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The charge order transition of commonly known magnetite has only recently been unraveled. Here, the measurement of the low-temperature high-pressure phase diagram of a related material (Fe4O5) elucidates the interplay of average oxidation state and charge-ordering phenomena in the iron oxide family.

Abstract: This paper reports on a novel temporary 0-level packaging process for MEMS (Micro Electro Mechanical Systems), in particular MEMS for optical applications. In this process protective caps, with a heat decomposable and photo- patternable polymer sealing ring, are placed by flip-chip on the MEMS wafer. The resulting temporary packages are gross leak tight, fulfil the MIL spec for shear testing and respect the thermal budget of Al-coated SiGe micro-mirrors. After debonding the cap, the SiGe mirrors are unharmed. [Copyright &y& Elsevier]

Rheological behavior of coriander and mint leaf puree was determined at temperatures of 30 to 80C. Applicability of various rheological models available in the literature was evaluated. The Herschel–Bulkley model provided a good description of the flow behavior of coriander and mint leaf puree over the temperature range of 30–80C. The Arrhenius model successfully described the effect of temperature on consistency index of coriander and mint puree. The temperature dependence of apparent viscosity of mint puree however did not obey the Arrhenius model. The activation energy of flow for coriander and mint puree was 23.99 and 32.62 kJ/mol, respectively. PRACTICAL APPLICATIONS Flow properties of foods are determined for a number of purposes, such as quality control, understanding the structure, process engineering applications and correlation with sensory evaluation ( Cepeda et al. 2002 ; Nindo et al. 2005 ). Knowledge of the rheology of suspensions contributes to a better understanding of the underlying mechanisms of momentum and heat transfer process ( Telis-Romero et al. 1999 ; Nindo et al. 2005 ). Rheological properties are also important for the design of related processing systems, including filling in bottles/cans and appropriate piping arrangements ( Steffe 1992 ; Bhattacharya 1999 ). Krokida et al. (2001 ) recently assembled additional data on rheological properties of fruit and vegetable puree. Limited information is available in the literature on the rheological characteristics of herb purees. Herbal purees vary widely in their rheological characteristics and it is necessary to investigate each product separately. Results of this study would be useful in the quality control and design of processing equipment for processing coriander- and mint-based products. [ABSTRACT FROM AUTHOR]

Gold prices in the Indian market may be influenced by a multitude of factors such as the value of gold in investment decisions, as an inflation hedge, and in consumption motives. We develop a model to explain and forecast gold prices in India, using a vector error correction model. We identify investment decision and inflation hedge as prime movers of the data. We also present out-of-sample forecasts of our model and the related properties.

Imaging is routinely used in post-treatment surveillance of HPV-related oropharyngeal cancer (HPVOPC) but frequently identifies indeterminant areas of concern that prompt further imaging to ensure stability or resolution. Serum ctHPVDNA has emerged as an adjunctive surveillance strategy with high sensitivity for recurrence. To the best of our knowledge, there are no studies directly comparing ctHPVDNA with imaging in surveillance. Hypothesizing that ctHPVDNA would lead to fewer false positive results than imaging, we compared the performance of these modalities in early surveillance. We retrospectively reviewed patients evaluated by our multidisciplinary clinic from 2022 onward with a new diagnosis of HPVOPC who received radiotherapy with planned dose > = 50Gy in either the definitive or adjuvant setting. Eligible patients had 1) detectable pretreatment ctHPVDNA, 2) surveillance imaging and ctHPVDNA at 3 months posttreatment, and 3) 6-month posttreatment assessment. ctHPVDNA was quantified via liquid biopsy TTMV score. Minimum thresholds for a "positive" test were results that would prompt short-interval repeat testing: an indeterminate or detectable ctHPVDNA and imaging NI-RADS 2+ OR at least mild avidity on PET. Recurrences were ascertained up to the 6-month assessment. 41 patients met eligibility criteria, with subsites divided evenly between tonsil (51%) and base of tongue (49%). Patients were clinically T0-4, N0-2. Fifteen (37%) received surgery, and 31 (76%) received concurrent systemic therapy. Delivered radiation doses ranged from 46-70 Gy(E), with 28 (62%) receiving proton therapy. Median pretreatment ctHPVDNA was 471 (range 8-174,881). At 3 months follow up, 40 (98%) patients had undetectable ctHPVDNA and 14 (34%) had nonsuspicious imaging; 24 (59%) patients had NI-RADS 2+ imaging. By 6-month follow-up, there was 1 true recurrence that was detected at 3 months by both imaging and ctHPVDNA. Imaging yielded 26 false positives (63%) versus none for ctHPVDNA. Comparing ctHPVDNA versus imaging, sensitivity was identical at 100%, specificity was 100% vs 35%, positive predictive value (PPV) was 100% vs 4%, and negative predictive value (NPV) was identical at 100% (Table). When setting the threshold for a positive surveillance test at a level that would prompt short-interval repeat testing, ctHPVDNA outperforms imaging as a 3-month surveillance strategy, with superior PPV and specificity. Relying on ctHPVDNA rather than imaging at 3-month posttreatment assessment may enable a significant portion of HPVOPC survivors to forgo unnecessary short-term follow-up imaging. [ABSTRACT FROM AUTHOR]

The quasi-two-dimensional organic charge-transfer salt κ -(BEDT-TTF) 2 Cu 2 (CN) 3 is one of the prime candidates for a quantum spin-liquid due the strong spin frustration of its anisotropic triangular lattice in combination with its proximity to the Mott transition. Despite intensive investigations of the material’s low-temperature properties, several important questions remain to be answered. Particularly puzzling are the 6 K anomaly and the enigmatic effects observed in magnetic fields. Here we report on low-temperature measurements of lattice effects which were shown to be particularly strongly pronounced in this material (R. S. Manna et al., Phys. Rev. Lett. 2010, 104, 016403)). A special focus of our study lies on sample-to-sample variations of these effects and their implications on the interpretation of experimental data. By investigating overall nine single crystals from two different batches, we can state that there are considerable differences in the size of the second-order phase transition anomaly around 6 K, varying within a factor of 3. In addition, we find field-induced anomalies giving rise to pronounced features in the sample length for two out of these nine crystals for temperatures T < 9 K. We tentatively assign the latter effects to B-induced magnetic clusters suspected to nucleate around crystal imperfections. These B-induced effects are absent for the crystals where the 6 K anomaly is most strongly pronounced. The large lattice effects observed at 6 K are consistent with proposed pairing instabilities of fermionic excitations breaking the lattice symmetry. The strong sample-to-sample variation in the size of the phase transition anomaly suggests that the conversion of the fermions to bosons at the instability is only partial and to some extent influenced by not yet identified sample-specific parameters.

Abstract Background Visceral leishmaniasis (VL) is a major public health problem in Bangladesh with the highest disease burden in the Mymensingh District. The disease is transmitted by sand fly bites, but it may also be transmitted through blood transfusions. No information is available about the prevalence of Leishmania infection among blood donors in Bangladesh; therefore we aimed to investigate this question. Methods The study was carried out in the Blood Transfusion Department of Mymensingh Medical College Hospital. One thousand one hundred and ninety five adult healthy blood donors attending in this department were enrolled in the study from August 2010 to April 2011. After obtaining written consent, socio-demographic data and a detailed health history were collected. The medical officer in the unit performed a complete physical examination to exclude any acute or chronic diseases, which was followed by sero-diagnosis for exposure to Leishmania by rK39 strip test using finger prick blood. Blood donors with a positive rK39 strip test underwent a PCR test for detection of leishmania DNA in their peripheral blood buffy coat. Results Eighty two percent of enrolled blood donors were male (n=985) and 18% (n=210) were female. The mean age of blood donors was 27 years (SD, 7.95 years). The majority of donors were literate and had mid-to-higher socioeconomic condition reflected by household conditions reported by the subject. Only 2.6% had a family member with VL in the past. Three blood donors were positive for leishmania infection by rK39 strip test (0.3%, 95%CI, 0.05%-0.73%). None of these 3 had active leishmania infection as demonstrated by PCR analysis. During six months of follow up, neither rK39 positive (n=3) nor rK39 negative (n=1192) donors developed VL. Conclusion The prevalence of Leishmania donovani infection among blood donors attending the Blood Transfusion Department of Mymensingh Medical College Hospital was very low. Therefore the chance for transmission of VL through blood transfusion is negligible. We believe that the National VL Elimination Program does not need set up routine screening for Leishmania donovani infection in blood transfusion departments located in VL endemic areas of Bangladesh.

