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Daley-Yates P, Keppler B, Baines A, Bardsley G, Fingleton J. Metabolomic changes related to airway inflammation, asthma pathogenesis and systemic activity following inhaled fluticasone furoate/vilanterol: a randomized controlled trial. Respir Res 2022; 23:258. [PMID: 36127726 PMCID: PMC9487108 DOI: 10.1186/s12931-022-02164-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fluticasone furoate/vilanterol trifenatate (FF/VI) is an inhaled therapy for the treatment of asthma, with a prolonged duration of anti-inflammatory and bronchodilatory action. This study investigated the global metabolomic and lipidomic profile following treatment with FF/VI or placebo and assessed whether changes correlated with exhaled nitric oxide levels as a measure of airway inflammation. METHODS This was a single-center, randomized, double-blind, placebo-controlled, two-period, crossover, repeat-dose study. Adults with asthma (forced expiratory volume in 1 s ≥ 60% predicted; fraction of exhaled nitric oxide [FeNO] > 40 parts per billion) received once-daily FF/VI 100 µg/25 µg or placebo for 14 days, followed by a 21-day washout period. Serum samples were taken at pre-dose (T1), and 15 and 21 days (T2 and T3, respectively) post dose in each period. The metabolomic and lipidomic profiles were analyzed by liquid chromatography with tandem mass spectrometry and polar liquid chromatography platforms, and ions were matched to a library of standards for metabolite identification and quantification. FeNO values at each timepoint were evaluated for correlations with the biochemical data. RESULTS Of 27 randomized participants (mean age 24.5 years, 63% male), 26 provided serum samples for metabolomic analysis. A total of 1969 metabolites were identified, 1634 of which corresponded to a named structure in a reference library. Treatment-related changes in the metabolome were generally subtle, with a modest increase in metabolite perturbations across timepoints. The percentage of metabolites with significant changes (p < 0.05 for all) (increases↑/decreases↓) versus placebo were: 2.1% (1.1%↑/1.0%↓), 6.7% (0.46%↑/6.2%↓) and 11.8% (0.86%↑/10.9%↓) at T1, T2 and T3, respectively. Treatment with FF/VI reduced FeNO levels by 60%, whereas the systemic intermediates involved in NO biosynthesis remained unaffected. Evidence of systemic anti-inflammatory activity was seen in complex lipid pathways, suggesting reduced phospholipase-A2 activity, but without downstream impact on free fatty acids or inflammatory mediators. Consistent with the pathogenesis of asthma, there was evidence of higher fatty acid β-oxidation and lower glycolysis in the placebo arm; this pattern was reversed in the treatment arm. CONCLUSIONS Despite the prolonged airway anti-inflammatory action of FF/VI, this was accompanied by only subtle systemic metabolomic and lipidomic changes. Trial registration Prospectively registered on ClinicalTrials.gov registry number NCT02712047.
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Affiliation(s)
- Peter Daley-Yates
- Respiratory Clinical Development, GSK Research and Development, Stockley Park West, 1-3 Ironbridge Road, Uxbridge, Middlesex, UB11 1BT, UK.
| | - Brian Keppler
- Metabolon Inc., 617 Davis Drive, Suite 100, Morrisville, NC, 27560, USA
| | - Amanda Baines
- Medicines Development Centre, GSK Research and Development, Stevenage, UK
| | - George Bardsley
- Tauranga Hospital, 829 Cameron Road, Tauranga South, Tauranga, 3112, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Bardsley G, Pilcher J, McKinstry S, Shirtcliffe P, Berry J, Fingleton J, Weatherall M, Beasley R. Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial. BMC Pulm Med 2018; 18:157. [PMID: 30285695 PMCID: PMC6171193 DOI: 10.1186/s12890-018-0720-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In exacerbations of chronic obstructive pulmonary disease, administration of high concentrations of oxygen may cause hypercapnia and increase mortality compared with oxygen titrated, if required, to achieve an oxygen saturation of 88-92%. Optimally titrated oxygen regimens require two components: titrated supplemental oxygen to achieve the target oxygen saturation and, if required, bronchodilators delivered by air-driven nebulisation. The effect of repeated air vs oxygen-driven bronchodilator nebulisation in acute exacerbations of chronic obstructive pulmonary disease is unknown. We aimed to compare the effects of air versus oxygen-driven bronchodilator nebulisation on arterial carbon dioxide tension in exacerbations of chronic obstructive pulmonary disease. METHODS A parallel group double-blind randomised controlled trial in 