A method of amputation at the ankle-joint which leaves the heel intact: Tibio-calcaneal resection, with amputation of the remainder of the foot. Notes and illustrations of seven cases

n/

Brainstem metastases treated with Gamma Knife stereotactic radiosurgery: the Indiana University Health experience

Brainstem metastases offer a unique challenge in cancer treatment, yet stereotactic radiosurgery (SRS) has proven to be an effective modality in treating these tumors. This report discusses the clinical outcomes of patients with brainstem metastases treated at Indiana University with Gamma Knife (GK) radiosurgery from 2008 to 2016. 19 brainstem metastases from 14 patients who had follow-up brain imaging were identified. Median tumor volume was 0.04 cc (range: 0.01-2.0 cc). Median prescribed dose was 17.5 Gy to the 50% isodose line (range: 14-22 Gy). Median survival after GK SRS treatment to brainstem lesion was 17.2 months (range: 2.8-45.6 months). The experience at Indiana University confirms the safety and efficacy of range of GK SRS prescription doses (14-22 Gy) to brainstem metastases

Inflation without Inflaton(s)

We propose a model for early universe cosmology without the need for fundamental scalar fields. Cosmic acceleration and phenomenologically viable reheating of the universe results from a series of energy transitions, where during each transition vacuum energy is converted to thermal radiation. We show that this `cascading universe' can lead to successful generation of adiabatic density fluctuations and an observable gravity wave spectrum in some cases, where in the simplest case it reproduces a spectrum similar to slow-roll models of inflation. We also find the model provides a reasonable reheating temperature after inflation ends. This type of model may also be relevant for addressing the smallness of the vacuum energy today.Comment: 13 pages, 4 figures, published versio

Effects of Proton Center Closure on Pediatric Case Volume and Resident Education at an Academic Cancer Center

Purpose To analyze effects of closure of an academic proton treatment center (PTC) on pediatric case volume, distribution, and resident education. Methods and Materials This was a review of 412 consecutive pediatric (age ≤18 years) cases treated at a single institution from 2012 to 2016. Residents' Accreditation Council for Graduate Medical Education case logs for the same years were also analyzed. Characteristics of the patient population and resident case volumes before and after closure of the PTC are reported. Results Overall pediatric new starts declined by approximately 50%, from 35 to 70 per 6 months in 2012 to 2014 to 22 to 30 per 6 months in 2015 to 2016. Central nervous system (CNS) case volume declined sharply, from 121 patients treated in 2012 to 2015 to 18 patients in 2015 to 2016. In 2012 to 2014 our institution treated 36, 24, and 17 patients for medulloblastoma/intracranial primitive neuroectodermal tumor, ependymoma, and low-grade glioma, respectively, compared with 0, 1, and 1 patient(s) in 2015 to 2016. Forty-nine patients were treated with craniospinal radiation (CSI) from 2012 to 2014, whereas only 2 patients underwent CSI between 2015 and 2016. Hematologic malignancy patient volume and use of total body irradiation remained relatively stable. Patients treated when the PTC was open were significantly younger (9.1 vs 10.7 years, P=.010) and their radiation courses were longer (35.4 vs 20.9 days, P<.0001) than those treated after its closure. Resident case logs showed only a small decline in total pediatric cases, because the percentage of pediatric cases covered by residents increased after PTC closure; however, residents logged fewer CNS cases after PTC closure versus before. Conclusions Overall pediatric case volume decreased after PTC closure, as did the number of patients treated for potentially curable CNS tumors. Our findings raise important questions regarding resident training in pediatric radiation oncology as these cases become increasingly concentrated at specialized centers

Metallicities, dust and molecular content of a QSO-Damped Lyman-{\alpha} system reaching log N (H i) = 22: An analog to GRB-DLAs

We present the elemental abundance and H2 content measurements of a Damped Lyman-{\alpha} (DLA) system with an extremely large H i column density, log N(H i) (cm-2) = 22.0+/-0.10, at zabs = 3.287 towards the QSO SDSS J 081634+144612. We measure column densities of H2, C i, C i^*, Zn ii, Fe ii, Cr ii, Ni ii and Si ii from a high signal-to-noise and high spectral resolution VLT-UVES spectrum. The overall metallicity of the system is [Zn/H] = -1.10 +/- 0.10 relative to solar. Two molecular hydrogen absorption components are seen at z = 3.28667 and 3.28742 (a velocity separation of \approx 52 km s-1) in rotational levels up to J = 3. We derive a total H2 column density of log N(H2) (cm-2) = 18.66 and a mean molecular fraction of f = 2N(H2)/[2N(H2) + N(H i)] = 10-3.04+/-0.37, typical of known H2-bearing DLA systems. From the observed abundance ratios we conclude that dust is present in the Interstellar Medium (ISM) of this galaxy, with a enhanced abundance in the H2-bearing clouds. However, the total amount of dust along the line of sight is not large and does not produce any significant reddening of the background QSO. The physical conditions in the H2-bearing clouds are constrained directly from the column densities of H2 in different rotational levels, C i and C i^* . The kinetic temperature is found to be T = 75 K and the particle density lies in the range nH = 50-80 cm-3 . The neutral hydrogen column density of this DLA is similar to the mean H i column density of DLAs observed at the redshift of {\gamma}-ray bursts (GRBs). We explore the relationship between GRB-DLAs and high column density end of QSO-DLAs finding that the properties (metallicity and depletion) of DLAs with log N(H i) > 21.5 in the two populations do not appear to be significantly different