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The shape of a plasma meniscus is a key factor to determine the beam focusing. The physics model of the meniscus formation for hydrogen negative ion sources has not been established yet. A backward trajectory calculation based on experimental observation is performed in order to derive the particle information at the meniscus. It is observed that the negative ion density is spatially nonuniform in the direction parallel to the magnets for suppression of co-extracted electrons. A nonuniformity of the negative ion density in the vicinity of the meniscus is taken into account in the forward trajectory calculation. It reveals that the nonuniform negative ion distribution leads to degradation of the beam focusing and the beam splitting in phase space. The importance of the spatial distribution of negative ions on meniscus modelling is discussed with a comparison to uniform extraction model.

Background Endoscopic transsphenoidal adenomectomy (eTSA) is widely utilized for resection of pituitary adenoma. eTSA patients undergo healing for weeks to months and are potentially at risk for complications. Multidisciplinary follow-up monitoring is necessary. We hypothesized that patients with deviations from the routine postoperative course, broadly termed complications of interest (COI) in this study, following eTSA would increase the duration of follow-up in the rhinology clinic. Methods Retrospective review was performed on patients undergoing eTSA for pituitary adenoma from August 2007 to May 2016 at a single tertiary care center. COIs were reviewed for their influence on follow-up time. Results A total of 985 patient records were reviewed (mean age 51.0 ± 15.7 years, 55.2% female), of which, 21.1% of patients had a deviation from the expected postoperative course (7.0% rhinologic, 10.8% surgical, 0.6% perioperative medical, and 2.7% endocrinologic COIs). The most common COI was cerebrospinal fluid leak 5.6% (n = 55) followed by sinusitis 5.0% (n = 49). Moreover, 935 patients (94.9%) attended rhinology follow-up (172 patients with COI). For patients seen postoperatively by the rhinology service, COIs significantly increased the number of rhinologic follow-up visits (median 2 [interquartile range, IQR: 2–3] vs 3 visits [IQR: 2–4], P Conclusions Patients who develop postoperative complications after eTSA have significantly extended follow-up with the multidisciplinary team.

Bud dormancy allows most temperate fruit tree species, including sweet cherry (Prunus avium), to avoid cold injury and synchronize their annual growth patterns. The progression of bud dormancy release is influenced by environmental factors, including chilling accumulation. Global climate changes may affect bud dormancy release, resulting in an irregular bud break. Thus, a more thorough characterization of dormancy is required. The peach (Prunus persica) and Japanese apricot (Prunus mume) genomes contain at least six DORMANCY-ASSOCIATED MADS-box (DAM) genes that may have important roles related to bud dormancy regulation. The DAM gene expression levels are diverse among species. For example, peach DAM1, 2, and 4 expression levels are up-regulated during terminal bud formation, while peach and P. mume DAM5 and 6 expression levels are down-regulated during dormancy release. In this study, we first identified six sweet cherry DAM genes (PavDAM1-6) by mapping short-read transcript sequences for dormant 'Satonishiki' flower buds against reference gene sequences (PmDAM1-6). We then conducted quantitative real-time polymerase chain reaction analyses of PavDAM4-6 expression in 'Satonishiki' lateral buds collected at low-, medium-, and high-chill regions in Japan between November and March. PavDAM4 expression was first up-regulated as chilling accumulated and then down-regulated. In contrast, PavDAM6 expression was down-regulated from November onward. The expression of PavDAM4 was up-regulated faster at high- and medium-chill locations than at the low-chill location where chilling accumulated slowly. The PavDAM5-6 expression patterns were similar at all three locations. These results suggest that chilling treatments induce distinct changes to the expression of PavDAM genes.

Placing a transanal endoscopic rectal purse-string suture (taEPS) is the crucial first component of transanal total mesorectal excision (taTME). However, no structured training is available to improve the procedure-specific skills for taEPS. The aim of this study was to create a performance rubric to improve taEPS skills and provide preliminary evidence for its validity.A performance rubric was created based on technical considerations for taEPS, identified by consulting with taTME surgical and performance assessment experts. Ten independent, blinded raters assessed 10 videotaped taEPS procedures of consecutive taTME cases, at National Cancer Center Hospital East (NCCHE), Chiba, Japan, in January 2018-March 2019 using the rubric and the Global Operative Assessment of Laparoscopic Skills (GOALS). Internal consistency and inter-rater reliabilities were calculated. Videotaped taEPS procedures were timed and assessed by the rubric. Correlation between rubric scores and suturing times were analyzed.The rubric consists of four items: loading the needle (LN), atraumatic needle passage (AP), planned suture path (PS), and overall performance (OA). Videotaped performances were graded on a 3-point Likert scale; scores were calculated as sums of the points. Cronbach's α for internal consistency was 0.713. Inter-rater reliabilities were LN: 0.73, AP: 0.76, PS: 0.71, and OA: 0.70. Rubric and GOALS scores were strongly correlated (r = 0.964, p 0.001). In 112 consecutive taEPS performances, rubric scores were strongly correlated with suturing time (r = - 0.69, p 0.001). Surgeons' experience with taTME was associated with rubric scores and suturing time.This study provides preliminary validation for the taEPS skill performance rubric. The rubric's structured training may facilitate skill acquisition by providing trainees with critical clinical considerations.

Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit‐to‐visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2‐year follow‐up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all‐cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP‐SD (P =0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36–4.97, P =0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11–3.07, P =0.018 for all‐cause death) after adjusting for components of the CHA 2 DS 2 ‐VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP‐coefficient of variation was used instead of BP‐SD. Conclusions Systolic BP visit‐to‐visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique Identifier: UMIN000001569.

Sputtering yields of molybdenum (Mo) are computed for deuterium, oxygen and carbon as impurity ions from the residual gas of the vacuum system, as well as Mo and Cs using Yamamura formula. The incident ion energy ranges from 10 keV to 1 MeV, the back-streaming ion beam energy from the extraction voltage up to ITER full acceleration potential. The sputtering yield of Cs against Mo reached ten atoms per ion and was the largest among the investigated ion species. The effect due to retention of deuterons in Mo was studied for the case of grazing angle incidence of D+ at D- ion extraction energy to confirm the small effect onto the sputtering yield; the result obtained for 10 keV D+ for 10% retention of D atoms in Mo increased the sputtering yield only by 2%. The back-streaming D+ ions at 1 MeV energy should make a layer of high concentration deuterium atoms at 6 µm depth from the Mo surface. Possible failure mode associated with the particle implantation is discussed.

The extraction mechanism of negative ion beams is affected by the behavior of positive and negative ions near the extraction apertures. Flow of the charged particles in a hydrogen discharge were measured with a newly developed directional photodetachment probe which has a single probe tip. Compared with our previous multiple-tip directional probe, the single-tip directional probe was able to measure fine flow structure of the positive and the negative ions without spatial ambiguity associated with electron deflection magnetic field and density gradient. The single-tip probe observed the turning of the flow of the negative hydrogen ion by increasing the bias voltage in the extraction region of the negative ion source.

Patients lacking functional adenosine deaminase activity have severe combined immunodeficiency (ADA SCID), which can be treated with ADA enzyme replacement therapy (ERT), allogeneic hematopoietic stem cell transplantation (HSCT), or autologous HSCT with gene-corrected cells (gene therapy [GT]). A cohort of 10 ADA SCID patients, aged 3 months to 15 years, underwent GT in a phase 2 clinical trial between 2009 and 2012. Autologous bone marrow CD34+ cells were transduced ex vivo with the MND (myeloproliferative sarcoma virus, negative control region deleted, dl587rev primer binding site)–ADA gammaretroviral vector (gRV) and infused following busulfan reduced-intensity conditioning. These patients were monitored in a long-term follow-up protocol over 8 to 11 years. Nine of 10 patients have sufficient immune reconstitution to protect against serious infections and have not needed to resume ERT or proceed to secondary allogeneic HSCT. ERT was restarted 6 months after GT in the oldest patient who had no evidence of benefit from GT. Four of 9 evaluable patients with the highest gene marking and B-cell numbers remain off immunoglobulin replacement therapy and responded to vaccines. There were broad ranges of responses in normalization of ADA enzyme activity and adenine metabolites in blood cells and levels of cellular and humoral immune reconstitution. Outcomes were generally better in younger patients and those receiving higher doses of gene-marked CD34+ cells. No patient experienced a leukoproliferative event after GT, despite persisting prominent clones with vector integrations adjacent to proto-oncogenes. These long-term findings demonstrate enduring efficacy of GT for ADA SCID but also highlight risks of genotoxicity with gRVs. This trial was registered at www.clinicaltrials.gov as #NCT00794508.