90 hospital in-patients with an acute exacerbation of COPD. Participants were randomised to receive two 2.5 mg salbutamol nebulisers, both driven by air or oxygen at 8 L/min, each delivered over 15 min with a 5 min interval in-between. The primary outcome measure was the transcutaneous partial pressure of carbon dioxide at the end of the second nebulisation (35 min). The primary analysis used a mixed linear model with fixed effects of the baseline PtCO2, time, the randomised intervention, and a time by intervention interaction term; to estimate the difference between randomised treatments at 35 min. Analysis was by intention-to-treat. RESULTS Oxygen-driven nebulisation was terminated in one participant after 27 min when the PtCO2 rose by > 10 mmHg, a predefined safety criterion. The mean (standard deviation) change in PtCO2 at 35 min was 3.4 (1.9) mmHg and 0.1 (1.4) mmHg in the oxygen and air groups respectively, difference (95% confidence interval) 3.3 mmHg (2.7 to 3.9), p < 0.001. The proportion of patients with a PtCO2 change ≥4 mmHg during the intervention was 18/45 (40%) and 0/44 (0%) for oxygen and air groups respectively. CONCLUSIONS Oxygen-driven nebulisation leads to an increase in PtCO2 in exacerbations of COPD. We propose that air-driven bronchodilator nebulisation is preferable to oxygen-driven nebulisation in exacerbations of COPD. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry number ACTRN12615000389505 . Registration confirmed on 28/4/15.
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Affiliation(s)
- George Bardsley
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - Janine Pilcher
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Steven McKinstry
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Philippa Shirtcliffe
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - James Berry
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Wellington School of Medicine & Health Sciences, University of Otago Wellington, Wellington, New Zealand
| | - James Fingleton
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
| | - Mark Weatherall
- Wellington School of Medicine & Health Sciences, University of Otago Wellington, Wellington, New Zealand
| | - Richard Beasley
- Capital and Coast District Health Board, Wellington, New Zealand
- Medical Research Institute of New Zealand, Box 7902, Wellington, PO 6242 New Zealand
- Victoria University Wellington, Wellington, New Zealand
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Bardsley G, Daley-Yates P, Baines A, Kempsford R, Williams M, Mallon T, Braithwaite I, Riddell K, Joshi S, Bareille P, Beasley R, Fingleton J. Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomised controlled trial. Respir Res 2018; 19:133. [PMID: 30001712 PMCID: PMC6044077 DOI: 10.1186/s12931-018-0836-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fluticasone furoate/Vilanterol trifenatate (FF/VI) is an inhaled corticosteroid/long-acting beta-agonist combination with a prolonged bronchodilator duration of action. We characterised the time-course of onset and offset of airway anti-inflammatory action of FF/VI, as assessed by fraction of exhaled nitric oxide (FeNO), and compared this to the bronchodilator duration of action. METHODS A single-centre, randomised, double-blind, placebo-controlled, two-period, crossover study was undertaken in 28 steroid-naïve adults with asthma. Participants with an FEV1 ≥ 60% predicted, reversible airway disease, and FeNO > 40 ppb received FF/VI 100/25 mcg or placebo once daily for 14 days. FeNO and peak expiratory flow were measured twice-daily during treatment and during a 21-day washout period. FEV1 was measured for five days from treatment cessation. The primary outcome measure was FeNO change from baseline ratio for 21 days following treatment cessation. RESULTS In the 27 subjects who completed the study, median (range) baseline FeNO was 87 ppb (42-212). FF/VI 100/25 mcg reduced FeNO by day 3, ratio FF/VI versus placebo 0.72 (95% confidence interval 0.61-0.86) with the maximum reduction occurring at day 14, 0.32 (0.27-0.37). Following cessation of treatment FeNO remained suppressed for 18 days, ratio on day 18 0.77 (0.59-1.00), whereas improvements in FEV1 and peak flow were maintained for 3 to 4 days post-treatment. CONCLUSIONS The anti-inflammatory duration of action of FF/VI is consistent with the high glucocorticoid receptor affinity and long lung retention of fluticasone furoate. The anti-inflammatory effect of FF/VI was of greater duration than its bronchodilator effect in adults with mild asthma. Funding GlaxoSmithKline (201499). TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov registry number NCT02712047 .
