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The electron cyclotron (EC) heating & current drive (H&CD) system on ITER provides plasma heating by generating, transmitting, and launching high-intensity, high-frequency (170 GHz) electromagnetic wave energy steerable across the plasma cross-section. The transmission line (TL) subsystem connects the Matching Optics Unit (MOU) on each of the 24 gyrotrons to the 32 feed points in the four upper launchers and the 24 feed points in the equatorial launcher. Each TL must be able to operate at up to 1.2 MW of input power for up to 1 hour pulse lengths. The TL system contains 50 mm water-cooled corrugated waveguide, 90o miter bends, 140o miter bends, polarizer miter bend pairs, switches, expansion units, pumpouts, DC breaks, MOU-TL adapters, Radio Frequency (RF) loads, and isolation shutter valves. A detailed finite element analysis has been used to verify the thermo-mechanical performance of each component. The microwave performance has been analyzed using a 2-D electromagnetic code combined with a Monte Carlo code. This approach allows the impact of manufacturing and installation tolerances to be assessed and optimized to provide a high probability of achieving the system performance requirements. Prototypes of the waveguide and TL components have been fabricated and tested at high-power. Production contracts are now being issued for fabrication and delivery of the waveguide and components to ITER.

The ITER Electron Cyclotron Resonance Heating (ECRH) & Current Drive (ECCD) system is planned to be progressively installed and commissioned following the four stage approach of the ITER Research Plan. Starting with an injection of up to 5.8 MW from one Upper Launcher (UL) in the vacuum vessel to assist the plasma breakdown during First Plasma (FP) operation, the system will then be extended to achieve a capability of 20 MW injected power in Pre-Fusion Plasma Operation (PFPO) and Fusion Power Operation (FPO) phases. Development of optical modelling was required to characterize the optical performance of the FP configuration with the so-called First Plasma Protection Components. An optical 3D model using Zemax OpticStudio® has been developed and extended to the UL. Effects of higher order modes, thermal deformations and tolerances on the UL functionality have been characterized and are presented. Finally, in preparation of plasma operation and in the frame of the EC system upgrade layout optimisation, ECRH-ECCD modelling is being undertaken within the ITER Integrated Modelling and Analysis (IMAS) suite.

ProblemOur nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity.ApproachWith support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks.OutcomesSince 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

This Viewpoint discusses what higher education institutions can learn from UC Davis when it comes to ensuring equity for their students now that the US Supreme Court has eliminated race-conscious college admissions.

ImportanceDespite decades-long calls for increasing racial and ethnic diversity, the medical profession continues to exclude members of Black or African American, Hispanic or Latinx, and Indigenous groups.ObjectiveTo describe US medical school admissions leaders' experiences with barriers to and advances in diversity, equity, and inclusion.Design, setting, and participantsThis qualitative study involved key-informant interviews of 39 deans and directors of admission from 37 US allopathic medical schools across the range of student body racial and ethnic composition. Interviews were conducted in person and online from October 16, 2019, to March 27, 2020, and analyzed from October 2019 to March 2021.Main outcomes and measuresParticipant experiences with barriers to and advances in diversity, equity, and inclusion.ResultsAmong 39 participants from 37 medical schools, admissions experience ranged from 1 to 40 years. Overall, 56.4% of participants identified as women, 10.3% as Asian American, 25.6% as Black or African American, 5.1% as Hispanic or Latinx, and 61.5% as White (participants could report >1 race and/or ethnicity). Participants characterized diversity broadly, with limited attention to racial injustice. Barriers to advancing racial and ethnic diversity included lack of leadership commitment; pressure from faculty and administrators to overemphasize academic scores and school rankings; and political and social influences, such as donors and alumni. Accreditation requirements, holistic review initiatives, and local policy motivated reforms but may also have inadvertently lowered expectations and accountability. Strategies to overcome challenges included narrative change and revision of school leadership structure, admissions goals, practices, and committee membership.Conclusions and relevanceIn this qualitative study, admissions leaders characterized the ways in which entrenched beliefs, practices, and power structures in medical schools may perpetuate institutional racism, with far-reaching implications for health equity. Participants offered insights on how to remove inequitable structures and implement process changes. Without such action, calls for racial justice will likely remain performative, and racism across health care institutions will continue.

