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Background: Simultaneous involvement of multiple distinct brain regions occurs in 2-5% of all high-grade gliomas (HGG) and is associated with poor prognosis. Whereas radiotherapy (RT) is an important and well-established treatment for high-grade glioma, the role of dose-escalated radiotherapy has yet to be established. In this case series, we report upon the dosimetry, adverse effects, and response in patients with multiple un-methylated high-grade gliomas receiving dose-escalated radiation. Materials and methods: We reviewed charts of patients with multifocal high grade glioma treated at our institution since January 2022. All patients had stereotactic biopsies after an magnetic resonance imaging (MRI) contrast-enhanced with T1, T2, FLAIR sequences and were discussed in a multidisciplinary oncology team. MGMT-positive patients received either TMZ alone or RT with TMZ and were excluded from this analysis. Un-methylated patients received dose-escalated RT without temezolamide (TMZ). Following computed tomography (CT) and MR simulation, the gros tumor volume (GTV) was delineated and prescribed 52.5 Gy in 15 fractions within the standard 40.05 Gy planning treatment volume (PTV). Treatment planning was volumetric modulated arc therapy. Results: A total of 20 patients with multiple un-methylated MGMT glioblastoma multiforme were treated with dose-escalated radiation therapy between January 2022 and June 2023. All patients completed dose escalated radiotherapy without acute adverse effects. Progression-free survival at six months was 85%, as defined by the RANO criteria. Conclusion: In this case series, we showed that un-methylated multiple high-grade glioma could be safely treated with dose escalation. Results of progression-free survival should be validated in a larger prospective clinical trial. [ABSTRACT FROM AUTHOR]

The results of the generation of a high-power microwave (~550 MW, 0.5 ns, ~9.6 GHz) beam and feasibility of wakefield-excitation with this beam in under-dense plasma are presented. The microwave beam is generated by a backward wave oscillator (BWO) operating in the superradiance regime. The BWO is driven by a high-current electron beam (~250 keV, ~1.5 kA, ~5 ns) propagating through a slow-wave structure in a guiding magnetic field of 2.5 T. The microwave beam is focused at the desired location by a dielectric lens. Experimentally obtained parameters of the microwave beam at its waist are used for numerical simulations, the results of which demonstrate the formation of a bubble in the plasma that has almost 100% electron density modulation and longitudinal and transverse electric fields of several kV/cm. [ABSTRACT FROM AUTHOR]

The space charge limited current of an electron beam generated in a magnetically insulated foil-less diode by a cylindrical or hollow cathode and injected into a cylindrical drift tube depends on the energy of the electrons and on the ratio of the beam radius to the tube radius. When this beam drifts into a tube of larger radius, it exceeds the corresponding space charge limit. This leads to the formation of a virtual cathode and to the reduction of the energy of the beam. The latter is known as a squeezed beam state. When the cylindrical tube consists of more segments of different radii and lengths, the dynamics of the beam can be manipulated. We propose a simple configuration resulting in the production of a high-frequency periodic train of high-current electron beam pulses. [ABSTRACT FROM AUTHOR]

Background: Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation., Methods: A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low human leukocyte antigen (HLA) matching (5-6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS) and readmissions post-transplant., Results: The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-basiliximab, when compared with low HLA-matched KTRs who received basiliximab alone (9.1% vs 23.9%, P  = .067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and cytomegalovirus viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant., Conclusion: In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

