Enhanced energy coupling by using structured nano-wire targets

We have investigated the interaction of ultra intense laser light with a carbon nanotube (CNT) target. The experimental results show an increased electron acceleration and a very low laser reflection as compared to non-structured targets. In addition, interferograms show very weak plasma expansion in front of the CNT target whereas the flat target creates a considerable amount of preformed plasma. A 2-D PIC calculation indicates that high laser absorption is possible via a Brunel mechanism following the ponderomotive heating in the expanded plasma between nanotubes

ECONOMIC BENEFITS OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To evaluate by modelling the economic benefits of left ventricular hypertrophy (LVH) regression in patients with arterial hypertension (HT) due to therapy with fixed combination of valsartan/amlodipine.  Material and methods. 20 patients (15 females and 5 males, aged 18 to 70 years) with essential HT accompanied by metabolic syndrome with a history of previous ineffective antihypertensive therapy were included into the study. All patients were treated with fixed combination of amlodipine/valsartan in doses of 5/160 and 10/160 mg depending on blood pressure (BP) level. Treatment duration was 24 weeks. Changes in BP level, LVH regression were assessed. Economic evaluation was performed on the basis of modelling with the specialized software Decision Tree 4.xla. Results. Effect of fixed amlodipine/valsartan combination therapy on LVH was used to estimate treatment effectiveness and to build the model. Patients were distributed according to left ventricular (LV) mass (at baseline and after 24 weeks of therapy). Significant decrease in LV mass from 205.8±50.4 to 181.9±45.1 g (p<0.05) was revealed. The model took into account economic and frequency factors for 10 year prognosis: this therapy prevents 36 deaths, 6 strokes, 24 myocardial infarction per 1000 patients. Absence of need in treatment of these prevented events can save 2 516 772.42 RUR for every 1 000 patients. It would reduce the total costs per patient during 10 years. Conclusion. Treatment with amlodipine/valsartan single pill combination has not only clinical advantages, but also pharmacoeconomic benefits. This combination reduces risk of acute myocardial infarction and death more effectively. Treatment with fixed valsartan/amlodipine combination saves maximum years of life with less cost during 10 years. Despite of higher pharmacotherapy costs, fixed valsartan/amlodipine combination reduces total costs due to prevention of fatal and nonfatal cardiovascular events

Theory of laser ion acceleration from a foil target of nanometers

A theory for laser ion acceleration is presented to evaluate the maximum ion energy in the interaction of ultrahigh contrast (UHC) intense laser with a nanometer-scale foil. In this regime the energy of ions may be directly related to the laser intensity and subsequent electron dynamics. This leads to a simple analytical expression for the ion energy gain under the laser irradiation of thin targets. Significantly, higher energies for thin targets than for thicker targets are predicted. Theory is concretized to the details of recent experiments which may find its way to compare with these results.Comment: 22 pages 7 figures. will be submitted to NJ

Влияние полиморбидности у пожилых больных с фибрилляцией предсердий на «стоимость болезни»

