The Spherical Tokamak for Energy Production (STEP) requires high-field magnet designs and has therefore adopted the REBCO-based high-temperature superconductor (HTS) as its current carrier. The HTS enables the toroidal field (TF) coils to be remountable, which unlocks STEP\'s vertical maintenance approach; however, remountable joints, approximately 18 GJ of stored energy and limited space down the centre of a spherical tokamak, make the TF coils the most challenging. STEP has pursued a passive approach to TF coil quench protection in order to limit coil terminal voltage. Initial results suggest that a solution may rely on tuning internal coil resistance coupled with actively powered heaters. The pre-conceptual inter-coil structure demonstrates acceptable stresses and deflections under steady-state operating conditions and preliminary fault scenarios, and loads are distributed to limit the tensile force on the TF centre rod. Finally, the HTS must operate reliably in a high radiation environment and endure high neutron fluences, ensuring commercially relevant magnet lifetimes. Initial experiments indicate that instantaneous gamma irradiation of HTS has no negative impact on current carrying capacity. Experimental programmes are underway to cold irradiate HTS to fusion-relevant fluences and to develop a method of assuring tape irradiation tolerance using oxygen ions as an analogue for neutrons.This article is part of the theme issue \'Delivering Fusion Energy - The Spherical Tokamak for Energy Production (STEP)\'.

OBJECTIVE: The number of postanesthesia care unit (PACU) registered nurses (RNs) with a specialty nursing certification at an orthopedic hospital in an academic health system was below the organizational benchmark. A clinical nurse-led process was developed to increase the percentage of PACU RNs with a specialty certification. This article will describe the strategies and interventions identified to support, reward, and recognize nurses who obtain or maintain their specialty certifications.
METHODS: A performance improvement project using the Plan-Do-Study-Act cycle.
METHODS: A gap analysis identified barriers preventing PACU nurses from obtaining specialty certifications in an orthopedic acute care American Nurses Credentialing Center Magnet-designated hospital. An anonymous web-based survey was distributed to 18 nurses who, although eligible, were not certified. The survey assessed common barriers to certification (eg, cost of the examination, comfort level with the testing process, level of access to review courses and study materials, expense to maintain credentials, personal interest in certification, and awareness of qualification information to take the exam). The project team included PACU nurse leaders, certified clinical nurses, nursing professional development specialists, and other interdisciplinary team members (eg, content experts from different departments).
RESULTS: Eighteen RNs completed the anonymous survey. The leading barrier was the expense of the certification exam (73%), while 66% of respondents reported discomfort with the test-taking process. Additionally, 61% of nurses reported that more access to review courses and study materials is needed, 44% responded that the expense of maintaining credentials is a barrier, 39% responded that the additional compensation pay for a specialty certification was considered to be insufficient, 39% agreed there is a lack of information on eligibility criteria, and 6% responded that they have no interest or desire to become certified. The survey results informed implementation strategies to increase certification rates, including initiating peer-to-peer exam groups and ongoing collaboration with nurse leaders on reward and recognition strategies. The removal of known barriers to obtaining specialty certification significantly increased certification rates in the PACU. Over the project period, the percentage of PACU-certified nurses increased to 60%, exceeding the project goal of 51%.
CONCLUSIONS: Peer-to-peer education and collaboration with nursing leadership and other interdisciplinary team members helped increase PACU\'s certification rates in this orthopedic specialty hospital. The informational and recognition strategies were impactful, resulting in additional nurses interested in becoming certified. Newly certified nurses are now motivating others to seek certification. Based on this well-established support system, the PACU certification rate is anticipated to continue to rise.

BACKGROUND: The partial diversion of intestinal contents facilitates achieving and maintaining weight loss and improving glycemic control in patients with obesity and with or without T2DM. The purpose of this study is to report our experience and 1-year follow-up with novel modification of SADI-S.
METHODS: This study is a part of a multicentric trial of patients that underwent primary side-to-side duodeno-ileostomy and sleeve gastrectomy (SG) with GT metabolic solutions magnetic anastomosis system. Feasibility, safety, and initial efficacy were evaluated.
RESULTS: The mean age of the patients included was 48 ± 8.75 years and the preoperative BMI was 43.32 ± 2.82 kg/m2. The complications were present in 30% of patients. The anastomosis patency was confirmed by the passage of radiological contrast under fluoroscopy at a mean of 17 days (17-29 days), and the mean expulsion time was 42 days (32-62). The mean diameter of the anastomosis after the magnet expulsion was 13.8 × 11.4 mm. The percentage of total weight lost at 1 year was 38.68 ± 8.48% (p < 0.001). The percentage of excess weight loss 82.5 ± 18.44% (p < 0.001) and improvements in glucose profiles were observed. Mean baseline HbA1c 5.77 ± 0.31% was reduced to 5.31 ± 0.26% (p < 0.024).
CONCLUSIONS: Latero-lateral duodeno-ileostomy + SG with magnetic duodenal bipartition is afeasible and reasonably safe technique and induces weight loss in patients with obesity and improvement of glycemic control. This modification could be considered as an option to standard SADI-S or as a first step in two stages procedure. However, larger studies are needed.
BACKGROUND: Clinicaltrials.gov Identifier: #NCT05322122.

