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Background Improvements in therapies have led to an increasing number of long-term survivors of brain metastases. The present series compares a population of 5-year survivors of brain metastases to a generalized brain metastases population to assess for factors attributable to long-term survival. Methods A single institution retrospective review was performed to identify 5-year survivors of brain metastases who received stereotactic radiosurgery (SRS). A historical control population of 737 patients with brain metastases was used to assess similarities and differences between the long-term survivor population and the general population treated with SRS. Results A total of 98 patients with brain metastases were found to have survived over 60 months. No differences between long-term survivors and controls were identified with regards to the age at first SRS (P  = .19), primary cancer distribution (P  = .80), and the number of metastases at first SRS (P  = .90). Cumulative incidence of neurologic death at 6, 8 and 10 years for the long-term survivor cohort was 4.8%, 16%, and 16% respectively. In the historical controls, cumulative incidence of neurologic death reached a plateau at 40% after 4.9 years. A significant difference in the distribution of burden of disease at the time of the first SRS was found between the 5-year survivors and the control (P  = .0049). 58% of 5-year survivors showed no evidence of clinical disease at the last follow-up. Conclusion Five-year survivors of brain metastases represent a diverse histologic population, suggesting a small population of oligometastatic and indolent cancers exist for each cancer type. [ABSTRACT FROM AUTHOR]

Background: Radial scars (RS) and complex sclerosing lesions (CSL) are breast radiologic findings described as small, stellate lesions causing architectural distortion. This can mimic malignancy. Core needle biopsy (CNB) is often performed. Advances in breast imaging have led to increased detection of RS/CSL. The upstage rate of RS/CSL to in situ or invasive disease is 0-40%. We sought to determine the upstaging rate of RS/CSL to in situ, invasive disease, or high-risk lesion at our institution to create excision guidelines.Methods: The pathology database of a single center was searched for RS/CSL, from January 2013 to September 2020. We included CNB without malignancy or high-risk lesion (eg, atypical ductal hyperplasia). Patient demographics, indications for biopsy, imaging findings, biopsy procedure, and final pathology were collected.Results: Forty-four patients were included. 52.3% had CNB for architectural distortion on mammography, 18.2% for mass, 11.4% for calcifications, 2.3% for abnormal MRI, and 15.9% for multiple reasons (eg, calcifications and mass). Most had an ultrasound: 43.2% had no abnormality and 34.1% had a mass. All CNB were vacuum assisted, 65.9% with 9-gauge needle, and averaged 10.0 cores. 77.3% were stereotactic biopsies, 13.6% ultrasound, and 6.8% MRI. 59.1% had excision after CNB. 82.1% of patients did not upstage. One patient upstaged to invasive ductal carcinoma (3.6%) and two patients to high-risk lesion (7.1%).Discussion: There was low upstage rate of RS/CSL on excisional biopsy. Centers could consider close surveillance for RS/CSL on CNB. Longer follow-up in cases of deferred excision is needed to ensure oncologic safety. [ABSTRACT FROM AUTHOR]

Background: The American College of Surgeons Oncology Group Z1071 trial in 2013 demonstrated the fesability of sentinel lymph node biopsy in clinically node-positive patients following neoadjuvant chemotherapy. The goal of this study was to determine the continued impact of this study on our practice pattern. Materials and Methods: This is a retrospective review of institutional changes in the management of axillary nodal disease following the publication of Z1071. Patients with clinically node-positive disease that completed neoadjuvant chemotherapy between 2014 and 2020 were included. The Cocoran-Armitage trend test was used to analyze change in categorical variables over time, and the Spearman's rank coefficient was used to analyze two-ranked variables. Results: A cohort of 102 patients were included in the study and demonstrated that the number of sentinel lymph node biopsies to evaluate axillary disease increased over time. Additionally, the number of biopsies of suspicious nodes, and the use of marker clips on the biopsied nodes increased over time. Conclusion: Our institution has continued to incorporate the result from Z1071 in our practice patterns. [ABSTRACT FROM AUTHOR]