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Affiliation(s)
- George Bardsley
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Peter Daley-Yates
- Respiratory Clinical Development, GlaxoSmithKline Research and Development, Stockley Park, Uxbridge, UK
| | - Amanda Baines
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Rodger Kempsford
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Mathew Williams
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Tony Mallon
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Kylie Riddell
- GlaxoSmithKline Research and Development, 82 Hughes Ave, Ermington, NSW, 2115, Australia
| | | | - Philippe Bareille
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Richard Beasley
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand.
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Abstract
OBJECTIVE To determine the feasibility of a randomised controlled trial (RCT) of rhinothermy for the common cold. DESIGN Open label, randomised, controlled feasibility study. SETTING Single-centre research institute in New Zealand recruiting participants from the community. PARTICIPANTS 30 adult participants with symptoms of a common cold, presenting within 48 hours of the onset of symptoms. INTERVENTIONS Participants were randomly assigned 2:1 to receive either 35 L/min of 100% humidified air at 41°C via high flow nasal cannulae, 2 hours per day for up to 5 days (rhinothermy), or vitamin C 250 mg daily for 5 days (control). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of screened candidates who were randomised. Secondary outcomes included: proportion of randomised participants who completed the study; modified Jackson scores from randomisation to 10 days after initiation of randomised regimen; time until feeling 'a lot better' compared with study entry; time until resolution of symptoms or symptom score at 10 days postrandomisation; proportion of organisms identified by PCR analysis of nasal swabs taken at baseline; the patterns of use of the rhinothermy device; estimated adherence of the control group; and rhinothermy device tolerability. RESULTS In all 30/79 (38%, 95% CI 27% to 50%) of potential participants screened for eligibility were randomised. Rhinothermy was well tolerated, and all randomised participants completed the study (100%, 95% CI 88% to 100%). The reduction from baseline in the modified Jackson score was greater with rhinothermy compared with control at days 2, 3, 4, 5 and 6, with the maximum difference at day 4 (-6.4, 95% CI -9.4 to -3.3). The substantial clinical benefit threshold for modified Jackson score was a 5-unit change. CONCLUSIONS This study shows that an RCT of rhinothermy compared with low-dose vitamin C in the treatment of the common cold is feasible. TRIAL REGISTRATION NUMBER ACTRN12616000470493; Results.
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Affiliation(s)
- Susanne van de Hei
- Medical Research Institute of New Zealand, Wellington, New Zealand
- University of Groningen, Groningen, The Netherlands
| | - Steven McKinstry
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - George Bardsley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Mark Weatherall
- Capital and Coast District Health Board, Wellington, New Zealand
- University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
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Pilcher J, Richards M, Eastlake L, McKinstry SJ, Bardsley G, Jefferies S, Braithwaite I, Weatherall M, Beasley R. High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial. Med J Aust 2017; 207:430-434. [PMID: 29129174 DOI: 10.5694/mja17.00270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the effects on transcutaneous carbon dioxide tension (Ptco2) of high concentration and titrated oxygen therapy in medical inpatients with morbid obesity who were not selected for a pre-existing diagnosis of obesity hypoventilation syndrome. DESIGN A randomised, crossover trial undertaken between February and September 2015. SETTING Internal medicine service, Wellington Regional Hospital, New Zealand. PARTICIPANTS 22 adult inpatients, aged 16 years or more, with a body mass index exceeding 40 kg/m<sup>2</sup>. INTERVENTIONS Participants received in random order two 60-minute interventions, with a minimum 30-minute washout period between treatments: titrated oxygen therapy (oxygen delivered, if required, via nasal prongs to achieve peripheral oxygen saturation [Spo2] of 88-92%), and high concentration oxygen therapy (delivered via Hudson mask at 8 L/min, without regard to Spo2). Ptco2 and Spo2 were recorded at 10-minute intervals. MAIN OUTCOME MEASURE Ptco2 at 60 minutes, adjusted for baseline. RESULTS Baseline Ptco2 was 45 mmHg or lower for 16 participants with full data (73%). The mean difference in Ptco2 between high concentration and titrated oxygen therapy at 60 minutes was 3.2 mmHg (95% CI, 1.3-5.2 mmHg; P = 0.002). CONCLUSION High concentration oxygen therapy increases Ptco2 in morbidly obese patients. Our findings support guidelines that advocate oxygen therapy, if required in patients with morbid obesity, be titrated to achieve a target Spo2 of 88-92%. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12610000522011.