Utilizing the difference in surface tension between SiO2 and metal catalysts (Mn2+, Ni2+), we show how metals form nanoshells, nanodiscs and nanospheres at the tips of the SiO2 nanostructures of nanocones, nanorods and nanowires. For the Mn2+ catalyst (i), SiO2-nanocones are formed with the hemispherical convex cap of the MnO/SiO2 composite. For the Ni2+ catalyst (ii), SiO2 nanowires are grown due to the concave shape of SiO2 surrounding the multi-faceted NiSi particles at their tip. For the Mn2+/Ni2+ catalyst (iii), SiO2 nanorods are formed with large-sized spherical ferromagnetic single Ni nanocrystals (50-200 nm in diameter) surrounded by the concave MnO2/SiO2 composite at the tip of the SiO2 nanorods. This large-sized spherical formation of the single Ni crystal is possible because Ni is able to be chemically reduced by Mn at 950 degC, well below the melting point of Ni (1455 degC) due to the alloying effect. [ABSTRACT FROM AUTHOR]

The incidence of anal cancer and anal cancer death continues to rise. People of color (POC) have been underrepresented in prospective clinical trials, including trials that have established anal cancer treatment to include modern radiation therapy (RT) techniques and concurrent chemotherapy. We evaluated our institutional experience to determine if disparities in oncologic outcomes and treatment tolerability exist among POC. We performed a retrospective chart review of anal cancer patients who received definitive organ-preserving treatment for localized anal cancer between 2008 and 2020 at a single health system. Outcomes including overall survival (OS), local recurrence-free survival (LRFS), and progression free-survival (PFS) were estimated using the Kaplan-Meier method. Toxicities were scored using the National Cancer Institute-Common Terminology Criteria for Adverse Events v5. Of the 201 consecutively treated patients, 16% were stage I, 24% were stage II, and 58% were stage III. Mean age at diagnosis was 53 years (range 31 – 78 years). The majority (95%) were treated with intensity modulated RT technique and most (98%) patients received concurrent chemotherapy. Median RT dose was 54 Gy (range 45 to 60.2 Gy). Over half (n = 111) had human immunodeficiency virus infection (HIV) at time of cancer diagnosis; among those with HIV, 81% identified as POC. With a median follow-up of 4 years (range 0 – 14.8 years), POC with anal cancer (n = 127) had greater risk of dying than non-Hispanic White patients (n = 72), hazard ratio (HR) = 2.00, confidence interval (CI): 1.10-3.64, p = 0.02. POC were also more likely to have local recurrence compared to non-Hispanic White patients (HR = 2.67, CI 1.10-6.48, p = 0.03). No significant difference was observed with PFS (HR 1.54, CI 0.81-2.93, p = 0.185). Notably, HIV infection was not associated with differences in OS, LRFS, or PFS. The mean age of diagnosis was younger in POC at 50.7 years (standard deviation [SD] 10.4 years) compared to non-Hispanic White patients (58.1 years [SD 7.6 years]). POC were more likely to have prolonged RT course (> 5 missed RT sessions) compared to their non-Hispanic White counterparts, 30% vs 23%, respectively. While most acute and late toxicities were similar between the two groups, POC had higher likelihood of late grade 2 skin toxicities than non-Hispanic White patients, 17% vs 3%, respectively, p < 0.01. Our study found worse OS and LRFS among POC compared to non-Hispanic white patients. Sustained late skin toxicities and prolonged treatment times were more common among POC. HIV infection was not independently correlated with worse outcomes even though minority race and extended RT course were seen more frequently among the group with HIV infection. Addressing barriers and biases to diagnosis and treatment, as well as inclusion of POC in prospective clinical trials, are urgently needed to optimize treatment and close the disparity gap that POC with anal cancer may face. [ABSTRACT FROM AUTHOR]

