Speirs, D.C., Bingham, R., Cairns, R.A., Vorgul, I., Kellett, B.J., Phelps, A.D.R.,Ronald, K, 2014, Phys. Rev. Lett., 113, art 15500

Numerical analysis of high-power X-band sources, at low magnetic confinement, for use in a multi-source array

High-power microwave sources are typically relativistic in nature, employing multi-kilo-ampere electron beams that require significant magnetic confinement for efficient operation. As the desired output power increases so does the complexity, and overall energy requirements, of the source. It can therefore be advantageous to consider the use of several, moderate-power, sources operating as a phased array; for an array of N sources the far-field peak intensity scales as N2, and the peak-of-field may be steered electronically by varying the relative phases of the different output signals. In this paper we present the numerical analysis of a short-pulse (∼1ns) X-band backward-wave oscillator, driven by a 210keV, 1.4kA electron beam, suitable for use as the radiative element in such an array. Investigation of the required magnetic confinement showed two peaks in performance, with the highest efficiency, of 43%, predicted at the low magnetic confinement peak at 0.3T, corresponding to 125MW peak output power. The magnitude, and timing, of the peak in the output pulse were functions of the rise-time of the electron beam energy, with longer rise-times resulting in delayed peak-of-field and lower peak output power. When operating in an array, to maintain effective output in the region of N2, it was determined that the beam rise-times, across all sources, should be ≤150ps with the adjustment of the relative timing between output’s being ±30ps

Design and experiments of a five-fold helically corrugated waveguide for microwave pulse compression

Metal waveguide can be used as a dispersive medium to convert long duration, lower power pulses into short, higher peak power pulses. This provides an advanced method to generate radiation with gigawatts power in the millimeter and sub-millimeter wavelength range by compressing a megawatt level long duration pulse. In this paper, a five-fold helically corrugated waveguide operating in X-band was designed and constructed. The experiments conducted show that a 5.75 kW average power microwave pulse with a 6% bandwidth and duration of 80 ns can be compressed into a 144.8 kW, 1.6 ns pulse with a power compression factor of 25.2

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation