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Real-time monitoring of volcanic eruptions involving caldera-forming events are rare (see the Perspective by Sigmundsson). Anderson et al. used several types of geophysical observations to track the caldera-forming collapse at the top of Kīlauea Volcano, Hawai'i, during the 2018 eruption. Gansecki et al. used near–real-time lava composition analysis to determine when magma shifted from highly viscous, slow-moving lava to low-viscosity, fast-moving lava. Patrick et al. used a range of geophysical tools to connect processes at the summit to lava rates coming out of far-away fissures. Together, the three studies improve caldera-collapse models and may help improve real-time hazard responses. Science , this issue p. eaaz0147 , p. eaay9070 ; p. eaaz1822 ; see also p. 1200 Near–real-time chemical monitoring of lava during the Kīlauea eruption allowed forecasting of high-temperature eruptions. Changes in magma chemistry that affect eruptive behavior occur during many volcanic eruptions, but typical analytical techniques are too slow to contribute to hazard monitoring. We used rapid energy-dispersive x-ray fluorescence analysis to measure diagnostic elements in lava samples within a few hours of collection during the 2018 Kīlauea eruption. The geochemical data provided important information for field crews and civil authorities in advance of changing hazards during the eruption. The appearance of hotter magma was recognized several days before the onset of voluminous eruptions of fast-moving flows that destroyed hundreds of homes. We identified, in near real-time, interactions between older, colder, stored magma—including the unexpected eruption of andesite—and hotter magma delivered during dike emplacement.

Nanometer‐scale titanomagnetite crystals have been detected in nominally aphyric rhyolite pumice, but whether they are numerous enough to impact bubble nucleation in explosive silicic volcanism was unresolved. This study examines sub‐micron crystals using rock magnetic techniques, Rhyolite‐MELTS modeling, and physical characterization. We analyzed pumice from four eruptions spanning wide ranges in intensity, storage depth, and bubble number density (1016 to 1013 m−3 liquid): 1060 CE Glass Mountain, 1912 CE Novarupta, 232 CE Taupo, and 0.45 Ma Pudahuel. Calculations assuming monospecific assemblages of 10 and 1,000 nm cubic particles yield titanomagnetite number densities of 1021 to 1013 m−3 dense rock equivalent, respectively. In all cases, titanomagnetite is thermodynamically stable at pre‐eruptive storage conditions and magnetic susceptibility (χLF) is independent of vesicularity and permeability, indicating that crystals likely formed prior to vesiculation. The existence of nm‐scale Fe‐Ti oxides in four diverse cases suggests that heterogeneous bubble nucleation is a general feature of explosive rhyolite volcanism.

Nucleation of H2O vapor bubbles in magma requires surpassing a chemical supersaturation threshold via decompression. The threshold is minimized in the presence of a nucleation substrate (heterogeneous nucleation, <50 MPa), and maximized when no nucleation substrate is present (homogeneous nucleation, >100 MPa). The existence of explosively erupted aphyric rhyolite magma staged from shallow (<100 MPa) depths represents an apparent paradox that hints at the presence of a cryptic nucleation substrate. In a pair of studies focusing on Glass Mountain eruptive units from Medicine Lake, California, we characterize titanomagnetite nanolites and ultrananolites in pumice, obsidian, and vesicular obsidian (Brachfeld et al., 2024, https://doi.org/10.1029/2023GC011336), calculate titanomagnetite crystal number densities, and compare titanomagnetite abundance with the physical properties of pumice to evaluate hypotheses on the timing of titanomagnetite crystallization. Titanomagnetite crystals with grain sizes of approximately 3–33 nm are identified in pumice samples from the thermal unblocking of low‐temperature thermoremanent magnetization. The titanomagnetite number densities for pumice are 1018 to 1020 m−3, comparable to number densities in pumice and obsidian obtained from room temperature methods (Brachfeld et al., 2024, https://doi.org/10.1029/2023GC011336). This range exceeds reported bubble number densities (BND) within the pumice from the same eruptive units (average BND ∼4 × 1014 m−3). The similar abundances of nm‐scale titanomagnetite crystals in the effusive and explosive products of the same eruption, together with the lack of correlation between pumice permeability and titanomagnetite content, are consistent with titanomagnetite formation having preceded the bubble formation. Results suggest sub‐micron titanomagnetite crystals are responsible for heterogeneous bubble nucleation in this nominally aphyric rhyolite magma. Key Points Aphyric rhyolite eruptions staged from shallow magma reservoirs lack the overpressure needed for homogeneous bubble nucleation Heterogeneous bubble nucleation may occur on sub‐µm titanomagnetite crystals, which are undetectable using standard analytical techniques Sub‐µm titanomagnetite crystals can be detected and quantified with low temperature magnetic analyses