This article highlights a research study on the fabrication of a 25.2 T ultra-high field NMR magnet for an extreme condition user facility in China.

BACKGROUND: Magnetic anchor technique (MAT) has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy, but has not been reported in laparoscopic partial hepatectomy.
OBJECTIVE: To evaluate the feasibility of the MAT in laparoscopic left lateral segment liver resection.
METHODS: Retrospective analysis was conducted on the clinical data of eight patients who underwent laparoscopic left lateral segment liver resection assisted by MAT in our department from July 2020 to November 2021. The Y-Z magnetic anchor devices (Y-Z MADs) was independently designed and developed by the author of this paper, which consists of the anchor magnet and magnetic grasping apparatus. Surgical time, intraoperative blood loss, intraoperative accidents, operator experience, postoperative incision pain score, postoperative complications, and other indicators were evaluated and analyzed.
RESULTS: All eight patients underwent a MAT-assisted laparoscopic left lateral segment liver resection, including three patients undertaking conventional 5-port and five patients having a transumbilical single-port operation. The mean operation time was 138 ± 34.32 min (range 95-185 min) and the mean intraoperative blood loss was 123 ± 88.60 mL (range 20-300 mL). No adverse events occurred during the operation. The Y-Z MADs showed good workability and maneuverability in both tissue and organ exposure. In particular, the operators did not experience either a \"chopstick\" or \"sword-fight\" effect in the single-port laparoscopic operation.
CONCLUSIONS: The results show that the MAT is safe and feasible for laparoscopic left lateral segment liver resection, especially, exhibits its unique abettance for transumbilical single-port laparoscopic left lateral segment liver resection.

Obstructions encountered in biliary, gastrointestinal, and urinary tracts are increasing in number due to successful percutaneous and endoscopic organ-saving procedures. Although functional recovery is established to an extent, failure of traversing an obstruction may end up necessitating invasive surgical procedures. Multidisciplinary collaboration may traverse the limitations of each individual approach, therefore creating the perfect intervention for the patient. Magnetic compression anastomosis is a minimally invasive procedure that can provide a great outcome in select cases with biliary, gastrointestinal, or urinary tract obstructions. CRITICAL RELEVANCE STATEMENT: In this article, various applications of magnetic compression anastomosis are reviewed with illustrative cases of esophageal, biliary, colonic, and urinary obstructions that cannot be traversed with a wire. This method will expand the spectrum of interventions performed in the IR unit. KEY POINTS: Magnets can enable wire access beyond an impassable obstruction. Magnets can create anatomical and non-anatomical anastomosis at an occlusion. Magnetic compression anastomosis is a minimally invasive procedure that can provide great outcomes.

Despite the spread of novel-generation cochlear-implant (CI) magnetic systems, access to magnetic resonance imaging (MRI) for CI recipients is still limited due to safety concerns. The aim of this study is to assess and record the experiences of Hires Ultra 3D (Advanced Bionics) recipients who underwent an MRI examination. A multicentric European survey about this topic was conducted focusing on safety issues, and the results were compared with the current literature. We collected a total of 65 MRI scans performed in 9 otologic referral centers for a total of 47 Hires Ultra 3D recipients, including, for the first time, 2 children and 3 teenagers. Preventive measures were represented by scanning time and sedation for children. Head wrapping was used in eight cases, and six of the eight cases received local anesthesia, even if both measures were not needed. Only three patients complained of pain (3/65 examinations, 4.6%) due to the tight head bandage, and one of the three cases required MRI scan interruption. No other adverse events were reported. We believe that these results should encourage MRI execution in accordance with manufacturer recommendations for Ultra 3D recipients.