An isotope effect of negative ion motion in plasma near a plasma grid (PG), which is a plasma-beam boundary grid, has been investigated in a negative hydrogen-ion source with the surface production process of the negative ion on the PG surface. Negative deuterium-ion (D-) density was higher than negative hydrogen-ion (H-) density in the condition without extraction-grid bias (V egb) and approached the H- density in the condition with V egb. Thus, the D- density responded stronger than the H- density to the V egb. The density of the negative hydrogen-ion isotopes and the density response to the V egb have been organized into respective identical trends by momenta of isotopes emitting from the PG. The Larmor motion can be a dominant mechanism of the negative ion transport from the PG to the plasma.

Flows of the charged particles in hydrogen (H) and deuterium (D) plasmas were measured with the single-tip directional Langmuir probe. The flow patterns of positive and negative ions have been constructed from the data by moving the probe near the plasma grid. The positive ion flow from driver to extraction regions showed the different velocity equivalent to the mass difference between H and D. The negative ion flow indicated the surface production of negative ions on the plasma grid, and changed the direction corresponding to the magnitude of the extraction electric field.

The structure of Cu

We are developing a neutron polarizer with polarized $^3$He gas, referred to as a $^3$He spin filter, based on the Spin Exchange Optical Pumping (SEOP) for polarized neutron scattering experiments at Materials and Life Science Experimental Facility (MLF) of Japan Proton Accelerator Research Complex (J-PARC). A $^3$He gas-filling station was constructed at J-PARC, and several $^3$He cells with long spin relaxation times have been fabricated using the gas-filling station. A laboratory has been prepared in the MLF beam hall for polarizing $^3$He cells, and compact pumping systems with laser powers of 30~W and 110~W, which can be installed onto a neutron beamline, have been developed. A $^3$He polarization of 85% was achieved at a neutron beamline by using the pumping system with the 110~W laser. Recently, the first user experiment utilizing the $^3$He spin filter was conducted, and there have been several more since then. The development and utilization of $^3$He spin filters at MLF of J-PARC are reported., Comment: 9 pages, 15 figures

Objective Patients undergoing endoscopic transsphenoidal adenomectomy (eTSA) for pituitary tumors are at risk for postoperative complications, including rhinosinusitis. We aimed to determine if preoperative sinonasal disease is a risk factor for postoperative rhinosinusitis (PRS). Study Design Retrospective review. Setting Tertiary academic center in U.S. Subjects and Methods Patients with a diagnosis of pituitary adenoma who underwent eTSA between 2007-2016. PRS patients were matched to non-PRS patients or sex, age, tumor size, skull base reconstruction with intranasal tissue grafting, and concurrent septoplasty. Groups were statistically analyzed for potential preoperative risk factors of sinonasal disease (patient-reported, radiographic, endoscopic). Results 49 of 987 patients who underwent eTSA developed PRS (44.9% male, 71.4% Caucasian, mean age 49.3y). On analysis of individual risk factors, there was a significantly higher proportion of patients with a history of prior sinonasal surgery in the PRS group than the non-PRS group (25.5% vs. 6.5%, p = 0.01); however, this group difference became insignificant on multivariate analysis. There were no significant group differences with regard to history of sinus infections, nasal symptoms, seasonal allergies, radiographic abnormalities, or sinonasal disease on endoscopy. Conclusion This is the first study to investigate preoperative sinonasal disease as a risk factor for PRS after eTSA. The risk factors considered did not demonstrate definitive risk for PRS, although a history of prior sinonasal surgery should be investigated further.