Purpose: To enhance the solubility and dissolution characteristics of ketoprofen using various crystallization techniques. Methods: Ketoprofen crystals were prepared by various crystallization technique including spherical agglomeration (SA), spray drying (SD), freeze drying (FD) and super cooling (SC). The crystallization medium used for all the techniques consisted of water and chloroform. Residual solvents in the crystals were determined and the crystals were characterized by DSC, FT-IR, XRD and SEM. Both solubility and dissolution behavior studies were carried out. The physical stability of the crystals were also evaluated after storage over a period of time. Results: Residual IPA and chloroform in the crystals ranged from 4.10 - 5.70 and 1.84 - 2.57 ppm, respectively, which are well below their toxic limits. The crystals obtained exhibited lower crystallinity than the original drug. The solubility of FD crystals in water increased almost fivefold to 0.0926 mg/ml compared with that of the drug (0.0172 mg/ml), while the dissolution rates of the developed crystals were than that of the original crystals. For example, FD crystals demonstrated the highest dissolution (99.9 %) compared with original crystals (64.3 %). In the stability test, the dissolution profiles of the developed crystals remained largely unchanged over the period of the stability study. Conclusion: The re-crystallization techniques used in this study can be applied to obtain modified ketoprofen for formulation of tablets of the drug with improved drug dissolution. [ABSTRACT FROM AUTHOR]

Up to 50% of patients with head and neck cancer (HNC) may recur after initial treatment, which often includes a combination of surgery, chemotherapy, and radiation. Reirradiation is an effective treatment option with high rates of local control. Hypofractionated regimens may be desirable due to high biologically effective doses, however they can be complicated by high rates of toxicity. Intensity-modulated proton therapy (IMPT) plans have dosimetric advantages compared to standard photon plans. We sought to review initial patient tolerance and treatment outcomes of proton-based stereotactic body radiotherapy (SBRT) for reirradiation of HNC. A single institution retrospective review of HNC patients treated with proton-based SBRT for reirradiation in the head and neck from July 2020 to December 2022 was performed. Acute and late toxicities were prospectively recorded. Patient reported outcomes were assessed prior to and at completion of treatment using the MD Anderson Symptom Inventory (MDASI) and EQ-5D5L visual analogue score (VAS). Planning outcomes and dosimetry parameters, including GTV volume, conformity (CI and R50), and PTV coverage were evaluated. Local control and overall survival were estimated using the Kaplan-Meier method. Paired t-test was used to compare continuous variables. 9 patients were treated with proton SBRT to 10 lesions in the head and neck. Most patients had squamous cell carcinoma histology (89%). All patients received a biologically effective dose of at least 58.5 Gy at initial course. Patients were reirradiated at median time of 2 years following prior head and neck radiotherapy (range 0.4, 15.8). The most commonly used dose and fractionation for reirradiation was 40 Gy (range 34, 40) in 5 fractions. Three patients received immunotherapy during treatment. Average gross target volume (GTV) was 9.1 cc (1.7, 28.6). The mean conformity index was 1.0 (0.6, 1.1) and mean R50% was 4.0 (2.3, 6.7). PTV V100% was 86.0% on average (54.9% – 96.2%). No patients developed a new grade 3 or greater toxicity during treatment or at last follow up. Comparing pretreatment to end of treatment timepoints, there was no significant increase in the mean VAS (55 to 62, p = 0.10), with no significant change in the mean MDASI symptom (2.5 to 2.4, p = 0.77) or interference (3.7 to 3.2, p = 0.63) scores. Local control was 100% at last follow up or death. Median overall survival was 0.8 years. Proton-based SBRT for reirradiation of HNC is well tolerated with high rates of local control and median overall survival consistent with other reports in this population. Further follow up is necessary to assess tumor control and toxicities. [ABSTRACT FROM AUTHOR]

