Evaluation of an individualized education program in pituitary diseases: a pilot study.

INTRODUCTION: The low prevalence of pituitary diseases makes patient autonomy crucial, and self-management programs should be more common. OBJECTIVES: To assess the efficacy of an education program for patients with pituitary diseases in terms of patients' quality of life, satisfaction and goal attainment. DESIGN AND METHODS: Adult patients with pituitary disorders were recruited in a tertiary referral center and chose at least three of eight possible sessions on various topics, from disease management to psychosocial issues. Patients were included if they attended at least three sessions between 2012 and 2016 and completed the initial, final, and follow-up questionnaires. Data on quality of life (SF36), satisfaction and goal attainment were analyzed. RESULTS: Fifty-three patients were included (33 women; mean age, 53.5 years). There were a significant quality of life improvements in terms of physical and psychic limitation scores at the final assessment that persisted at follow-up evaluation. Most patients reached their objectives, especially those on sharing experiences and improving autonomy and self-confidence. More than half set new objectives at the end of the program, the most popular one being to reinforce their knowledge of their pituitary disease, its evolution and treatment (17.1% of patients). The mean overall satisfaction score was 3.75/4. At follow-up evaluation, patients reported improved self-management of pituitary disease (3.6/5) and improved self-efficacy (3.8/5). CONCLUSION: Individualizing the educational objectives of patients with pituitary disease improves the way they live with their disease. If confirmed in other cohorts, this approach could become the gold standard for education programs in rare endocrine diseases.

Experimental Investigation of the Collective Raman Scattering of Multiple Laser Beams in Inhomogeneous Plasmas.

Experiments have been performed evidencing significant stimulated Raman sidescattering (SRS) at large angles from the density gradient. This was achieved in long scale-length high-temperature plasmas in which two beams couple to the same scattered electromagnetic wave further demonstrating for the first time this multiple-beam collective SRS interaction. The collective nature of the coupling and the amplification at large angles from the density gradient increase the global SRS losses and produce light scattered in novel directions out of the planes of incidence of the beams. These findings obtained in plasmas conditions relevant of inertial confinement fusion experiments similarly apply to the more complex geometry of these experiments where anomalously large levels of SRS were measured.

Spatial and Transient Effects during the Amplification of a Picosecond Pulse Beam by a Nanosecond Pump.

Amplification of a picosecond pulse beam by a lower intensity nanosecond pulse beam was experimentally observed in a flowing plasma. Modifications of intensity distributions in beam focal spots due to nonhomogeneous energy transfer and its transient regime were investigated. The mean transferred power reached 57% of the incident power of the nanosecond pulse beam. An imaging diagnostic allowed the intensity profile of the picosecond pulse beam to be determined, bringing to evidence the spatial nonuniformity of energy transfer in the amplified beam. This diagnostic also enabled us to observe the temporal evolution of the speckle intensity distribution because of the transfer. These results are reproduced by numerical simulations of two complementary codes. The method and the observed effects are important for the understanding of experiments with multiple crossing laser beams in plasmas.

Experimental Evidence of the Collective Brillouin Scattering of Multiple Laser Beams Sharing Acoustic Waves.

The indirect-drive scheme to inertial confinement fusion uses a large number of laser beams arranged in a symmetric angular distribution. Collective laser plasma instabilities can therefore develop that couple all the incident laser waves located in a cone to the daughter wave growing along the cone symmetry axis [D. F. DuBois et al., Phys. Fluids B 4, 241 (1992)]. With complementary diagnostics of Thomson scattering and of the scattered light, we demonstrate the occurrence of collective stimulated Brillouin sidescattering driving collective acoustic waves in indirect-drive experiments.

Laser-initiated primary and secondary nuclear reactions in Boron-Nitride.

Nuclear reactions initiated by laser-accelerated particle beams are a promising new approach to many applications, from medical radioisotopes to aneutronic energy production. We present results demonstrating the occurrence of secondary nuclear reactions, initiated by the primary nuclear reaction products, using multicomponent targets composed of either natural boron (B) or natural boron nitride (BN). The primary proton-boron reaction (p + (11)B → 3 α + 8.7 MeV), is one of the most attractive aneutronic fusion reaction. We report radioactive decay signatures in targets irradiated at the Elfie laser facility by laser-accelerated particle beams which we interpret as due to secondary reactions induced by alpha (α) particles produced in the primary reactions. Use of a second nanosecond laser beam, adequately synchronized with the short laser pulse to produce a plasma target, further enhanced the reaction rates. High rates and chains of reactions are essential for most applications.

CR-39 track detector calibration for H, He, and C ions from 0.1-0.5 MeV up to 5 MeV for laser-induced nuclear fusion product identification.

Laser-accelerated ion beams can be used in many applications and, especially, to initiate nuclear reactions out of thermal equilibrium. We have experimentally studied aneutronic fusion reactions induced by protons accelerated by the Target Normal Sheath Acceleration mechanism, colliding with a boron target. Such experiments require a rigorous method to identify the reaction products (alpha particles) collected in detectors among a few other ion species such as protons or carbon ions, for example. CR-39 track detectors are widely used because they are mostly sensitive to ions and their efficiency is near 100%. We present a complete calibration of CR-39 track detector for protons, alpha particles, and carbon ions. We give measurements of their track diameters for energy ranging from hundreds of keV to a few MeV and for etching times between 1 and 8 h. We used these results to identify alpha particles in our experiments on proton-boron fusion reactions initiated by laser-accelerated protons. We show that their number clearly increases when the boron fuel is preformed in a plasma state.

Fusion reactions initiated by laser-accelerated particle beams in a laser-produced plasma.

The advent of high-intensity-pulsed laser technology enables the generation of extreme states of matter under conditions that are far from thermal equilibrium. This in turn could enable different approaches to generating energy from nuclear fusion. Relaxing the equilibrium requirement could widen the range of isotopes used in fusion fuels permitting cleaner and less hazardous reactions that do not produce high-energy neutrons. Here we propose and implement a means to drive fusion reactions between protons and boron-11 nuclei by colliding a laser-accelerated proton beam with a laser-generated boron plasma. We report proton-boron reaction rates that are orders of magnitude higher than those reported previously. Beyond fusion, our approach demonstrates a new means for exploring low-energy nuclear reactions such as those that occur in astrophysical plasmas and related environments.

Experimental approach to interaction physics challenges of the shock ignition scheme using short pulse lasers.

An experimental program was designed to study the most important issues of laser-plasma interaction physics in the context of the shock ignition scheme. In the new experiments presented in this Letter, a combination of kilojoule and short laser pulses was used to study the laser-plasma coupling at high laser intensities for a large range of electron densities and plasma profiles. We find that the backscatter is dominated by stimulated Brillouin scattering with stimulated Raman scattering staying at a limited level. This is in agreement with past experiments using long pulses but laser intensities limited to 2×10(15) W/cm2, or short pulses with intensities up to 5×10(16) W/cm2 as well as with 2D particle-in-cell simulations.