Task-based functional MRI (fMRI) is a common non-invasive method of confirming hemispheric language dominance prior to neurosurgery in epilepsy. However, the use of this method is not recommended for individuals with cognitive dysfunction and in those with IQ below 70 due to concerns about accuracy of task performance in the scanner. This manuscript describes successful use of task-based functional MRI to lateralize language dominance in two individuals with cognitive dysfunction and intellectual disability.Two patients completed a pre-surgical epilepsy work-up at the QEII Health Sciences Centre in Halifax, Nova Scotia, which included comprehensive neuropsychological assessment. They also completed an fMRI paradigm that involved semantic category fluency, sentence completion, naming to description and passage listening tasks with stimuli delivered both visually and auditorily.In both cases, fMRI maps were successful in lateralizing language dominance in relation to other clinical data, including intraoperative cortical mapping in one of the cases.This manuscript is the first to demonstrate that task-based fMRI can be used successfully to lateralize language in adult patients with cognitive and intellectual disabilities, and is the first to propose a specific paradigm for this purpose.

Simultaneous measurement of negative ion source plasma and extracted beam is carried out in order to clarify a key plasma parameter governing the meniscus formation in negative ion sources for fusion. The plasma discharge is performed with various discharge powers at different bias voltages in order to vary the plasma parameters. It is shown that the beam width changes along the same curve with respect to the negative ion density at any bias voltage while it varies along different curves with other plasma parameters depending on the bias voltage. This implies that the mechanism of meniscus formation in negative ion sources could be described along the similar manner as positive ion sources.

Shared decision making (SDM) is a collaborative process in which patients, families, and clinicians develop a mutually agreed upon treatment plan when more than one reasonable treatment option exists. This cooperative engagement fosters improvements in patient satisfaction, disease management, and outcomes and also has the capacity to promote evidence-based care. Thus, this seventh installment of our Evidence-Based Medicine in Otolaryngology series focuses on SDM. We introduce SDM, including its potential to reduce decisional conflict and decisional regret, when it should be used, its potential benefits, barriers to implementation, and its role in the management of chronic disease and otolaryngological conditions.

Objectives To investigate the potential association of macrolide antibiotics with sensorineural hearing loss (SNHL) and which agents and dosage may be related. To evaluate whether an optimal treatment exists for reversing SNHL that occurs after macrolide therapy. Study Design Systematic review of the literature. Methods Computerized (PubMed, EMBASE, Cochrane Library) and manual searches were performed to identify human studies of all ages (patients) who received macrolides (intervention, with or without control) and documented SNHL (outcome). All study designs were assessed. Extracted data included macrolide regimen details, as well as the timing, severity, and reversibility of SNHL with drug cessation alone or with additional medical intervention. Study designs and the associated risk of bias were assessed. Results The 44 publications (3 prospective, 41 retrospective) that met these criteria described 78 cases of audiometrically confirmed SNHL. SNHL was associated with oral and intravenous macrolide administration at standard and elevated doses. SNHL was irreversible in six cases, despite macrolide cessation (n = 5) and oral steroid treatment (n = 1). Irreversible SNHL was observed following 2 to 3 days of exposure. SNHL was reversible with macrolide cessation alone in 70 cases. In two cases, macrolide cessation coupled with oral steroid administration restored hearing. Reversible cases improved within hours to days. Nine studies also described 42 cases of subjective patient-reported hearing loss. Limitations in the data arose from study design, related comorbidities, and concomitant drug administration. Conclusion SNHL may follow macrolide exposure, even at standard oral doses. Further research is needed to understand the incidence, prevalence, and biological mechanism of its ototoxicity. Laryngoscope, 128:228–236, 2018

Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P.001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P.001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.