We document the presence, composition, and number density (TND) of titanomagnetite nanolites and ultra‐nanolites in aphyric rhyolitic pumice, obsidian, and vesicular obsidian from the 1060 CE Glass Mountain volcanic eruption of Medicine Lake Volcano, California, using magnetic methods. Curie temperatures indicate compositions of Fe2.40Ti0.60O4 to Fe3O4. Rock‐magnetic parameters sensitive to domain state, which is dependent on grain volume, indicate a range of particle sizes spanning superparamagnetic (<50–80 nm) to multidomain (>10 μm) particles. Cylindrical cores drilled from the centers of individual pumice clasts display anisotropy of magnetic susceptibility with prolate fabrics, with the highest degree of anisotropy coinciding with the highest vesicularity. Fabrics within a pumice clast require particle alignment within a fluid, and are interpreted to result from the upward transport of magma driven by vesiculation, ensuing bubble growth, and shearing in the conduit. Titanomagnetite number density (TND) is calculated from titanomagnetite volume fraction, which is determined from ferromagnetic susceptibility. TND estimates for monospecific assemblages of 1,000 nm–10 nm cubes predict 1012 to 1020 m−3 of solid material, respectively. TND estimates derived using a power law distribution of grain sizes predict 1018 to 1019 m−3. These ranges agree well with TND determinations of 1018 to 1020 m−3 made by McCartney et al. (2024), and are several orders of magnitude larger than the number density of bubbles in these materials. These observations are consistent with the hypothesis that titanomagnetite crystals already existed in extremely high number‐abundance at the time of magma ascent and bubble nucleation. Plain Language Summary We use magnetism experiments to prove that nanometer‐sized magnetic particles are present in volcanic rocks with low iron content and few visible crystals. Nanolites (particles between 30 and 1,000 nm) and ultra‐nanolites (particles smaller than 30 nm) are extremely difficult to detect in volcanic rocks composed mainly of glass using conventional methods such as optical and electron microscopy. Titanomagnetite nano‐particles may play a role in controlling the explosiveness of volcanic eruptions. The magnetic signatures of minerals can be used to determine their chemical composition, particle size range, and particle abundance. Pumice and obsidian contain the mineral titanomagnetite, with no evidence of prolonged crystallization at high oxygen levels at the Earth's surface. Observed magnetic behaviors are very similar to those of previously published studies of titanomagnetite in the 10–1,000 nm size range, and similar to mathematical models that simulate this size range. We find that pumice clasts have a magnetic fabric, suggesting that the nanolites and ultra‐nanolites were aligned in spatial patterns before the magma solidified, with stronger alignment coinciding with high degrees of vesicularity. Our results indicate that titanomagnetite crystals are highly abundant, and had crystallized in the magma chamber before the eruption. Key Points Magnetic methods document titanomagnetite nanolites in rhyolitic materials from Glass Mountain, Medicine Lake Volcano, California Titanomagnetite number densities for pumice, obsidian, and vesicular obsidian span 1012 to 1020 m−3 of solid material Titanomagnetite crystals already existed in extremely high number‐abundance at the time of magma ascent and bubble nucleation

This randomized study showed that including autologous transplantation as part of primary treatment improved progression-free survival but not overall survival among high-intermediate-risk and high-risk patients with aggressive lymphoma. Autologous stem-cell transplantation has long been known to improve both progression-free survival and overall survival among patients with diffuse, aggressive non-Hodgkin's lymphoma in second remission. 1 When it became possible to identify patients at diagnosis who have less than a 50% chance of sustained remission, as defined by the International Prognostic Index 2 (IPI) (see Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org), trials of up-front transplantation in this group were conducted. In the first trial, LNH-87, patients received full-course induction chemotherapy, regardless of their IPI risk category; those with a complete response were randomly . . .

In patients who had undergone stem-cell transplantation, lenalidomide maintenance therapy improved progression-free and overall survival, though at the expense of some increased hematologic toxicity and second malignant tumors. A goal of therapy for multiple myeloma, to induce complete remission and prolong survival, is usually accomplished with combination therapy. 1 , 2 Autologous hematopoietic stem-cell transplantation is often used after induction chemotherapy to improve the response or to consolidate complete remission. 1 , 2 However, since most patients with multiple myeloma have disease recurrence or progression after transplantation, maintenance therapies have been used to prolong complete remission and prevent relapse or progressive disease. Low-dose melphalan, interferon alfa, and glucocorticoids have been used for maintenance after primary therapy, but their long-term use is limited by toxicity and modest efficacy. 3 – 6 Five studies involving patients who . . .