In the face of global adversities such as pandemics, military conflicts, and socio-political unrest, the resilience and well-being of populations can be severely tested. This study examines the fluctuating levels of distress within the Israeli population over a period of 2.5 years, encompassing events like the COVID-19 pandemic and various socio-political and security crises. Utilizing a quasi-longitudinal design, data were collected at thirteen time-points, mirroring the demographic makeup of the Israeli Jewish adult population. Measures of psychological distress, societal and individual resilience, hope, morale, and perceived danger were assessed, alongside demographic variables. Statistical analyses included ANOVA and stepwise regression models. Distress levels displayed significant oscillations in response to adverse events. High distress was noted during the latter stages of the study, particularly following a major security incident on October 7, 2023. The regression analyses identified morale and perceived danger as consistent important associations with distress, with individual resilience also inversely related across all time points. The study reveals the dynamic nature of psychological distress in relation to a range of adversities. Morale emerged as a key buffer against distress, whereas perceived danger was a significant stressor, especially during acute- existential threats. These findings have important implications for mental health interventions and policy-making aimed at fostering resilience and mitigating distress in crisis conditions., (© 2024. The Author(s).)

Background: Autosomal dominant polycystic kidney disease (ADPKD)-related end-stage kidney disease (ESKD) often necessitates transplantation. However, the impact of ADPKD on post-transplant outcomes, specifically hemoglobin levels, remains unknown., Methods: We retrospectively analyzed 513 Kidney Transplant Recipients (KTRs), of whom 81 had ESKD due to ADPKD (20 with pre-transplant native nephrectomy and 61 without). Hemoglobin levels were evaluated at multiple time intervals post-transplant., Results: Kidney transplant recipients with ADPKD vs. KTRs with ESKD due to other causes exhibited significantly higher hemoglobin levels in repeated measurement analysis. Multivariable analyses confirmed ADPKD as an independent predictor for elevated hemoglobin levels. In a multivariable logistic regression analysis, the odds for maximum hemoglobin > 15 mg/dL at 3-12 months post-transplant were more than twice as high in ADPKD patients vs. all the other KTRs (Odds Ratio [OR] 2.31, 95% Confidence Interval [CI] 1.3-4.13, p < 0.001). Pre-transplant native nephrectomy revealed a trend toward lower hemoglobin levels. Elevated hemoglobin levels were linked to improved estimated glomerular filtration rate (eGFR) at one year post-transplant. Patient survival was enhanced among KTRs with ADPKD compared to other ESKD causes., Conclusions: Kidney transplant recipients with ADPKD exhibited elevated hemoglobin levels post-transplant, possibly due to prolonged native kidney erythropoietin production. These elevated hemoglobin levels were linked to improved outcomes, including allograft function and patient survival. Future research should further investigate the underlying mechanisms driving favorable ADPKD KTR outcomes., (© 2024. The Author(s).)

Introduction: Combat ground maneuvers consist of various platforms and have several environmental characteristics, influenced by the terrain, the operational mission, and the force's capabilities. This study assesses data on injuries sustained during urban warfare, aiming to evaluate the relationship between injury characteristics, maneuver platform, and personal protective gear on the battlefield., Materials and Methods: IDF soldiers injured infantry soldiers from the "Cast Lead" and the "Protective Edge" operations in the Gaza Strip (2008-2009 and 2014, respectively) were divided into four groups according to the maneuver platform and the environment: mounted infantry (armored and unarmored vehicle) and dismounted infantry (urban and open area). The primary outcome was the severity of the injury, and the secondary outcome was the injured body part., Results: Overall, 588 casualties were included in the final analysis, of whom 507 were dismounted infantry soldiers (265 in open terrain and 242 in urban area) and 81 were mounted infantry soldiers (20 in unarmored and 61 were injured in armored vehicles). The Injury Severity Score was similar in all subgroups. Open terrain subgroups were found to have fewer head injuries and higher levels of lower extremity injuries, similar to the unarmored vehicle group. More facial injuries were documented in the urban area group., Conclusions: The Injury Severity Score was not influenced by environmental protection. Although we found differences in the injured body parts, further studies on the exact mechanism of injury are needed to elucidate further the relationship and differences between the various platforms used and injuries seen in urban warfare, aiming for tailor-made protection., (© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Living kidney donation has increased significantly, but little is known about the post-donation health-related quality of life (HRQoL) of non-directed donors (NDs) vs. directed donors (DDs). We thus examined the outcomes of 112 living kidney donors (82 NDs, 30 DDs). For the primary outcomes-namely, the mean physical component summary (PCS) and mental component summary (MCS) scores of the 12-item Short Form Survey (SF-12) questionnaire-scores were significantly higher for the NDs vs. the DDs (PCS: +2.69, MCS: +4.43). For secondary outcomes, NDs had shorter hospital stays (3.4 vs. 4.4 days), returned to physical activity earlier (45 vs. 60 days), exercised more before and after donation, and continued physical activity post-donation. Regression analyses revealed that donor type and white blood cell count were predictive of the PCS-12 score, and donor type was predictive of the MCS-12 score. Non-directed donation was predictive of a shorter hospital stay (by 0.78 days, p < 0.001) and the odds of having PCS-12 and MCS-12 scores above 50 were almost 10 and 16 times higher for NDs, respectively ( p < 0.05). These findings indicate the safety and potential benefits of promoting non-directed donation. However, careful selection processes must be maintained to prevent harm and exploitation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Vital, Siman-Tov, Shlomai, Davidov, Cohen-Hagai, Shashar, Askenasy, Ghinea, Mor and Hod.)

