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PURPOSE: To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM). METHODS: This international, retrospective, multicenter study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified. RESULTS: At SRS, median patient age was 55 years [interquartile range (IQR) 47.6-62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm3 (IQR 0.1-0.5) and the median prescription dose was 16 Gy (IQR 16-18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p =

This article examines what activism looks like in an age of “deep writing.” As alumni find their ways through multiple domains of life after graduation, what role does writing play in helping them orient themselves toward engagement with the world around them? This article reviews relevant literature, including some of the difficulties of defining activism, and then analyzes focus group data in which participants describe different kinds of activism and the roles that writing plays in them. Wayfinding provides a framework for understanding how alumni writers orient their understanding of their own writing practices.

As part of ITER’s consideration to change its first wall material from beryllium to tungsten, the ITER Organization has proposed studying the feasibility of real-time solid boron injection (SBI) into the plasma to coat the walls and divertor to supplement glow discharge boronization (GDB) [1]. Boron deposits getter oxygen and reduce sputtering of tungsten from plasma facing components (PFCs). Particularly in areas with significant plasma wall interactions, boron coatings are expected to be short-lived under high performance plasma conditions. The proposed SBI system aims to maintain boron layers in these areas to avoid excessive radiation from tungsten in the plasma as a risk mitigation to ensure ITER will be able to reach and sustain Q = 10 conditions. The system will be used sparingly, as redeposition of boron can lead to significant tritium retention, which must be minimized in ITER to comply with nuclear safety concerns. SBI is proposed to limit and precisely control the amount of boron injected in real-time during plasma operation. Here, some of the design requirements and initial concepts for an SBI system in ITER are presented based on previous results carried out with SBI systems on a number of tokamaks and stellarators around the world [2–18].Previous results using SBI systems installed by PPPL have injected boron particles from 5 µm–2 mm diameter at calibrated rates of 2–200 mg/s in real-time during plasma operation on AUG [4], DIII-D [5], EAST [6], KSTAR [7], LHD [8], TFTR [9], WEST [10], and W7-X [11,12], leading to improved wall conditions with reduced plasma impurity concentrations and radiated power and improved plasma performance. The boron is ionized in the plasma edge and then deposited on plasma-wetted surfaces. On AUG [4], EAST [6] and WEST [10] reduced tungsten sputtering sources were observed following several discharges with SBI. Extrapolation of these SBI results are presented to estimate the amount of boron needed for wall conditioning in ITER. Real-time SBI control requirements and plasma operation scenarios for ITER are also described.

The toroidal distribution of boron deposition on plasma-facing components (PFCs) in boron powder injection using an impurity power dropper (IPD) was investigated by full-torus simulation and observations in a systematic plasma density-scan experiment. The images of the ablation of dropped boron powders observed with a visible CCD camera were consistently explained by the simulations of the ablation positions of the boron powders considering the size distribution. Simulations assuming full-torus boron deposition on the PFCs did not reproduce the observed intensity profile of boron emission lines for higher plasma densities. It indicated that the density of boron deposited on PFCs installed toroidally far from the IPD was low for higher plasma densities due to the change in the ablation positions of the boron powders toward the outboard side. The experimental results verified the previous full-torus simulation of the toroidal distribution of the boron deposition in both lower and higher plasma densities.

This study reviews the traditional culminating graduate student experiences, theses, and comprehensive exams, as well as a newer, more professionally relevant option, applied research projects. We conceptualize applied projects as student-led, client-connected, hands-on, experiential projects that address a real-world communication problem or topic through the creation of relevant deliverables. We used Glassick et al.'s (1997) scholarship assessed model and the National Communication Association's communication learning outcomes to determine perceived differences between culminating experiences. Survey results (N = 32) of recent alumni and current master's level Communication students demonstrate near-equal ratings of applied projects and theses in their ability to both meet scholarship assessment criteria and communication learning outcomes. Comprehensive exams are rated comparatively worse. Based on these criteria and others gained from implementing applied projects as an option for students, we offer a rubric for assessing master's level applied research projects.

INTRODUCTION: Historical reservations regarding stereotactic radiosurgery (SRS) for small-cell lung cancer (SCLC) brain metastases include concerns for short-interval and diffuse central nervous system (CNS) progression, poor prognoses, and increased neurological mortality specific to SCLC histology. We compared SRS outcomes for SCLC and non-small cell lung cancer (NSCLC) where SRS is well established. METHODS: Multicenter first-line SRS outcomes for SCLC and NSCLC from 2000 to 2022 were retrospectively collected (n = 892 SCLC, n = 4785 NSCLC). Data from the prospective Japanese Leksell Gamma Knife Society (JLGK0901) clinical trial of first-line SRS were analyzed as a comparison cohort (n = 98 SCLC, n = 814 NSCLC). Overall survival (OS) and CNS progression were analyzed using Cox proportional hazard and Fine-Gray models, respectively, with multivariable adjustment for cofactors including age, sex, performance status, year, extracranial disease status, and brain metastasis number and volume. Mutation-stratified analyses were performed in propensity score-matched retrospective cohorts of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) positive NSCLC, mutation-negative NSCLC, and SCLC. RESULTS: OS was superior for patients with NSCLC compared to SCLC in the retrospective dataset (median OS = 10.5 vs 8.6 months; P