Phosphorus zoning in olivine is receiving considerable attention for its capacity to preserve key information about rates and mechanisms of crystal growth. Its concentration can vary significantly over sub-micron spatial scales and form intricate, snowflake-like patterns that are generally attributed to fast crystal growth. Ostensibly similar aluminum enrichment patterns have also been observed, suggesting comparable incorporation and partitioning behavior for both elements. We perform 1-atm crystallization experiments on a primitive Kīlauea basalt to examine the formation of P and Al zoning as a function of undercooling − ΔT (− ΔT = Tliquidus − Tcrystallization) during olivine growth. After 24 h spent at Tinitial = 1290 °C (10 °C above olivine stability), charges are rapidly cooled to final temperatures Tfinal = 1220–1270 °C, corresponding to undercoolings − ΔT  = 10–60 °C (with Tliquidus = 1280 °C). Compositional X-ray maps of experimental olivine reveal that only a small undercooling (≤ 25 °C) is required to produce the fine-scale enrichments in P and Al associated with skeletal growth. Concentration profiles indicate that despite qualitatively similar enrichment patterns in olivine, P and Al have contrasting apparent crystal/melt mass distribution coefficients of \\[K_{\\text{P}}^{{{\\text{ol}}/{\\text{melt}}}\\] = 0.01‒1 and \\[K_{\\text{P}}^{{{\\text{ol}}/{\\text{melt}}}\\] = 0.002‒0.006. Phosphorus can be enriched by a factor > 40-fold in the same crystal, whereas Al enrichment never exceed factors of 2. Glass in the vicinity of synthetic and natural olivine is usually enriched in Al, but, within analytical uncertainty, not in P. Thus, we find no direct evidence for a compositional boundary layer enriched in P that would suffice to produce P enrichments in natural and synthetic olivine. Numerical models combining growth and diffusion resolve the conditions at which Al-rich boundary layers produce the observed enrichment patterns in olivine. In contrast, the same models fail to reproduce the observed P enrichments, consistent with our observation that P-rich boundary layers are insignificant. If instead, P olivine/melt partitioning is made to depend on growth rate, models adequately reproduce our observations of 40-fold enrichment without boundary layer formation. We surmise that near-partitionless behavior (\\[K_{\\text{P}}^{{{\\text{ol}}/{\\text{melt}}}\\] close to 1) of P is related to the olivine lattice being perhaps less stiff in accommodating P during rapid crystallization, and/or to enhanced formation of vacancy defects during fast growth. Our results confirm that P is a robust marker of initial rapid growth, but reveal that the undercooling necessary to induce these enrichments is not particularly large. The near-ubiquitous process of magma mixing under volcanoes, for instance, is likely sufficient to induce low-to-moderate degrees of undercooling required for skeletal growth.

There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39-56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥ 2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1-31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61-244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31-57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p<0.001) were associated with mortality. HIV was not associated with mortality, and findings were similar among patients with diffuse large B-cell lymphoma. Twenty-three deaths were from NHL (12 HIV+, 11 HIV-), and 12 from CHOP (9 HIV+, 3 HIV-). CHOP can be safe, effective, and feasible for aggressive NHL in Malawi with and without HIV.

Osteoporosis is a medical condition affecting men and women of different age groups and populations. The compromised bone quality caused by this disease represents an important challenge when a surgical procedure (e.g., spinal fusion) is needed after failure of conservative treatments. Different pedicle screw designs and instrumentation techniques have been explored to enhance spinal device fixation in bone of compromised quality. These include alterations of screw thread design, optimization of pilot hole size for non-self-tapping screws, modification of the implant’s trajectory, and bone cement augmentation. While the true benefits and limitations of any procedure may not be realized until they are observed in a clinical setting, axial pullout tests, due in large part to their reproducibility and ease of execution, are commonly used to estimate the device’s effectiveness by quantifying the change in force required to remove the screw from the body. The objective of this investigation is to provide an overview of the different pedicle screw designs and the associated surgical techniques either currently utilized or proposed to improve pullout strength in osteoporotic patients. Mechanical comparisons as well as potential advantages and disadvantages of each consideration are provided herein.

Purpose Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14. Methods A prospective, single-institution 1:1 pilot randomized, two-arm study recruited HCT patients. HCT inpatients ( N  = 76) reported daily on 16 common symptoms using the PRO version of the Common Terminology for Adverse Events (PRO-CTCAE). Fisher’s exact test was used to examine differences in the proportion of patients reporting individual symptoms. Multivariable linear regression modeling was used to examine group differences in peak symptom burden, while controlling for symptom burden at baseline, age, comorbidity, and transplantation type (autologous or allogeneic). Results HCT patients receiving the PRO intervention also experienced lower peak symptom burden (average of 16 symptoms) at days +7, +10, and +14 (10.4 vs 14.5, p  = 0.03). Conclusions Daily use of electronic symptom reporting to nurses in an inpatient bone marrow transplant clinic reduced peak symptom burden and improved individual symptoms during the 2 weeks post-transplant. A multi-site trial is warranted to demonstrate the generalizability, efficacy, and value of this intervention. Trial registration ClinicalTrials.gov identifier: NCT 02574897