Disparities in Oral Nutritional Supplement Usage and Dispensing Patterns across Primary Care in Ireland: ONSPres Project

When treating malnutrition, oral nutritional supplements (ONSs) are advised when optimising the diet is insufficient; however, ONS usage and user characteristics have not been previously analysed. A retrospective secondary analysis was performed on dispensed pharmacy claim data for 14,282 anonymised adult patients in primary care in Ireland in 2018. Patient sex, age, residential status, ONS volume (units) and ONS cost (EUR) were analysed. The categories of ‘Moderate’ (<75th centile), ‘High’ (75th–89th centile) and ‘Very High’ ONS users (≥90th centile) were created. The analyses among groups utilised t-tests, Mann–Whitney U tests and chi-squared tests. This cohort was 58.2% female, median age was 76 years, with 18.7% in residential care. The most frequently dispensed ONS type was very-high-energy sip feeds (45% of cohort). Younger males were dispensed more ONSs than females (<65 years: median units, 136 vs. 90; p < 0.01). Patients living independently were dispensed half the volume of those in residential care (112 vs. 240 units; p < 0.01). ‘Moderate’ ONS users were dispensed a yearly median of 84 ONS units (median cost, EUR 153), ‘High’ users were dispensed 420 units (EUR 806) and ‘Very High’ users 892 yearly units (EUR 2402; p < 0.01). Further analyses should focus on elucidating the reasons for high ONS usage in residential care patients and younger males.

Vacuum laser acceleration of super-ponderomotive electrons using relativistic transparency injection

Intense lasers can accelerate electrons to very high energy over a short distance. Such compact accelerators have several potential applications including fast ignition, high energy physics, and radiography. Among the various schemes of laser-based electron acceleration, vacuum laser acceleration has the merits of super-high acceleration gradient and great simplicity. Yet its realization has been difficult because injecting free electrons into the fast-oscillating laser field is not trivial. Here we demonstrate free-electron injection and subsequent vacuum laser acceleration of electrons up to 20 MeV using the relativistic transparency effect. When a high-contrast intense laser drives a thin solid foil, electrons from the dense opaque plasma are first accelerated to near-light speed by the standing laser wave in front of the solid foil and subsequently injected into the transmitted laser field as the opaque plasma becomes relativistically transparent. It is possible to further optimize the electron injection/acceleration by manipulating the laser polarization, incident angle, and temporal pulse shaping. Our result also sheds light on the fundamental relativistic transparency process, crucial for producing secondary particle and light sources.

A very high energy hadron collider on the Moon

The long-term prospect of building a hadron collider around the circumference of a great circle of the Moon is sketched. A Circular Collider on the Moon (CCM) of ~11000 km in circumference could reach a proton-proton center-of-mass collision energy of 14 PeV --- a thousand times higher than the Large Hadron Collider at CERN --- optimistically assuming a dipole magnetic field of 20 T. Several aspects of such a project are presented, including siting, construction, availability of necessary materials on the Moon, and powering, as well as a discussion of future studies and further information needed to determine the more concrete feasibility of each. Machine parameters and vacuum requirements are explored, and an injection scheme is delineated. Other unknowns are set down. Due to the strong interest from multiple organizations in establishing a permanent Moon presence, a CCM could be the (next-to-) next-to-next-generation discovery machine and a natural successor to next-generation machines, such as the proposed Future Circular Collider at CERN or a Super Proton-Proton Collider in China, and other future machines, such as a Collider in the Sea, in the Gulf of Mexico. A CCM would serve as an important stepping stone towards a Planck-scale collider sited in our Solar System.

Gamma-Ray Bursts at TeV Energies: Observational Status

Gamma-ray bursts (GRBs) are some of the most energetic events in the Universe and are potential sites of cosmic ray acceleration up to the highest energies. GRBs have therefore been a target of interest for very high energy gamma-ray observatories for many years, leading to the recent discovery of a number of bursts with photons reaching energies above 100 GeV. We summarize the GRB observational campaigns of the current generation of very high energy gamma-ray observatories as well as describing the observations and properties of the GRBs discovered so far. We compare the properties of the very high energy bursts to the total GRB distribution and make predictions for the next generation of very high energy gamma-ray observations.

