Rationing Rotational Magnet Cochlear Implant Technology in a Single Payer Healthcare System

Introduction: In a publicly funded health care system, fiscally responsible management of any program is required. This is especially pertinent as evolving technology and associated incremental costs, places pressure on device availability within a fixed funding envelope. The application of rotational magnet technology and associated escalating surgical wait times must be justified to patients and the single-payer system. We present a single cochlear implant center’s attempt at a rationing schema for magnetic resonance compatible cochlear implantation. Contrasting approaches to rationing care are evaluated and deliberated. Methods: Based on a comparison of magnetic resonance imaging (MRI) rates within the general population to our cochlear implant (CI) cohort, we attempt the development of a decision-making schema that maximizes the number of patients to receive a CI while rationing the distribution of a rotational magnet technology to similarly situated individuals most likely to benefit. Results: We elect to provide rotational magnet technology to select patient cohorts. This is based on the dominant imaging needs of these populations and the probability of requiring recurrent imaging studies. We consider this an ethical approach grounded in the egalitarian principle of equality of opportunity within cohorts of patients. Conclusion: Given finite resources, increasing per unit cost will unavoidably extend wait times for adult patients. Our approach does not afford similar implant devices for all patients, but rather all similarly situated individuals. Therefore, access to a scare medical resource requires program rigor and a formalized policy around candidacy for emergent technology.

Simulation of the CBETA 4-pass FFAG ERL using field maps — exclusively

The Cornell-BNL Electron Test Accelerator (CBETA), a four-pass, 150 MeV energy recovery linac (ERL), is now in construction at Cornell. Commissioning commenced on March 2019. A particularity of CBETA is that a single channel loop recirculates the four energies (42, 78, 114 and 150 MeV). The return loop arcs are based on fixed-field alternating gradient (FFAG) optics. The loop is comprised of 107 quadrupole-doublet cells, built using Halbach permanent magnet technology. Spreader and combiner sections (4 independent beam lines each) connect the 36 MeV linac to the FFAG arcs. We introduce here a start-to-end simulation of the 4-pass ERL, based entirely, and exclusively, on the use of magnetic field maps to model the optical components.

Dipole Magnets Above 20 Tesla: Research Needs for a Path via High-Temperature Superconducting REBCO Conductors

To enable the physics research that continues to deepen our understanding of the Universe, future circular colliders will require a critical and unique instrument—magnets that can generate a dipole field of 20 T and above. However, today’s maturing magnet technology for low-temperature superconductors (Nb-Ti and Nb 3 Sn) can lead to a maximum dipole field of around 16 T. High-temperature superconductors such as REBCO can, in principle, generate higher dipole fields but significant challenges exist for both conductor and magnet technology. To address these challenges, several critical research needs, including direct needs on instrumentation and measurements, are identified to push for the maximum dipole fields a REBCO accelerator magnet can generate. We discuss the research needs by reviewing the current results and outlining the perspectives for future technology development, followed by a brief update on the status of the technology development at Lawrence Berkeley National Laboratory. We present a roadmap for the next decade to develop 20 T-class REBCO accelerator magnets as an enabling instrument for future energy-frontier accelerator complex.