Introduction In Japan, the many of the patients are not able to access the specialized sleep medical facilities for overnight polysomnography(PSG) due to less availability and cost issues. Purpose of the study is to examine whether combination of video monitoring and other clinical examinations can reliably predict the severity of pediatric OSA compared with PSG. Methods Between April 1, 2012 and March 31, 2019, total of 175 children (3-12 years of age, boy 122, girl 53) with SDB were enrolled in this individual prospective-cohort study. In-laboratory based PSG were performed for all patients and sleep stages and respiratory events were manually scored. Video monitoring was performed during PSG. Modified video-recording test scoring system (based on Sivan et al 1996), were scored by laboratory technicians. Other clinical examinations were extracted from each PSG with ENT examinations, cephalogram, and rhinomanometry for all patient Results Multiple linear regression analyses was performed with a forward stepwise approach in which independent predictors that were significantly related to severity of OSA (AHI: 5/hr and 10/hr). Applying the multiple logistic regression analysis, the independent predictors for AHI 5/hr were ODI 3% >3/hr, rhinomanometry (NR>0.5 Pa/cm3/sec), enlargement of tonsils (Brodsky classification more than 2), two video monitoring items and total score, with an accuracy of predictive statistic model was 88.0% (sensitivity 78.3%, and specificity 93.0%). For the severity above AHI 10/hr, the independent predictors were Cephalogram parameter (Fx>84°), Oximetry (ODI 3% >5/hr) and BMI Conclusion Video monitor scoring parameters contributed to predict both AHI 5/hr and 10/hr with good overall sensitivity, specificity and overall accuracy compare with the combination of objective results alone. Instead of PSG, the combination of video scoring system and multiple clinical examinations could potentially provide reliable diagnostic approach for pediatric OSA with high accuracy. These results will support to establish more efficient diagnostic strategy for both patients and physicians Support N/A

Plasmodium infection depletes arginine, the substrate for nitric oxide synthesis, and impairs endothelium-dependent vasodilation. Increased conversion of arginine to ornithine by parasites or host arginase is a proposed mechanism of arginine depletion. We used high-performance liquid chromatography to measure plasma arginine, ornithine, and citrulline levels in Malawian children with cerebral malaria and in mice infected with Plasmodium berghei ANKA with or without the arginase gene. Heavy isotope-labeled tracers measured by quadrupole time-of-flight liquid chromatography-mass spectrometry were used to quantify the in vivo rate of appearance and interconversion of plasma arginine, ornithine, and citrulline in infected mice. Children with cerebral malaria and P. berghei-infected mice demonstrated depletion of plasma arginine, ornithine, and citrulline. Knock out of Plasmodium arginase did not alter arginine depletion in infected mice. Metabolic tracer analysis demonstrated that plasma arginase flux was unchanged by P. berghei infection. Instead, infected mice exhibited decreased rates of plasma arginine, ornithine, and citrulline appearance and decreased conversion of plasma citrulline to arginine. Notably, plasma arginine use by nitric oxide synthase was decreased in infected mice. Simultaneous arginine and ornithine depletion in malaria parasite-infected children cannot be fully explained by plasma arginase activity. Our mouse model studies suggest that plasma arginine depletion is driven primarily by a decreased rate of appearance.

Second deuterium operation of the negative ion based neutral beam injector was performed in 2018 in the large helical device. The electron and ion current ratio improves to Ie/Iacc(D) = 0.31 using the short extraction gap distance of 7 mm between the plasma grid (PG) and the extraction grid (EG). The strength of the magnetic field by the electron deflection magnet installed in the EG increases by 17% at the PG ingress surface, which effectively reduces the electron component in the negative ion rich plasma in the vicinity of PG apertures. The reduction of the electron current made it possible to operate at a high power arc discharge and beam extraction. Then, the deuterium negative ion current increases to 55.4 A with the averaged current density of 233 A/m2. The thermal load on the EG using 7 mm gap distance is 0.6 times smaller than the thermal load using a 8 mm gap caused by the reduction of coextracted electron current. The injection beam power increases to 2.9 MW in the beam line BL3, and the total beam injection power increases to 7 MW by three beam lines in the second deuterium campaign.

The aim of this review is to investigate the growth of diversity and inclusion in global academic dental research with a focus on gender equality. A diverse range of research methodologies were used to conduct this review, including an extensive review of the literature, engagement of key informants in dental academic leadership positions around the world, and review of current data from a variety of national and international organizations. Results provide evidence of gender inequalities that currently persist in dental academics and research. Although the gender gap among graduating dental students in North America and the two most populous countries in Europe (the United Kingdom and France) has been narrowed, women make up 30% to 40% of registered dentists in countries throughout Europe, Oceania, Asia, and Africa. In academic dentistry around the globe, greater gender inequality was found to correlate with higher ranking academic and leadership positions in the United States, United Kingdom, several countries in European Union, Japan, and Saudi Arabia. Further disparities are noted in the dental research sector, where women make up 33% of dental researchers in the European Union, 35% in North America, 55% in Brazil, and 25% in Japan. Family and societal pressures, limited access to research funding, and lack of mentoring and leadership training opportunities are reported as also contributing to gender inequalities. To continue advancing gender equality in dental academia and research, efforts should be geared toward the collection and public dissemination of data on gender-specific distributions. Such evidence-driven information will guide the selection of future strategies and best practices for promoting gender equity in the dental workforce, which provides a major pipeline of researchers and scholars for the dental profession.