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Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Leonie Eastlake
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - George Bardsley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Sarah Jefferies
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Mark Weatherall
- Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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McKinstry S, Pilcher J, Bardsley G, Berry J, Van de Hei S, Braithwaite I, Fingleton J, Weatherall M, Beasley R. Nasal high flow therapy and PtCO2in stable COPD: A randomized controlled cross-over trial. Respirology 2017; 23:378-384. [DOI: 10.1111/resp.13185] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/06/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Steven McKinstry
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - George Bardsley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - James Berry
- Medical Research Institute of New Zealand; Wellington New Zealand
| | | | - Irene Braithwaite
- Medical Research Institute of New Zealand; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
| | - Mark Weatherall
- Capital and Coast District Health Board; Wellington New Zealand
- School of Medicine and Health Sciences; University of Otago Wellington; Wellington New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
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Bardsley G. Short reports of the latest research in Medical Education. Clinical Teacher 2007. [DOI: 10.1111/j.1743-498x.2007.00155_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Landen OL, Glenzer S, Froula D, Dewald E, Suter LJ, Schneider M, Hinkel D, Fernandez J, Kline J, Goldman S, Braun D, Celliers P, Moon S, Robey H, Lanier N, Glendinning G, Blue B, Wilde B, Jones O, Schein J, Divol L, Kalantar D, Campbell K, Holder J, McDonald J, Niemann C, Mackinnon A, Collins R, Bradley D, Eggert J, Hicks D, Gregori G, Kirkwood R, Niemann C, Young B, Foster J, Hansen F, Perry T, Munro D, Baldis H, Grim G, Heeter R, Hegelich B, Montgomery D, Rochau G, Olson R, Turner R, Workman J, Berger R, Cohen B, Kruer W, Langdon B, Langer S, Meezan N, Rose H, Still B, Williams E, Dodd E, Edwards J, Monteil MC, Stevenson M, Thomas B, Coker R, Magelssen G, Rosen P, Stry P, Woods D, Weber S, Alvarez S, Armstrong G, Bahr R, Bourgade JL, Bower D, Celeste J, Chrisp M, Compton S, Cox J, Constantin C, Costa R, Duncan J, Ellis A, Emig J, Gautier C, Greenwood A, Griffith R, Holdner F, Holtmeier G, Hargrove D, James T, Kamperschroer J, Kimbrough J, Landon M, Lee D, Malone R, May M, Montelongo S, Moody J, Ng E, Nikitin A, Pellinen D, Piston K, Poole M, Rekow V, Rhodes M, Shepherd R, Shiromizu S, Voloshin D, Warrick A, Watts P, Weber F, Young P, Arnold P, Atherton L, Bardsley G, Bonanno R, Borger T, Bowers M, Bryant R, Buckman S, Burkhart S, Cooper F, Dixit S, Erbert G, Eder D, Ehrlich B, Felker B, Fornes J, Frieders G, Gardner S, Gates C, Gonzalez M, Grace S, Hall T, Haynam C, Heestand G, Henesian M, Hermann M, Hermes G, Huber S, Jancaitis K, Johnson S, Kauffman B, Kelleher T, Kohut T, Koniges AE, Labiak T, Latray D, Lee A, Lund D, Mahavandi S, Manes KR, Marshall C, McBride J, McCarville T, McGrew L, Menapace J, Mertens E, Munro D, Murray J, Neumann J, Newton M, Opsahl P, Padilla E, Parham T, Parrish G, Petty C, Polk M, Powell C, Reinbachs I, Rinnert R, Riordan B, Ross G, Robert V, Tobin M, Sailors S, Saunders R, Schmitt M, Shaw M, Singh M, Spaeth M, Stephens A, Tietbohl G, Tuck J, Van Wonterghem B, Vidal R, Wegner P, Whitman P, Williams K, Winward K, Work K, Wallace R, Nobile A, Bono M, Day B, Elliott J, Hatch D, Louis H, Manzenares R, O'Brien D, Papin P, Pierce T, Rivera G, Ruppe J, Sandoval D, Schmidt D, Valdez L, Zapata K, MacGowan B, Eckart M, Hsing W, Springer P, Hammel B, Moses E, Miller G. The first experiments on the national ignition facility. ACTA ACUST UNITED AC 2006. [DOI: 10.1051/jp4:2006133009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- G Bardsley
- Tayside Rehabilitation Engineering Services, Dundee Limb Fitting Centre.
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