This article describes the "The Admissions Revolution: Bold Strategies for Diversifying the Healthcare Workforce" conference, which preceded the 2022 Beyond Flexner Alliance Conference and called for health professions institutions to boldly reimagine the admission process to diversify the health care workforce. Proposed strategies encompassed 4 key themes: admission metrics, aligning admission practices with institutional mission, community partnerships to fulfill social mission, and student support and retention. Transformation of the health professions admission process requires broad institutional and individual effort. Careful consideration and implementation of these practices will help institutions achieve greater workforce diversity and catalyze progress toward health equity.

Introduction: Understanding how abundance, productivity and distribution of individual species may respond to climate change is a critical first step towards anticipating alterations in marine ecosystem structure and function, as well as developing strategies to adapt to the full range of potential changes. Methods: This study applies the NOAA (National Oceanic and Atmospheric Administration) Fisheries Climate Vulnerability Assessment method to 64 federally-managed species in the California Current Large Marine Ecosystem to assess their vulnerability to climate change, where vulnerability is a function of a species’ exposure to environmental change and its biological sensitivity to a set of environmental conditions, which includes components of its resiliency and adaptive capacity to respond to these new conditions. Results: Overall, two-thirds of the species were judged to have Moderate or greater vulnerability to climate change, and only one species was anticipated to have a positive response. Species classified as Highly or Very Highly vulnerable share one or more characteristics including: 1) having complex life histories that utilize a wide range of freshwater and marine habitats; 2) having habitat specialization, particularly for areas that are likely to experience increased hypoxia; 3) having long lifespans and low population growth rates; and/or 4) being of high commercial value combined with impacts from non-climate stressors such as anthropogenic habitat degradation. Species with Low or Moderate vulnerability are either habitat generalists, occupy deep-water habitats or are highly mobile and likely to shift their ranges. Discussion: As climate-related changes intensify, this work provides key information for both scientists and managers as they address the long-term sustainability of fisheries in the region. This information can inform near-term advice for prioritizing species-level data collection and research on climate impacts, help managers to determine when and where a precautionary approach might be warranted, in harvest or other management decisions, and help identify habitats or life history stages that might be especially effective to protect or restore.

Time dependent simulations that evolve consistently the magnetic equilibrium and plasma pressure profiles and the width and frequency rotation of magnetic islands under the effect of the Electron Cyclotron feedback system are used to assess whether the control of NTMs on ITER is compatible with other simulataneous functionalities of the EC system, like core heating and current profile tailoring, or sawtooth control. Results indicate that the power needs for control can be reduced if the EC power is reserved and if pre-emptive control is used as opposed to an active search for an already developed island.

Patients with valvular heart disease may present with or without symptoms. A thorough cardiac physical examination can identify patients who require further evaluation and management. Although the utility of different cardiac findings varies widely, diastolic murmurs indicate important underlying valvular pathology requiring further investigation, typically with echocardiography. The proper examination of patients with systolic murmurs, the most common murmurs in clinical practice, is fundamental to cost-effective care. We will review the key components of the cardiac examination and findings relevant to functional murmurs, aortic stenosis, mitral valve prolapse and regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, aortic regurgitation, and mitral stenosis.