Objective: to analyze whether comorbidity affects the cost of treatment and medical services in elderly patients with atrial fibrillation (AF). Materials and methods. We conducted a retrospective analysis of 98 patients with AF. Comorbidity was evaluated using the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson criterion. The “cost of illness” calculations included direct costs only. Results. In elderly patients with AF (mean age 74.7±8.8 years), high rate of comorbidity was typically found. Charlson comorbidity index amounted to 4.0±1.8, and the CIRS-G score – to 8.0±2.8. AF is often associated with heart diseases such as hypertension – 98.9%, coronary heart disease – 27.6%, and congestive heart failure – 76.5%. A patient with AF received on average 7.5±3.8 medications. Direct costs amounted to 18298.2±9440.4 RUB per patient with AF per year. Of this amount, 78.8% were spent for outpatient treatment, 16.5% for hospitalization and 4.7% for ambulance service. Cardiac medications comprised 66.4% of the total direct costs. In patients with high comorbidity, there are high costs of treatment of concomitant diseases, high secondary costs as well as costs for a doctor visit. Conclusion. An average elderly patient with AF receives 7.5±3.8 permanent medications, which correlates with the severity of comorbidity by the Charlson index (r=0.59; p=0.000) and the CIRS-G score (r=0.29; p=0.004). Management of such patients at the outpatient clinic is by large (66.4%) associated with direct costs of the prescribed medications. However, patients with high comorbidity still need more vital drugs, as the cost of treatment of concomitant diseases increases. Notably, these patients spend 4 times more funds for drugs without proven efficacy. Цель – провести анализ затрат на лекарства и медицинские услуги у пожилых больных с фибрилляцией предсердий (ФП) с учетом полиморбидности. Материалы и методы. Ретроспективный анализ 98 амбулаторных карт пациентов с ФП. Уровень коморбидности оценивали с по мощью шкалы CIRS-G (Cumulative Illness Rating Scale for Geriatrics) и критерия Чарлсона. В расчете «стоимости болезни» учитывали только прямые затраты. Результаты. У пожилых больных с ФП (средний возраст – 74,7±8,8 лет) выявлены высокие показатели коморбидности. Индекс коморбидности Чарлсона составил 4,0±1,8; CIRS-G – 8,0±2,8. Чаще ФП сопутствуют кардиологические заболевания: гипертоническая болезнь – у 98,9%, ишемическая болезнь сердца – у 27,6%, хроническая сердечная недостаточность – у 76,5% пациентов. Высокая полиморбидность объясняет частую полипрагмазию. На одного пациента в среднем приходилось 7,5±3,8 лекарственных средств (ЛС). При расчете прямых затрат оказалось, что на одного пациента с ФП тратится 18298,2±9440,4 руб. в год. При этом на амбулаторную помощь – 78,8%, на госпитализации – 16,5%, на вызовы скорой медицинской помощи – 4,7%. 66,4% всех прямых затрат составляют расходы на ЛС, в основном кардиологического профиля. С ростом коморбидности увеличиваются затраты на лечение сопутствующих заболеваний, второстепенные затраты и затраты на визиты к врачу. Заключение. Пожилой больной с ФП одновременно получает 7,5±3,8 ЛС, что коррелирует с тяжестью коморбидности по индексу Чарлсона (r=0,59; p=0,000) и шкале CIRS-G (r=0,29; p=0,004). Большую часть прямых расходов на ведение пациента с ФП на амбулаторном этапе составляют траты на лекарственные препараты (66,4%). Вместе с тем с увеличением коморбидности жизненно-необходимых ЛС используется недостаточно, увеличиваются затраты на лечение сопутствующих заболеваний, в 4 раза – на второстепенные лекарства без доказанной эффективности. 

Zettawatt-Exawatt Lasers and Their Applications in Ultrastrong-Field Physics: High Energy Front

Since its birth, the laser has been extraordinarily effective in the study and applications of laser-matter interaction at the atomic and molecular level and in the nonlinear optics of the bound electron. In its early life, the laser was associated with the physics of electron volts and of the chemical bond. Over the past fifteen years, however, we have seen a surge in our ability to produce high intensities, five to six orders of magnitude higher than was possible before. At these intensities, particles, electrons and protons, acquire kinetic energy in the mega-electron-volt range through interaction with intense laser fields. This opens a new age for the laser, the age of nonlinear relativistic optics coupling even with nuclear physics. We suggest a path to reach an extremely high-intensity level $10^{26-28}$W/cm$^2$ in the coming decade, much beyond the current and near future intensity regime $10^{23}$W/cm$^2$, taking advantage of the megajoule laser facilities. Such a laser at extreme high intensity could accelerate particles to frontiers of high energy, tera-electron-volt and peta-electron-volt, and would become a tool of fundamental physics encompassing particle physics, gravitational physics, nonlinear field theory, ultrahigh-pressure physics, astrophysics, and cosmology. We focus our attention on high-energy applications in particular and the possibility of merged reinforcement of high-energy physics and ultraintense laser.Comment: 25 pages. 1 figur

Прогнозирование влияния прямых оральных антикоагулянтов на прямые медицинские затраты у больных фибрилляцией предсердий

Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy.Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”.Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment.Conclusion. Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost. Цель. Оценить клинико-экономическую эффективность использования прямых оральных антикоагулянтов (ПОАК) – дабигатрана, ривароксабана, апиксабана по сравнению с варфарином при лечении фибрилляции предсердий (ФП).Материалы и методы. Математическое моделирование (построение дерева решений) на временном горизонте 5 лет с перспективы системы здравоохранения. Методы клинико-экономического анализа: анализ «затраты-эффективность»; анализ «влияния на бюджет»; анализ  «упущенных возможностей».Результаты. Суммарные прямые затраты (ПЗ) при использовании дабигатрана были на 10,3% меньше, при использовании ривароксабана – на 5,2% меньше; при использовании апиксабана – на  10,9% меньше по сравнению с варфарином. При этом наибольшая разница возникала вследствие различной стоимости терапии геморрагических осложнений (в структуре затрат они составляли 30–38%). В группе дабигатрана ПЗ на геморрагические осложнения была меньше группы варфарина на 22,0%, в группе ривароксабана – на 10,9%, в группе апиксабана – на 36,8%. Кроме того, в группе дабигатрана на 28,1% были меньше затраты, связанные с лечением ишемического инсульта. Стратегия применения ПОАК по сравнению с варфарином позволяет обеспечить большее количество сохраненных лет жизни (СЛЖ) и сохраненных лет жизни без осложнений (СЛЖБО) и меньшую их стоимость. Использование ПОАК позволяет сохранить  значительные средства бюджета, при этом сэкономленные средства позволяют пролечить  современными ЛС пациентов дополнительно. Экономия средств достигает 12% за 5 лет, при этом  до 33 больных из 1000 могут быть пролечены дополнительно.Заключение. Прямые затраты в результате предупреждения тромбоэмболических осложнений при использовании прямых оральных антикоагулянтов в сравнении с варфарином могут быть снижены на 28,1%, геморрагических осложнений – на 36,8%. Прямые оральные антикоагулянты позволяют  сохранить большее количество лет жизни и лет жизни без осложнений за меньшую стоимость. 

X-ray radiation from ions with K-shell vacancies

Abstract New types of space resolved X-ray spectra produced in light matter experiments with high intensity lasers have been investigated experimentally and theoretically. This type of spectra is characterised by the disappearance of distinct resonance line emission and the appearance of very broad emission structures due to the dielectronic satellite transitions associated to the resonance lines. Atomic data calculations have shown, that rather exotic states with K-shell vacancies are involved. For quantitative spectra interpretation we developed a model for dielectronic satellite accumulation (DSA-model) in cold dense optically thick plasmas which are tested by rigorous comparison with space resolved spectra from ns-lasers. In experiments with laser intensities up to 10 19 W/cm 2 focused into nitrogen gas targets, hollow ion configurations are observed by means of soft X-ray spectroscopy. It is shown that transitions in hollow ions can be used for plasma diagnostic. The determination of the electron temperature in the long lasting recombining regime is demonstrated. In Light-matter interaction experiments with extremely high contrast (up to 10 10 ) short pulse (400 fs) lasers electron densities of n e ≈3×10 23 cm −3 at temperatures between kT e =200–300 eV have been determined by means of spectral simulations developed previously for ns-laser produced plasmas. Expansion velocities are determined analysing asymmetric optically thick line emission. Further, the results are checked by observing the spectral windows involving the region about the He α -line and the region from the He β -line to the He-like continuum. Finally, plasmas of solid density are characteristic in experiments with heavy ion beams heating massive targets. We report the first spectroscopic investigations in plasmas of this type with results on solid neon heated by Ar-ions. A spectroscopic method for the determination of the electron temperature in extreme optically thick plasmas is developed

Observation of the plasma channel dynamics and Coulomb explosion in the interaction of a high-intensity laser pulse with a He gas jet

We report the first interferometric observations of the dynamics of electron-ion cavitation of relativistically self-focused intense 4 TW, 400 fs laser pulse in a He gas jet. The electron density in a channel 1 mm long and 30 μm in diameter drops by a factor of approximately 10 from the maximum value of ∼8×10 19 cm −3 . A high radial velocity of the plasma expansion, ∼3.8×10 8 cm/s, corresponding to an ion energy of about 300 keV, is observed. The total energy of fast ions is estimated to be 6% of the laser pulse energy. The high-velocity radial plasma expulsion is explained by a charge separation due to the strong ponderomotive force. This experiment demonstrates a new possibility for direct transmission of a significant portion of the energy of a laser pulse to ions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45800/1/11448_2006_Article_813.pd

Physicochemical Properties and Electrochemical Performance of the La1.7Ca0.3Ni1-yCuyO4+ δ Cathodes

The results of present work demonstrate that the developed La1.7Ca0.3Ni1-yCuyO4+δ-based electrode can be considered as prospective cathode for intermediate temperature solid oxide fuel cells