Black Hole Flares: Ejection of Accreted Magnetic Flux through 3D Plasmoid-mediated Reconnection

Magnetic reconnection can power bright, rapid flares originating from the inner magnetosphere of accreting black holes. We conduct extremely high-resolution (5376 × 2304 × 2304 cells) general-relativistic magnetohydrodynamics simulations, capturing plasmoid-mediated reconnection in a 3D magnetically arrested disk for the first time. We show that an equatorial, plasmoid-unstable current sheet forms in a transient, nonaxisymmetric, low-density magnetosphere within the inner few Schwarzschild radii. Magnetic flux bundles escape from the event horizon through reconnection at the universal plasmoid-mediated rate in this current sheet. The reconnection feeds on the highly magnetized plasma in the jets and heats the plasma that ends up trapped in flux bundles to temperatures proportional to the jet’s magnetization. The escaped flux bundles can complete a full orbit as low-density hot spots, consistent with Sgr A* observations by the GRAVITY interferometer. Reconnection near the horizon produces sufficiently energetic plasma to explain flares from accreting black holes, such as the TeV emission observed from M87. The drop in the mass accretion rate during the flare and the resulting low-density magnetosphere make it easier for very-high-energy photons produced by reconnection-accelerated particles to escape. The extreme-resolution results in a converged plasmoid-mediated reconnection rate that directly determines the timescales and properties of the flare.

Radiation and Polarization Signatures from Magnetic Reconnection in Relativistic Jets. II. Connection with γ-Rays

It is commonly believed that blazar jets are relativistic magnetized plasma outflows from supermassive black holes. One key question is how the jets dissipate magnetic energy to accelerate particles and drive powerful multiwavelength flares. Relativistic magnetic reconnection has been proposed as the primary plasma physical process in the blazar emission region. Recent numerical simulations have shown strong acceleration of nonthermal particles that may lead to multiwavelength flares. Nevertheless, previous works have not directly evaluated γ-ray signatures from first-principles simulations. In this paper, we employ combined particle-in-cell and polarized radiation transfer simulations to study multiwavelength radiation and optical polarization signatures under the leptonic scenario from relativistic magnetic reconnection. We find harder-when-brighter trends in optical and Fermi-LAT γ-ray bands as well as closely correlated optical and γ-ray flares. The swings in optical polarization angle are also accompanied by γ-ray flares with trivial time delays. Intriguingly, we find highly variable synchrotron self-Compton signatures due to inhomogeneous particle distributions during plasmoid mergers. This feature may result in fast γ-ray flares or orphan γ-ray flares under the leptonic scenario, complementary to the frequently considered minijet scenario. It may also imply neutrino emission with low secondary synchrotron flux under the hadronic scenario, if plasmoid mergers can accelerate protons to very high energy.

Deep Seated Tumour Treatments With Electrons of High Energy Delivered at FLASH Rates: The Example of Prostate Cancer

Different therapies are adopted for the treatment of deep seated tumours in combination or as an alternative to surgical removal or chemotherapy: radiotherapy with photons (RT), particle therapy (PT) with protons or even heavier ions like 12C, are now available in clinical centres. In addition to these irradiation modalities, the use of Very High Energy Electron (VHEE) beams (100–200 MeV) has been suggested in the past, but the diffusion of that technique was delayed due to the needed space and budget, with respect to standard photon devices. These disadvantages were not paired by an increased therapeutic efficacy, at least when comparing to proton or carbon ion beams. In this contribution we investigate how recent developments in electron beam therapy could reshape the treatments of deep seated tumours. In this respect we carefully explored the application of VHEE beams to the prostate cancer, a well-known and studied example of deep seated tumour currently treated with high efficacy both using RT and PT. The VHEE Treatment Planning System was obtained by means of an accurate Monte Carlo (MC) simulation of the electrons interactions with the patient body. A simple model of the FLASH effect (healthy tissues sparing at ultra-high dose rates), has been introduced and the results have been compared with conventional RT. The study demonstrates that VHEE beams, even in absence of a significant FLASH effect and with a reduced energy range (70–130 MeV) with respect to implementations already explored in literature, could be a good alternative to standard RT, even in the framework of technological developments that are nowadays affordable.

Gamma-ray Bursts at the Highest Energies

Emission from Gamma-ray bursts is thought to be powered mainly by synchrotron radiation from energetic electrons. The same electrons might scatter these synchrotron seed photons to higher (>10 GeV) energies, building a distinct spectral component (synchrotron self-Compton, SSC). This process is expected to take place, but its relevance (e.g., the ratio between the SSC and synchrotron emitted power) is difficult to predict on the basis of current knowledge of physical conditions at GRB emission sites. Very high-energy radiation in GRBs can be produced also by other mechanisms, such as synchrotron itself (if PeV electrons are produced at the source), inverse Compton on external seed photons, and hadronic processes. Recently, after years of efforts, very high-energy radiation has been finally detected from at least four confirmed long GRBs by the Cherenkov telescopes H.E.S.S. and MAGIC. In all four cases, the emission has been recorded during the afterglow phase, well after the end of the prompt emission. In this work, I give an overview, accessible also to non-experts of the field, of the recent detections, theoretical implications, and future challenges, with a special focus on why very high-energy observations are relevant for our understanding of Gamma-ray bursts and which long-standing questions can be finally answered with the help of these observations.