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An eight-cavity, 1.3 GHz, SLAC linac coherent light source II High Energy cryomodule was assembled and tested at Fermilab to verify performance before the start of production. Its cavities were processed with a novel nitrogen doping treatment to improve gradient performance. The cryomodule was tested with a modified protocol to process sporadic quenches, which were observed in Linac Coherent Light Source II production cryomodules and are attributed to multipacting. Dedicated vertical test experiments support the attribution to multipacting. The verification cryomodule achieved an acceleration voltage of 200 MV in continuous wave mode, corresponding to an average accelerating gradient of 24.1 MV/m, significantly exceeding the specification of 173 MV. The average Q0 (3.0×1010) also exceeded its specification (2.7×1010). After processing, no field emission was observed up to the maximum gradient of each cavity. This paper reviews the cryomodule performance and discusses operational issues and mitigations implemented during the several month program.

Background: Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this., Objective: This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients' correct pronouns., Methods: A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients' correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology., Results: Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions., Conclusion: The study identifies important barriers to medical professionals correctly using TGNB patients' pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns., (© 2024. The Author(s).)

Sex and gender diverse (SGD) neurology trainees include transgender, nonbinary, and intersex people. There has been historical exclusion of SGD trainees from participating in clinical care, medical research, and academic training programs. Therefore, neurology educators have unique opportunities to support SGD trainees and colleagues, but may lack the education to appropriately do so. Training programs and professional organizations can collaborate to create safe pathways for SGD trainees to disclose their identities in professional settings. Referral to community support and resources is important for SGD trainees considering professional disclosure. Educators should address the challenges and discrimination unique to SGD graduate trainees in neurology, such as lack of inclusion, affirming environments, supportive policies, and medical accommodations. Faculty training on sensitivity, bias, and bystander effects should be ongoing among institutions. Topics regarding sex and gender diversity are lacking in graduate medical education. Educational curricula often use outdated terminology or binary paradigms to teach about sex and gender. Health care training inequities may cause downstream harm to SGD patients; therefore, training curricula that are reflective of an accurate and affirming understanding of sex and gender may mitigate the potential for inequities. This article provides recommendations to support SGD neurology trainees and to incorporate specific training on sex and gender diversity in academic neurology curricula. Such support is critical to the career success and development of SGD neurology trainees.