The four ITER Electron Cyclotron Upper Launchers (UL) are designed to control Magneto- Hydrodynamic instabilities with the deposition of Electron Cyclotron power. According to the present design, each launcher comprises two rows of four input waveguides, whose output beam is focused and driven towards the plasma by four sets of mirrors. In order to study the beam-launcher interaction throughout quasi-optical propagation, with particular attention to straylight behaviour, and to verify analytical calculations, a 3D model of the UL optical system has been implemented with the electromagnetic code GRASP® and the Physical Optics method. Detailed description of the components are introduced: pure hybrid mode HE11 from cylindrical waveguide as input beams, real shapes of the mirror contours, semi-analytical description of the ellipsoidal surfaces of focussing mirrors. A conceptual calculation scheme has been developed in order to take into account not only the direct contribution of the single source on its next scatterer but also the first order indirect effects: crosstalk from different lines of the same row and crosstalk from different rows have been evaluated after reflection on the first and third set of mirrors. The evaluations presented have been performed on the preliminary UL design, the last major milestone before finalization; however, the numerical model is suitable to be applied to future evolutions of the setup and/or other configurations.

PurposeTo conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs).MethodFrom June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care.ResultsA total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08).ConclusionsStructural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

This cohort study examines the association between Medical College Admission Test (MCAT) scores, disability status and category, and performance on US Medical Licensing Examination (USMLE) Step 1 and Step 2 CK scores.

Studies employing data collected over 15 years ago suggested salutary effects of postbaccalaureate (PB) premedical coursework on medical school class diversity, academic performance, and primary care training. The studies may have limited current applicability given changes in medical school admissions paradigms and population demographics. Using data from interviewees at >1 of 5 California public medical schools between 2011-2013 (N=3805), we examined associations of PB premedical coursework with underrepresented race/ethnicity; academic performance (United States Medical Licensing Examination Step 1 and Step 2 scores, clerkship Honors); and primary care residency. Adjusting for age, sex, and year, PB coursework was associated with underrepresented race/ethnicity, but not after further adjustment for self-designated disadvantage (SDA). PB coursework was not associated with academic performance or primary care residency. Holistic consideration of SDA and UIM status in admissions coupled with robust matriculant support may merit exploration as an alternative to PB coursework for increasing medical school diversity.

As medical schools seek to address the growing disparity between the socioeconomic makeup of their students and the general population, it is important to understand the academic trajectory of disadvantaged students. We used a locally-developed multicomponent socioeconomic disadvantage (SED) measure and the self-designated disadvantaged (SDA) question ["yes" (+) or "no" (-)] from the American Medical College Application Service application to examine academic performance of students from three disadvantaged categories (high SED/SDA+, high SED/SDA-, and low SED/SDA+); with low SED/SDA-as the reference group across five California schools. Compared with reference, the DA+ subgroups scored lower on USMLE Step 1 and Step 2 Clinical Knowledge examinations and received fewer clerkship Honors. After adjustment for academic metrics and sociodemographic variables, high SED subgroups performed similarly to reference, but performance gaps for low SED/SDA+ students persisted. Medical schools must better understand the institutional and other drivers of academic success in disadvantaged students.

This article offers two case studies to illustrate the challenges in applying mainstream engineering educational training in a different culture and context while also offering some suggestions for more integrated and context-based educational approaches. The overall goal is not to dissuade energetic and well-meaning engineers looking to make a difference in the lives of communities around the world (although it is clear that in many cases, engineering solutions implemented at community levels have had mixed results) but rather to suggest that developing skills and contextual awareness to supplement those that they receive in traditional engineering programs is necessary to succeed in being part of a process of positive change in communities. This article will hopefully inspire engineering students and engineers to reflect on and ask important questions before they design solutions for communities different from the ones they grew up in. [ABSTRACT FROM AUTHOR]

The two-stage process for the treatment of rare earth phosphate minerals, involving an oxalic acid conversion leach and subsequent EDTA dissolution, has been demonstrated as a promising alternative to conventional extraction methods. To underpin a more detailed understanding, this work serves to further develop knowledge of the linkage between the stages and key practical aspects of the operation of the EDTA dissolution. A more detailed treatment of the phenomena observed in the EDTA treatment, characteristics of the solids, mass loss in dissolution, and the impact of parameter alterations in both stages provide greater holistic knowledge of the proposed flowsheet and considerations that will need to be addressed when increasing scale. Acid production (indicated by a pH decrease) in the EDTA dissolution stage was shown to be a feature of the reaction and not of residual acid associated with the solids from the oxalic acid stage. The consistency with which the rare earths were dissolved with respect to the phosphorus provided greater confidence that Nd and Pr (greater dissolution than P) are recovered at a higher efficiency than Ce and La (poorer dissolution than P). This was only not the case at high solids loading across both tests, leading to both oxalate and EDTA-deficient systems, respectively. Under high conversion conditions, it was demonstrated that Nd and Pr recoveries into solution approaching 70% were achieved. This equated to in excess of 17 gL−1 of total rare earths in solution. Solid/liquid separation was shown to be a significant challenge, created by both the fine particle size distribution of the leached residue and the dispersant nature of EDTA. [ABSTRACT FROM AUTHOR]

