Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators

Spinor Fields and Symmetries of the Spacetime

In the background of a stationary black hole, the "conserved current" of a particular spinor field always approaches the null Killing vector on the horizon. What's more, when the black hole is asymptotically flat and when the coordinate system is asymptotically static, then the same current also approaches the time Killing vector at the spatial infinity. We test these results against various black hole solutions and no exception is found. The spinor field only needs to satisfy a very general and simple constraint.Comment: 19 page

Development of online use of theory of mind during adolescence: An eye-tracking study

We investigated the development of theory of mind use through eye-tracking in children (9-13years old, n=14), adolescents (14-17.9years old, n=28), and adults (19-29years old, n=23). Participants performed a computerized task in which a director instructed them to move objects placed on a set of shelves. Some of the objects were blocked off from the director's point of view; therefore, participants needed to take into consideration the director's ignorance of these objects when following the director's instructions. In a control condition, participants performed the same task in the absence of the director and were told that the instructions would refer only to items in slots without a back panel, controlling for general cognitive demands of the task. Participants also performed two inhibitory control tasks. We replicated previous findings, namely that in the director-present condition, but not in the control condition, children and adolescents made more errors than adults, suggesting that theory of mind use improves between adolescence and adulthood. Inhibitory control partly accounted for errors on the director task, indicating that it is a factor of developmental change in perspective taking. Eye-tracking data revealed early eye gaze differences between trials where the director's perspective was taken into account and those where it was not. Once differences in accuracy rates were considered, all age groups engaged in the same kind of online processing during perspective taking but differed in how often they engaged in perspective taking. When perspective is correctly taken, all age groups' gaze data point to an early influence of perspective information

Macroscopic objects in quantum mechanics: A combinatorial approach

Why we do not see large macroscopic objects in entangled states? There are two ways to approach this question. The first is dynamic: the coupling of a large object to its environment cause any entanglement to decrease considerably. The second approach, which is discussed in this paper, puts the stress on the difficulty to observe a large scale entanglement. As the number of particles n grows we need an ever more precise knowledge of the state, and an ever more carefully designed experiment, in order to recognize entanglement. To develop this point we consider a family of observables, called witnesses, which are designed to detect entanglement. A witness W distinguishes all the separable (unentangled) states from some entangled states. If we normalize the witness W to satisfy |tr(W\rho)| \leq 1 for all separable states \rho, then the efficiency of W depends on the size of its maximal eigenvalue in absolute value; that is, its operator norm ||W||. It is known that there are witnesses on the space of n qbits for which ||W|| is exponential in n. However, we conjecture that for a large majority of n-qbit witnesses ||W|| \leq O(\sqrt{n logn}). Thus, in a non ideal measurement, which includes errors, the largest eigenvalue of a typical witness lies below the threshold of detection. We prove this conjecture for the family of extremal witnesses introduced by Werner and Wolf (Phys. Rev. A 64, 032112 (2001)).Comment: RevTeX, 14 pages, some additions to the published version: A second conjecture added, discussion expanded, and references adde

Fast Reset and Suppressing Spontaneous Emission of a Superconducting Qubit

Spontaneous emission through a coupled cavity can be a significant decay channel for qubits in circuit quantum electrodynamics. We present a circuit design that effectively eliminates spontaneous emission due to the Purcell effect while maintaining strong coupling to a low-Q cavity. Excellent agreement over a wide range in frequency is found between measured qubit relaxation times and the predictions of a circuit model. Using fast (nanosecond time-scale) flux biasing of the qubit, we demonstrate in situ control of qubit lifetime over a factor of 50. We realize qubit reset with 99.9% fidelity in 120 ns.Comment: 4 pages, 3 figure

Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir.

BackgroundPatients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcomes. The purpose of this study was to compare the PSA kinetics between CF-EBRT and SBRT in newly diagnosed localized prostate cancer.Materials/methods75 patients with low to low-intermediate risk prostate cancer (T1-T2; GS 3 + 3, PSA < 20 or 3 + 4, PSA < 15) treated without hormones with CF-EBRT (>70.2 Gy, <76 Gy) to the prostate only, were identified from a prospectively collected cohort of patients treated at the University of California, San Francisco (1997-2012). Patients were excluded if they failed therapy by the Phoenix definition or had less than 1 year of follow-up or <3 PSAs. 43 patients who were treated with SBRT to the prostate to 38 Gy in 4 daily fractions also met the same criteria. PSA nadir and rate of change in PSA over time (slope) were calculated from the completion of RT to 1, 2 and 3 years post-RT.ResultsThe median PSA nadir and slope for CF-EBRT was 1.00, 0.72 and 0.60 ng/ml and -0.09, -0.04, -0.02 ng/ml/month, respectively, for durations of 1, 2 and 3 years post RT. Similarly, for SBRT, the median PSA nadirs and slopes were 0.70, 0.40, 0.24 ng and -0.09, -0.06, -0.05 ng/ml/month, respectively. The PSA slope for SBRT was greater than CF-EBRT (p < 0.05) at 2 and 3 years following RT, although similar during the first year. Similarly, PSA nadir was significantly lower for SBRT when compared to EBRT for years 2 and 3 (p < 0.005).ConclusionPatients treated with SBRT experienced a lower PSA nadir and greater rate of decline in PSA 2 and 3 years following completion of RT than with CF-EBRT, consistent with delivery of a higher bioequivalent dose. Although follow-up for SBRT is limited, the improved PSA kinetics over CF-EBRT are promising for improved biochemical control

Greybody Factors and Charges in Kerr/CFT

We compute greybody factors for near extreme Kerr black holes in D=4 and D=5. In D=4 we include four charges so that our solutions can be continuously deformed to the BPS limit. In D=5 we include two independent angular momenta so Left-Right symmetry is incorporated. We discuss the CFT interpretation of our emission amplitudes, including the overall frequency dependence and the dependence on all black hole parameters. We find that all additional parameters can be incorporated Kerr/CFT, with central charge independent of U(1) charges.Comment: 27 pages. v2: typos fixed, references adde

Absence of Magnetism in Hcp Iron-Nickel at 11 K

Synchrotron Mössbauer spectroscopy (SMS) was performed on an hcp-phase alloy of composition Fe92Ni8 at a pressure of 21 GPa and a temperature of 11 K. Density functional theoretical calculations predict antiferromagnetism in both hcp Fe and hcp Fe-Ni. For hcp Fe, these calculations predict no hyperfine magnetic field, consistent with previous experiments. For hcp Fe-Ni, however, substantial hyperfine magnetic fields are predicted, but these were not observed in the SMS spectra. Two possible explanations are suggested. First, small but significant errors in the generalized gradient approximation density functional may lead to an erroneous prediction of magnetic order or of erroneous hyperfine magnetic fields in antiferromagnetic hcp Fe-Ni. Alternately, quantum fluctuations with periods much shorter than the lifetime of the nuclear excited state would prohibit the detection of moments by SMS