Introduction: Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures., Method: This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics)., Results: Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics., Discussion: The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Stolero, Elkady, Labaka, Siman Tov, Peleg and Adini.)

Amid the COVID-19 outbreak, Israel and numerous other governments closed schools as a precaution, leading to a sudden shift to online learning. The aim of the current study is to provide foundational insight into the perceived readiness of the school system to withstand future adversities, based on the challenges, complexities, as well as successes in adaptation faced by stakeholders during COVID-19. In this cross-sectional study, we assess the perceived levels of functional resilience of the school system among the key stakeholders of the Israeli education system-high school students, parents, teachers, and principals, as well as a composite functional resilience scale. The composite functional resilience consists of 10 main indexes: communication during distance learning (DL) and frontal learning (FL); Perceived stress scale-4 (PSS); psychosocial aspects during distance learning (DL) and frontal learning (FL); digital literacy; pedagogic support; resources; infrastructure; and distance versus frontal learning. The study findings demonstrate differences according to the stakeholders with regard to the perceived functional resilience and the composite functional resilience scores (e.g., students with respect to both of these scores exhibit the lowest results, while teachers display the highest scores). Furthermore, no one variable was significant across the board for all stakeholders in predicting the perceived functional resilience, with the most common predictors among the stakeholders being digital literacy, pedagogic support, PSS, as well as communication during distance and frontal learning. The findings of this study reveal areas for recommended priority actions to be conducted among school system stakeholders., (© 2024. The Author(s).)

Introduction: Preparing the school system for a future crisis requires the ability to examine the effectiveness of schools' functioning during distant learning and their level of preparedness for future crises. Functional resilience (FR) is defined as the ability to maintain vital operational continuity in the face of disturbance. The study objectives included to develop a FR index of schools and to evaluate and validate it., Methods: To enable examination of the study objectives, the study design included tool development, followed by a validation process among 20 content experts. Concurrently, an eDelphi process for building an inclusive index, based on various components of resilience was conducted. The final study tool consists of four tailored questionnaires to examine perceptions of key stakeholders, i.e.- teachers, principals, parents, and highschool students regarding communication, psychosocial aspects, perceived stress, infrastructure, resources, pedagogic support, digital literacy, and perceived FR. Using an internet panel, the tool was disseminated cross-sectionally among the four groups of stakeholders., Results: The results showed high reliability of most of the scales developed. Furthermore, a high consensus level was reached on the relative importance of each component/ stakeholder to the schools FR. The findings further suggest that there were no significant differences in the composite FR score based on characteristics such as school type/ size/geographic location. However, the findings revealed interesting variations among stakeholders, with findings suggesting greater vulnerability among some., Discussion: To increase resilience and preparedness for future adversities that school systems may face, it is recommended to periodically incorporate an assessment based on a structured tool., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kaim, Siman-Tov, Adini and Lev-ari.)