To compare surgical outcomes between 2 techniques for cribriform cerebrospinal fluid leak (CSF) repair with middle turbinate preservation (MTP) vs middle turbinate resection (MTR). A secondary outcome is to examine the effectiveness of collagen dura matrix (CDM) as a grafting material for repair of isolated cribriform skull base defects.A retrospective chart review was performed of consecutive patients who underwent cribriform CSF repair at Emory University over the past 15 years.Tertiary care rhinology practice.Adult patients with cribriform defects limited to the cribriform plate that did not extend lateral to the middle turbinate (MT) and were reconstructed with a free graft (mucosal or synthetic).Patients were stratified into 2 primary groups by surgical technique: MTP vs MTR. A subset of patients underwent repair with CDM alone and was analyzed separately for CSF repair failure rate.Of 68 patients identified with cribriform defects, 42 underwent repair with MTP and 26 underwent repair with MTR. Average follow-up time was 495 days. Patients with idiopathic intracranial hypertension were also equally distributed (We present an effective method for repair of cribriform CSF leaks while preserving the MT. CDM can be successfully used as a free graft alone for repair of isolated cribriform CSF leaks.

To evaluate negative ion beam properties, a dual beamlet monitor system has been developed. The dual beamlet monitor system has two diagnostics in one hexagonal box. One diagnostic is a “fast beamlet monitor” for measuring the time evolution of beamlet current profiles with the time resolution of up to 25 MHz. The other diagnostic is a “pepper-pot-type phase space analyzer,” which is applied for the evaluation of a phase space structure of the negative ion beamlet. The dual beamlet monitor system is applied to the measurement of the beamlet in the Neutral Beam Test Stand at National Institute for Fusion Science (NIFS-NBTS), in which the beam accelerator is almost identical to those of working beam injectors in the large helical device. It is demonstrated that the overlapping components from the neighboring beamlet can be eliminated, and the phase space structure can be obtained for the single beamlet.To evaluate negative ion beam properties, a dual beamlet monitor system has been developed. The dual beamlet monitor system has two diagnostics in one hexagonal box. One diagnostic is a “fast beamlet monitor” for measuring the time evolution of beamlet current profiles with the time resolution of up to 25 MHz. The other diagnostic is a “pepper-pot-type phase space analyzer,” which is applied for the evaluation of a phase space structure of the negative ion beamlet. The dual beamlet monitor system is applied to the measurement of the beamlet in the Neutral Beam Test Stand at National Institute for Fusion Science (NIFS-NBTS), in which the beam accelerator is almost identical to those of working beam injectors in the large helical device. It is demonstrated that the overlapping components from the neighboring beamlet can be eliminated, and the phase space structure can be obtained for the single beamlet.

Supplemental material, DS_10.1177_0022034519877398 for Gender Inequalities in the Dental Workforce: Global Perspectives by T. Tiwari, C.L. Randall, L. Cohen, J. Holtzmann, J. Webster-Cyriaque, S. Ajiboye, L. Schou, M. Wandera, K. Ikeda, M. Fidela de Lima Navarro, M. Feres, H. Abdellatif, E. Al-Madi, S. Tubert-Jeannin, C.H. Fox, E. Ioannidou and R.N. D’Souza in Advances in Dental Research

The structure of Cu67Zr33 amorphous alloy was investigated in terms of packing density and free volume by using neutron, x-ray diffraction and reverse Monte Carlo (RMC) modelling. The RMC model was analysed by a method of decomposing the three-dimensional atomic configuration into fundamental polyhedral units (termed as ‘holes’ referencing the Bernal’s works) of which faces are all triangles consisting of chemical bonds. Not only tetrahedral and octahedral holes but also other larger holes were identified. Moreover, the atomic packing fractions and free volumes in the respective polyhedral holes were evaluated with reference to those for the corresponding crystal structures. The results show that the distribution of free volumes for the larger holes can be described by the exponential function assuming that there are no energetic interactions between each other. On the other hand, the local structural fluctuations due to densely and loosely packed tetrahedral holes were observed, leading to the negative free volume spaces.