PurposeTo compare the predictive validities of medical school admissions multiple mini-interviews (MMIs) and traditional interviews (TIs).MethodThis longitudinal observational study of 2011-2013 matriculants to five California public medical schools examined the associations of MMI scores (two schools) and TI scores (three schools) with subsequent academic performance. Regression models adjusted for sociodemographics and undergraduate academic metrics examined associations of standardized mean MMI and TI scores with United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge (CK) scores and, for required clerkships, with mean National Board of Medical Examiners Clinical Science subject (shelf) exam score and number of honors grades.ResultsOf the 1,460 medical students, 746 (51.1%) interviewed at more than one study school; 579 (39.7%) completed at least one MMI and at least one TI. Neither interview type was associated with Step 1 scores. Higher MMI scores were associated with more clerkship honors grades (adjusted incidence rate ratio [AIRR] 1.28 more [95% CI 1.18, 1.39; P < .01] per SD increase) and higher shelf exam and Step 2 CK scores (adjusted mean 0.73 points higher [95% CI 0.28, 1.18; P < .01] and 1.25 points higher [95% CI 0.09, 2.41; P = .035], respectively, per SD increase). Higher TI scores were associated only with more honors grades (AIRR 1.11 more [95% CI 1.01, 1.20; P = .03] per SD increase).ConclusionsMMI scores were more strongly associated with subsequent academic performance measures than were TI scores.

Natural products and their derivatives continue to be wellsprings of nascent therapeutic potential. However, many laboratories have limited resources for biological evaluation, leaving their previously isolated or synthesized compounds largely or completely untested. To address this issue, the Canvass library of natural products was assembled, in collaboration with academic and industry researchers, for quantitative high-throughput screening (qHTS) across a diverse set of cell-based and biochemical assays. Characterization of the library in terms of physicochemical properties, structural diversity, and similarity to compounds in publicly available libraries indicates that the Canvass library contains many structural elements in common with approved drugs. The assay data generated were analyzed using a variety of quality control metrics, and the resultant assay profiles were explored using statistical methods, such as clustering and compound promiscuity analyses. Individual compounds were then sorted by structural class and activity profiles. Differential behavior based on these classifications, as well as noteworthy activities, are outlined herein. One such highlight is the activity of (-)-2(S)-cathafoline, which was found to stabilize calcium levels in the endoplasmic reticulum. The workflow described here illustrates a pilot effort to broadly survey the biological potential of natural products by utilizing the power of automation and high-throughput screening.

The expansion of Medicaid under the Affordable Care Act has strained the capacity of many academic health centers (AHCs) to deliver primary and specialty care to this traditionally underserved population. The authors, longtime faculty members in the University of California, Davis Health (UCDH) system, discuss the challenges of UCDH's participation in Medi-Cal, the nation's largest Medicaid program, and their institution's controversial decision in 2015 to withdraw from its last Medi-Cal primary care contract, which has had untoward effects on UCDH's social and educational missions. The authors call on AHCs to leverage their considerable intellectual and human capital as well as their focus on education and research to aggressively pursue innovative models of high-value primary care for underserved populations in their local communities, highlighting several recent successful examples of such programs. The UCDH experience has implications for other AHCs grappling with the financial realities of an increasingly competitive, value-based health care marketplace and the inherent difficulty in balancing educational, research, patient care, and social or community service missions.