HPV-driven oropharyngeal squamous cell cancer (OPSCC) has a high cure rate and a high burden of treatment-related toxicities. Transoral robotic surgery (TORS) is a treatment option for patients with early-stage disease. Most patients will be recommended adjuvant RT. ECOG 3311 was a phase 2 trial demonstrating that patients with intermediate pathologic risk factors treated with 50 Gy of adjuvant RT had similar survival as those receiving the current standard 60 Gy of adjuvant RT. However, 50 Gy is still associated with meaningful toxicity, specifically with respect to impaired swallowing function. Circulating tumor HPV DNA (ctHPVDNA) is a sensitive marker of tumor recurrence. We posit that HPV-driven OPSCC patients with intermediate pathologic risk factors and an undetectable post-operative ctHPVDNA are a subset of patients with particularly excellent prognosis that are candidates for further de-escalation of therapy. We initiated a trial treating those patients with 36 Gy of adjuvant RT based on the hypothesis that swallow function (as measured by the MD Anderson Dysphagia Inventory (MDADI)) will be improved at one year compared to historical controls from ECOG 3311. We opened a single institution study (NCT05387915) including patients with pT1-2, N0-1, M0 HPV-related OPSCC who had TORS resection of their primary site and neck dissection. Inclusion criteria include patients with <10 pack-year smoking history or a <30 pack-year smoking history if >10 years since last tobacco consumption. Pathologic criteria include a set of intermediate risk factors (close margin (1-4 mm), perineural invasion, 2-4 positive lymph nodes or a single lymph node >3 cm, and no ENE). Patients must have a detectable pre-operative ctHPVDNA. A ctHPVDNA is drawn 7-14 days post-operatively; if negative, patients receive 36 Gy of adjuvant RT in 2.4 Gy daily fractions; if positive, they receive care per the discretion of the treating radiation oncologist. If the final surgical margin at the the primary site is >2mm, patients are eligible to have the primary tumor site omitted from the radiation volume. Our primary endpoint is 1-year composite MDADI score. Secondary endpoints include overall/progression-free survival and other quality of life metrics. The study is powered to detect an 8.5-point improvement in MDADI composite score at one year over the historical control from ECOG 3311 Arm B. With an alpha of 0.05 and a power of 0.90 we require 27 evaluable patients. Accounting for dropout, we aim to enroll 33 total patients. We have been open for approximately one year at a single institution and have enrolled 13 patients thus far. We have plans to open at two additional sites.. This ongoing study of ctHPVDNA-guided adjuvant RT in patients with HPV-driven OPSCC continues to accrue well. [ABSTRACT FROM AUTHOR]