Mononegaviruses are promising tools as oncolytic and transgene vectors for gene therapy and regenerative medicine. However, when mononegaviruses are used for therapeutic applications, the viral activity must be strictly controlled due to concerns about toxicity and severe side effects. With this technology, mononegavirus vectors can be grown where they are intended and can be easily removed when they are no longer needed. In particular, a photoswitch protein called Magnet (consisting of two magnet domains) is incorporated into the hinge region between the connector and methyltransferase domains of the mononegavirus polymerase protein (L protein) to disrupt the L protein functions. Blue light (470 ± 20 nm) irradiation causes the dimerization of the two magnet domains, and the L protein is restored to activity, allowing viral gene expression and virus replication. Since the magnet domains\' dimerization is reversible, viral gene expression and replication cease when blue light irradiation is stopped.

BACKGROUND: The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula (TEF), but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control. We designed a T-shaped magnet system to overcome these problems and verified its effectiveness via animal experiments.
OBJECTIVE: To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs.
METHODS: Twelve beagles were randomly assigned to groups in which magnets of the T-shaped scheme (study group, n = 6) or normal magnets (control group, n = 6) were implanted into the trachea and esophagus separately under gastroscopy. Operation time, operation success rate, and accidental injury were recorded. After operation, the presence and timing of cough and the time of magnet shedding were observed. Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing, and gross specimens of TEFs were obtained. Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery, and gross specimens were obtained. Fistula size was measured in all animals, and then harvested fistula specimens were examined by hematoxylin and eosin (HE) and Masson trichrome staining.
RESULTS: The operation success rate was 100% for both groups. Operation time did not differ between the study group (5.25 min ± 1.29 min) and the control group (4.75 min ± 1.70 min; P = 0.331). No bleeding, perforation, or unplanned magnet attraction occurred in any animal during the operation. In the early postoperative period, all dogs ate freely and were generally in good condition. Dogs in the control group had severe cough after drinking water at 6-9 d after surgery. X-ray indicated that the magnets had entered the stomach, and gastroscopy showed TEF formation. Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm ± 1.29 mm (range, 3.52-6.56 mm). HE and Masson trichrome staining showed scar tissue formation and hierarchical structural disorder at the fistulas. Dogs in the study group did not exhibit obvious coughing after surgery. X-ray examination 2 wk after surgery indicated fixed magnet positioning, and gastroscopy showed no change in magnet positioning. The magnets were removed using a snare under endoscopy, and TEF was observed. Gross specimens showed well-formed fistulas with a diameter of 6.11 mm ± 0.16 mm (range, 5.92-6.36 mm), which exceeded that in the control group (P < 0.001). Scar formation was observed on the internal surface of fistulas by HE and Masson trichrome staining, and the structure was more regular than that in the control group.
CONCLUSIONS: Use of the modified T-shaped magnet scheme is safe and feasible for establishing TEF and can achieve a more stable and uniform fistula size compared with ordinary magnets. Most importantly, this model offers better controllability, which improves the flexibility of follow-up studies.

BACKGROUND: Removal of orbital foreign bodies is a surgical challenge. The purpose of this study is to report our experience in the removal of orbital foreign bodies and to evaluate the usefulness of various technological aids in their removal.
METHODS: We conducted a single-center retrospective study at Nice University Hospital (France) from January 2017 to December 2023. All patients undergoing surgery for an orbital foreign body during the study period were included. Data recorded included the nature of the orbital foreign body, its size, location, surgical route, outcome (success, partial success, failure), and technological aids used (intraoperative navigation, intraoperative imaging scope, orbital magnet). Concurrently, we designed a dedicated orbital magnet, which was tested in the anatomy laboratory and in two of our patients.
RESULTS: Six patients, all young men, were included during the study period. Removal was successful, partially successful, or unsuccessful in one-third of cases, respectively. Failure was associated with orbital foreign bodies located in the intraconal or posterior orbital space. Preoperatively, the use of a \"low-artifact\" scanner allowed us to better determine the exact size and shape of the orbital foreign body. Intraoperative navigation was not accurate enough, due to the mobility of the orbital bodies within the orbital fat. In our experience, intraoperative scope imaging was more accurate. The use of a dedicated orbital magnet was successfully tested in the anatomy laboratory and allowed the removal of a small orbital foreign body in one of our patients. Intraoperative surgical videos are provided.
CONCLUSIONS: Vegetal orbital foreign bodies must be systematically removed. Removal of non-vegetal orbital foreign bodies should be considered on a case-by-case basis based on their size, best assessed using a \"low artifact\" scanner, their location, and their intrinsic ferromagnetism. Intraoperative navigation does not appear useful, while intraoperative scope imaging does. A dedicated orbital magnet might be helpful in removing ferromagnetic orbital foreign bodies. However, an orbital magnet may be ineffective in removing intraorbital bullets, since they are made primarily of an alloy of copper and lead.