Introduction Patients with obstructive sleep apnea (OSA) are offered many treatment options spanning the spectrum of lifestyle modification, device therapy, and surgery. Sleep surgery, while often effective, results in moderate morbidity and has variable effectiveness on OSA improvement. Little is known about what patients consider when choosing treatment. We aim to identify factors that influenced the decision for sleep surgery among adults with OSA. Methods We conducted semi-structured virtual interviews with patients (≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep) who underwent sleep surgery at a tertiary academic center, querying patients about factors in their decision for OSA treatment. Interviews were audio-recorded, transcribed, and analyzed for thematic content. We anticipate enrolling 10–18 total participants based on previously reported sample size in specialty groups for thematic saturation in specialty groups (ie, when no new concepts or factors emerge from interviews). Here we report pilot qualitative analysis results. Results Of nine eligible patients, eight enrolled (mean +/- standard deviation age 45.8 +/- 13.4 years, 2 female/6 males). Four patients underwent nasal surgery only, two patients underwent staged procedures, one underwent pharyngeal surgery only, and the last underwent nasal surgery with tori removal. Patients reported decision making duration of days to years for scheduling surgery. Reasons for pursuing sleep surgery included fatigue, quality of life, work performance, and safety. Overarching thematic domains related to decision for surgery were (1) major concerns, (2) external factors influencing decision, and (3) retrospective satisfaction/regret with decision. Major concerns involved factors beyond surgeon’s control, such as anesthesia and postoperative pain management, not surgery itself. Family and friends were reported to be highly influential in the process, both in favor and against surgery. Social media features and celebrity patients with OSA heightened awareness of sleep surgery and set preconceived expectations. Patients were mostly satisfied with outcomes, despite unanticipated acute recovery challenges. Conclusion This pilot qualitative analysis identifies factors influencing patients’ OSA treatment decisions. Understanding patients’ major concerns and sources of information may help to guide physician counseling, set realistic expectations, offer peri-operative support, and better engage parents in shared decision-making for sleep surgery. Support (if any) None.

Heat input during welding is a basic index for weld quality and service properties associated with the resulting microstructure. In this study, the heat inputs during friction stir welding of Al alloy 5083 at various welding parameters were measured by calorimetry. Multiple regression analysis of the data was conducted to determine an empirical equation to estimate the heat input with the input variables. The effect of the heat input on the grain size of the stir zone was also examined, and a good correlation between the grain size and heat input was obtained. This study obtained a systematic relationship between the input variables, heat input and grain size of the stir zone through experimental measurements.

The paper sets forth a novel eigenvalue interlacing property across the finite-state birth-death process intensity matrix and two clearly identified submatrices as an extension of Cauchy’s interlace theorem for Hermitian matrix eigenvalues. A supplemental proof involving an examination of probabilities acquired from specific movements across states and a derivation of a form for the eigenpolynomial of the matrix through convolution and Laplace transform is then presented towards uncovering a similar characteristic for the general Markov chain transition rate matrix. Consequently, the proposition generates bounds for each eigenvalue of the original matrix, easing numerical computation. To conclude, the applicability of the property to some real square matrices upon transformation is explored.

Beam focusing is one of the most important elements for the stable and safe operation of high power negative ion beams, such as neutral beam injection into magnetically confined fusion plasmas. In order to investigate impacts of the source plasma fluctuation on beam focusing, a simultaneous measurement of the source plasma fluctuation and the beam current profile has been carried out in the research-and-development negative ion source at the National Institute for Fusion Science. The responses of beam width and of the beam centre deviation are observed for the first time, indicating the importance of the source plasma stability for the negative ion beam focusing.