Definitive therapy for nasopharyngeal cancer includes chemotherapy and radiation (RT). Common toxicities such as xerostomia, mucositis, and hearing loss are correlated with the RT dose delivered to associated organs at risk. We hypothesized that compared to our historical experience with IMRT, the implementation of proton therapy (PT) would reduce radiation dose to organs at risks without compromising oncologic outcomes. A retrospective review of all non-metastatic stage II-IV nasopharyngeal carcinoma (SCC, lymphoepithelioma, undifferentiated carcinomas) treated with definitive therapy at our institution from 2012-2022. Disease parameters and the mean dose to organs at risk were evaluated. Statistical comparison was made with the chi square test for categorical and Wilcoxon rank sum test for continuous variables. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), using a log-rank test to compare IMRT and PT. PFS was defined as the time from the start of treatment to the first of either disease progression, relapse or death from any cause. PT was delivered with pencil-beam scanning in all patients. IMRT included multi-field treatment and volumetric-modulated arc therapy. A total of 80 patients were included in analyses: 48 treated with IMRT and 32 with PT. Comparing IMRT to PT cohorts, there was no difference in the median age of patients (51 vs 55 years, p = 0.73), nor the distribution by T stage (p = 0.57) or N stage (p = 0.34) or in the percentage of patients with ECOG 2/3 performance status at presentation (p = 0.11). All but one patient received concurrent systemic therapy and there was no difference in the use of concurrent cisplatin between cohorts (83% vs 78%, p = 0.57). The most common non-cisplatin concurrent regimen was weekly carboplatin and paclitaxel. Induction chemotherapy was more commonly used in patients treated with PT (10.4% vs 25%, p = 0.04) while there was no difference in the use of adjuvant chemotherapy (10.4% vs 9.4%, p = 0.88). Among 42 cases initiating treatment since the opening of our proton center, 32 (76%) have received PT. Comparing IMRT and PT dosimetry, patients treated with PT received significantly lower mean dose to the better spared parotid gland (32.8 vs 25.7 Gy, p = 0.001), lesser spared parotid gland (35.5 vs 31.1 Gy, p = 0.047), better spared cochlea (31.5 vs 25.5 Gy, p = 0.004), lesser spared cochlea (41.8 vs 33.2 Gy, p = 0.004), larynx (44.5 vs 21.7 Gy, p<0.001), and oral cavity (42.6 vs 17.0 Gy, p<0.001). After a median follow-up time of 30 months (45 mos IMRT, 23 mos PT) the estimated 2-year PFS was 63.9% with IMRT and 90.3% with PT (p = 0.047). The estimate of 2-year overall survival was 86.8% with IMRT and 96.8% with PT (p = 0.17). Comparing patients by radiation treatment modality, PT was associated with a statistically significant reduction in mean radiation dose to the parotid glands, cochlea, larynx, and oral cavity with excellent initial oncologic outcomes. [ABSTRACT FROM AUTHOR]

Whole-lung, low-dose radiation (LD-RT) for COVID-19 requires randomization and biologic correlates to determine causality and mechanism. A phase III trial randomized COVID-19 patients to physician's choice of drug therapy with or without LD-RT. Primary endpoint was intubation-free survival (IFS). The trial was designed with 80% power (two-sided log rank, alpha 0.05) to detect a hazard ratio of 0.3 after 12 intubation events. Estimating a 25% event rate, the planned sample size was 84 patients plus 25 to account for declining intubation rates and screen failures. Due to hospitalization declines and other barriers, the trial closed prematurely. Available randomized data were analyzed by intention-to-treat and combined with phase II results and immunologic correlates, using one-sided significance and an alpha of 0.1 to inform future trial design. From Jun 2020-Jun 2022, 14 patients were randomized on a phase III trial. From Apr 2020-Dec 2020, 42 patients were enrolled on a phase II trial and blindly matched to 40 controls from contemporaneous trials. 96 total patients and 193 blood samples were available for analysis. Mean hospital duration with LD-RT was 12.9 vs 15.4 days in controls (p = 0.12). Oxygen flow rate >15 L/min (26% vs 38%, p =.27), high-flow oxygen >30 L/min (24% vs 38%, p = 0.18), non-invasive positive-pressure >60 L/min (9% vs 27%, p = 0.03), and mechanical ventilation (9% vs 24%, p = 0.05) reduced with LD-RT. Mean supplemented oxygen volume was 171,759 vs 547,626 liters in controls, with daily means of 10 vs 23 L/min (p = 0.03). Radiographs worsened in 43% vs 71% of controls (p = 0.03). Arterial blood gas mean P/F ratios improved 22% after LD-RT vs declined 8% in controls (p = 0.12). Mean days febrile were 1.8 vs 2.9 in controls (p = 0.10). Rate of myocardial injury was 47% vs 40% in controls (p = 0.77). Flow cytometry revealed 4-fold and 30-fold larger expansions, respectively, in CD8- and CD4-positive CD3+PD1+Ki67-high proliferating cytotoxic T-cells (300% vs 75% expansion, p = 0.07) and helper T-cells (200% expansion vs 6% contraction, p = 0.03) at day 7. In the randomized cohort, mean oxygen volume fell 75% with LD-RT to 78,336 vs 316,786 liters in controls (p = 0.13), mean flow rates were 5.1 vs 18.4 L/min (p = 0.13), radiographs worsened in 50% vs 100% (p =.17), P/F ratios improved 31% vs declined 68% in controls (p = 0.03), hospital duration was 8.9 vs 11.5 days (p = 0.22), and zero LD-RT patients vs one control intubated. Combined analysis of a phase II/III randomized trial suggests that LD-RT prevents ventilation, reduces supplemental oxygen need, improves clinical course, and enhances immune response. LD-RT may have both immediate direct effects and delayed enhanced immunity in COVID-19. Larger multi-institutional trials are justified. [ABSTRACT FROM AUTHOR]