In this work, we present numerical simulation results of powder injection in W7-X using the EMC3-EIRENE and DIS codes. First, we model powder injection experiments performed in W7-X with the Probe Mounted Powder Injector. The simulation results qualitatively agree with visible imaging measurements. Secondly, we perform predictive simulations to guide the installation of an Impurity Powder Dropper in W7-X, allowing to choose in between several available non-vertical ports to maximize the amount of powder penetrating into the plasma, as well as the verticality of the port, to minimize sticking of the powders in the in-vessel stainless steel guiding tube. Port AEM41 is selected as the best candidate for IPD installation. The robustness of the simulation results has been verified for different plasma densities, powder materials and sizes, powder friction coefficient and changes in the plasma flow.

In this article, we draw on focus group interviews collected for the Wayfinding Project to explore how university alumni orient themselves as writers while participating in social media after graduation. By looking at alumni's self descriptions of their writing processes across public networks, we are able to trace pathways that recognize the rhetorical and communicative intentions of users, while also acknowledging the roles that serendipity, creativity, and the unexpected play in shaping these literate practices. Specifically, we point to how these alumni describe their experiences as they adapt to addressing audiences across different platforms and confront the “reach” of those platforms for engaging unexpected audiences. Several focus group participants use the term “branding” as a way to describe how they conceive of their writing across multiple social networks. These participants describe their public, networked writing as a form of managing their identities at the same time that they are “branding” themselves to manage the expectations of multiple audiences. In sum, our research shows us how the unexpected audiences generated through social media participation operate in tension with writers’ deliberate shaping of their messages and their self-presentation.

Reactor relevant fusion devices will use tungsten (W) for their plasma facing components (PFCs) due to its thermomechanical properties and low tritium retention. However, W introduces high-Z impurities into the plasma, degrading its performance. Different wall conditioning methods have been developed to address this issue, including coating of W PFCs with layers of low-Z material. Wall conditioning by boron (B) powder injection using an impurity powder dropper (IPD) is being studied in WEST. Two series of experiments were conducted since the installation of the new ITER grade full W divertor. During the first series in 2023 ∼ 1 g of B powder was injected in total at a maximum rate of ∼ 58 mg/s, both of which are three times greater than respective values in the initial WEST powder injection experiments. The second series of experiments included injection of B and BN powders for comparison of their effects on plasma performance. The presence of an instantaneous conditioning effect is suggested by visible spectroscopy measurements of low-Z impurity lines and a rollover of total radiated power past an injection rate of ∼ 20 mg/s was observed. Presence of B coating layer formation is supported by the evolution of the average radiance of visible lines of B, W and oxygen (O). To understand B transport, an interpretative modeling workflow is employed, utilizing the SOLEDGE-EIRENE fluid boundary plasma code and the Dust Injection Simulator (DIS) code. Parameters like B perpendicular diffusivity and recycling coefficients are varied to match experimental results to see if the initial assumption of B sticking to the PFCs immediately after the contact with the wall is adequate for correctly modelling its distribution on the PFCs.

Over a series of experiments performed on the WEST device we have demonstrated the ability to perform controlled impurity injections and improve overall wall conditions. Positive changes to overall machine conditions are evidenced by reduced native impurity content after injection as well as decreases in radiated power and reductions in recycling. These results are consistent with the formation of a gettering layer which provides a particle sink and a reduction of source terms. We also observe a reduction in overall Zeff at the conclusion of the powder injection period consistent with a reduced impurity burden within the plasma. Finally, we have demonstrated a minimal injection quantity required to affect a positive change in wall conditions. These results confirm that plasma assisted deposition of conditioning material through particulate injection shows substantial promise as a supplemental wall conditioning technique.

Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020–2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.

The choice of first wall material is of paramount importance for the plasma start-up conditions in ITER and future fusion power plants. In this context, the present work focuses on the correlations between first wall impurity sources and total radiated power during plasma start-up in the tungsten (W) Environment in Steady-state Tokamak (WEST). The objective is to highlight experimental indications for a preferable combination of start-up plasma scenario and first wall materials. Until 2019, WEST featured a full high Z first wall with all limiters exposing only W surfaces to the plasma. To study the impact of a low Z first wall in WEST, boron nitride tiles were installed in the central part of the inner and outer limiters in 2020. Although visible spectroscopy and bolometry measurements show respectively a strong weakening of the WI line intensity on the limiters and a reduction of radiated power after the changeover, a degradation occurs with the accumulation of plasma exposure. In addition, the different plasma facing elements of the main chamber do not influence equally the radiated power during start-up. In both high Z and low Z environments, a clear non-linear dependence is found between the start-up radiated power and the outer limiter W impurity source. Since W seems to be the main cause for core radiation, correlation between outer limiter W sources and other impurity sources are investigated. Finally, analysis of the legacy of B powder drops on a number of start-up plasmas suggests that it is less effective at reducing radiated power when the first wall is covered with W.