Pre-operative patient education has been shown to reduce patient anxiety and increase patient medical comprehension. This prospective pilot study hypothesized that patient knowledge related to the radiotherapy treatment process would be low after receiving traditional radiation educational materials and counseling at the time of initial consultation. Patients with non-metastatic cancer receiving definitive or adjuvant radiotherapy at three suburban radiation therapy clinics affiliated with an academic medical center completed a 34-question survey. Patients received traditional radiation educational materials. The survey included questions on demographics, the Spielberger State-Trait Anxiety Inventory short-form (STAI-S-6), a modified radiotherapy Amsterdam preoperative anxiety and information scale (mRT-APAIS), and radiotherapy knowledge. Patients also provided qualitative responses. Surveys were administered prior to the patient's CT-simulation scan. Descriptive statistics were performed. 22 patients were enrolled in this prospective pilot study. 19 (86%) patients were female. The median age was 66 (range: 38-80). 14 (64%) patients were white, 7 (32%) black, and 1 (4%) American Indian/Alaskan Native. 6 (27%) patients received a high school degree or GED, 10 (46%) obtained a 2-year degree and 5 (22%) received a 4-year degree or higher. 16 (73%) patients had breast cancer with the others having lung, brain, gastrointestinal, gynecologic, or other malignancies. The median radiotherapy knowledge score was 35.0 [IQR: 31.0 - 39.5] and 58% of patients endorsed low overall radiotherapy knowledge (score < 35). Patients reported low levels of knowledge related to radiotherapy set-up (41%), immobilization (41%), x-ray use (64%), and sensation (tactile 41%, auditory: 59%). The median STAI-S-6 score was 43.3 [IQR: 36.7 - 46.7] and the median mRT-APAIS score was 18 [IQR: 14.8 - 20.0]. 68% of patients were "anxious" by STAI-S-6 (score ≥ 40) and 77% by mRT-APAIS (score ≥ 12). A majority of patients reported low levels of knowledge related to the radiotherapy treatment process prior to CT simulation. These findings suggest an educational intervention at the time of consultation may be beneficial to reduce patient anxiety and increase patient knowledge related to the radiotherapy treatment process. Accrual is ongoing in this prospective pilot study. Future research directions include a phase 3 multi-institutional stepped-wedge clinical trial to investigate the impact of a novel patient education tool such as the Communicating the External Beam Radiotherapy Experience (CEBRE) discussion guide used during initial consultation to reduce patient anxiety and increase patient knowledge about radiotherapy. [ABSTRACT FROM AUTHOR]