The L’Ralph instrument is a key component of NASA’s Lucy mission, intended to provide spectral image data of multiple Jupiter Trojans. The instrument operates from ∼0.35 to 4 μ m using two focal plane assemblies: a 350–950 nm multispectral imager, Multi-spectral Visible Imaging Camera (MVIC), and a 0.97–4 μ m imaging spectrometer, Linear Etalon Imaging Spectral Array (LEISA). Instrument calibration was established through ground testing before launch and has been monitored during cruise utilizing internal calibration sources and stellar targets. In-flight data have shown that the instrument thermal performance is exceeding expectations, allowing for early updates to LEISA radiometric and pointing calibrations. MVIC radiometric performance remains stable more than 3 yr since launch. The serendipitous identification of a new flyby target, (152830) Dinkinesh, allowed testing of instrument performance and interleaved LEISA and MVIC acquisitions on an asteroid target. Both MVIC and LEISA obtained data of Dinkinesh and its moon, Selam, demonstrating that they show good spectral agreement with an S- or Sq-type asteroid, along with evidence of a 3 μ m absorption feature.

Anatomy and Physiology should be considered a gateway course due to its challenging scope and key role as a foundational prerequisite for many degree programs. Students often encounter gateway classes early in their college career when they are academically vulnerable due to their lack of university experience. A&P teaching methods are evolving to address these issues and favor more positive outcomes. New approaches include emphasizing understanding of course content (rather than relying on memorization) and creating multi-modal learning opportunities. Utilizing active learning techniques allows students to more directly participate in their education and achieve more favorable results than traditional passive methods. Furthermore, unifying A&P lecture and lab classes into a cohesive "studio model" class taught by one instructor may encourage student collaboration and increase active learning. Implementing a formal supplemental instruction program led by peer facilitators supports struggling students and yields promising results. A renewed focus on improving the teaching skills of gateway instructors is integral in creating a learning environment that maximizes academic success. In this paper, we review special issues and problems associated with A&P instruction. We also discuss how changing perspectives on course organization could improve A&P courses.

Objective: The present study aimed to analyze the academic attributes of the presidents of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) over the past four decades to elucidate the trajectories of these societies' leaderships. Methods: Forty-three AANS and 43 CNS presidents of the past four decades were identified. Demographic and research productivity data were collected from publicly available sources. Results: Compared to AANS presidents, CNS presidents were younger (median = 48 years vs. 59.5 years; p

Objective: To elucidate the current academic, demographic, and professional factors influencing the career trajectories of the American Association of Neurological Surgeons (AANS) William P. Van Wagenen (VW) fellows while also identifying trends that may influence future fellow selection. Methods: Fifty-five VW fellows were identified from 1968 to 2022 from the AANS website, along with corresponding institutions, countries, and continents of study. Additional variables such as age at selection, accruing additional degrees, neurosurgical subspecialty, the number of publications at the time of selection, funding, and h-index were collected from various publicly available sources. Results: Eighty-five percent of VW fellows were male and had a mean age of 34 ± 2.4 years. Ninety-one percent of fellows chose to study in Europe, and 40% had earned additional degrees. Univariate linear regression demonstrated a positive relationship between the year of selection and both age at selection (p = 0.0094) and the number of publications at hire (p

BackgroundCranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.MethodsPatients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.ResultsOf 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).ConclusionsThe risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

PurposeSleep is vital to cognition, yet underlying mechanisms remain unclear. Although sleep duration and continuity are two well-established contributors, additional factors-including homeostatic sleep drive processes-may also underlie cognition-related sleep restoration. This study investigates the relative contributions of sleep EEG factors to psychomotor functioning in adults with insomnia and healthy controls (HC) to identify the most significant sleep factors supporting psychomotor functioning.Materials and methodsAdults with insomnia (n = 37) and HC (n = 39) completed 3 nights of polysomnography and a complex psychomotor task (switching attention task; SAT). Univariate correlations identified the most significant predictors (traditional PSG, spectral EEG, initial delta peak, and overnight delta decline) of SAT performance, which were then entered into multivariable linear regressions examining whether predictors remained significant after accounting for shortened/fragmented sleep and whether relationships differed across groups.ResultsIn addition to greater wake after sleep onset (WASO; r = 0.33), a slower overnight delta decline (r = 0.50) and a lower initial delta peak (r = -0.38) were the most significant predictors of poorer SAT performance. Both overnight delta decline (F(7, 68) = 12.52, p < 0.001) and initial delta peak (F(7, 68) = 7.85, p = 0.007) remained significant predictors after controlling for demographics, total sleep time, and WASO. Relationships were analogous across subject groups.ConclusionFindings suggest that, in addition to sleep duration and continuity, processes related to recovery from and dissipation of homeostatic sleep drive may support psychomotor performance and broadly support daytime functioning in individuals with and without insomnia. Future research may examine overnight delta dynamics as transdiagnostic processes supporting cognition-related sleep restoration across a range of clinical populations.