The provision of sustainable transport remains a high priority in the New Zealand cities of Auckland, Wellington and Christchurch. However, the lack of real progress in developing sustainable transport systems in these cities demands a search for new insights. This article investigates barriers to sustainable urban transport by applying the concept of discursive path dependence to the way in which policymakers conceive and address problems in an institutional context. The discursive barriers are investigated through the identification of ‘storylines’ from Auckland, Wellington and Christchurch transport and planning documents dating from the mid-1950s until late 2012. Economic, mobility, safety, consumer, funding and environment storylines show a developmental bias towards roads as compared to sustainable transport. The influence of storylines is discussed at political, institutional and social levels to provide greater understanding of the shaping of policy discourses. This article concludes that discourse constructed in the past, but continuously reiterated, has created a path dependency which is a barrier to sustainable transport in all three cities. The application of path dependence shows that once a road-based policy path has been taken, discourse strengthens that path and helps actors to consistently ignore the need for sustainable transport and obstruct change in policy implementation. [ABSTRACT FROM PUBLISHER]

Auckland’s first spatial plan (locally known as the Auckland Plan) is the principal document providing strategic direction for the city’s development over the next 30 years. The Auckland Plan aspires to radically transform transport in Auckland, from a car-dominant system into an integrated public transport network, by proposing a series of expensive infrastructure projects, including rail tunnels under the CBD, rail extension to the airport, and an additional harbour crossing. This paper critically assesses the transport strategies proposed by the Plan from a broad spectrum of sustainability perspectives. In drawing on the events leading to the 2009 Auckland local government reform, the Plan making process and the content of the Plan, this paper shows that the Plan’s transport strategy suffers a range of drawbacks, including limited political support, a rushed consultation process and lack of a robust framework for funding public transport projects. These problems raise questions about the Plan’s capacity to drive a ‘transformational shift’ in Auckland’s transport landscape and ultimately contribute to the vision of making Auckland the world’s most liveable city. This paper concludes by recommending Auckland Council adopts a more proactive approach to transport planning focusing on better civic engagement, more strategic mechanisms to incentivize public transport and to overcome institutional inertia. [ABSTRACT FROM AUTHOR]

Given the current climate of high levels of teacher attrition, it is critically important that we understand what keeps early career teachers in the profession. This paper reports early findings from a project addressing the question: ‘What conditions are conducive to promoting teacher resilience and retention in the first two years of teaching?’ The research aims to identify the internal strengths and external strategies that promote resilience in early career teachers. School leaders and first year teachers from 59 schools across two states in Australia contributed to in-depth, open-ended interviews in which they talked about the experiences of beginning teaching. From this data, narrative portraits were developed and emerging themes documented and analysed. A strong emerging theme is how relationships with principals influence teachers’ feelings of personal and professional well-being, with both negative and positive effects reported. This paper uses portraits of two early career teachers to examine this theme. The findings provide important insights for principals who wish to foster resilience in early career teachers. [ABSTRACT FROM PUBLISHER]

The Australian Government's policy to transform higher education by 2020 includes plans to significantly raise the levels of undergraduate enrolment by people of low socio-economic status. In light of this policy direction, this article examines how a group of undergraduate students of low socio-economic status work to maintain their desire for learning and to remain included in the university system despite experiencing cultural processes of exclusion. As the students reflect on the cultural and pedagogical conditions that promote, support and enhance their participation and engagement in higher education, a picture emerges of the importance of students' relationships with academics. Whilst positive relationships help students to remain engaged, negative experiences work against continuing participation and engagement. Given the desire of the Australian government to increase participation in higher education by students from under-represented groups, this research identifies some challenges and possibilities for both universities and academics. [ABSTRACT FROM AUTHOR]

Through the use of narrative portraits this paper discusses social class and identity, as working-class university students perceive them. With government policy encouraging wider participation rates from under-represented groups of people within the university sector, working-class students have found themselves to be the objects of much research. Working-class students are, for the most part, studied as though they are docile bodies, unable to participate in the construction of who they are, and working-class accounts of university experiences are quite often compared to the middle-class norms. This paper explores how workingclass students see themselves within the university culture. Working-class students' voices and stories form the focus of this paper, in which the language of 'disadvantage' is dealt with and the ideologies of class identity explored. [ABSTRACT FROM AUTHOR]

Despite the identification of risk factors for sudden infant death syndrome (SIDS) and decreased SIDS rates in many countries, there is still no coherent, widely accepted, mechanistic explanation for SIDS. As an extension of our work on the infectious aetiology of SIDS, we have explored the prediction that infectious agents might reach susceptible infants and babies, via particular sources of food. In this ecological study, we demonstrated significant correlations between SIDS rates and exposure to meat from some sources, and we propose that more detailed studies be carried out. [Copyright &y& Elsevier]

Objective: This study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19. Methods: A prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient-reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L). Results: Three hundred and forty-four participants were recruited (154 COVID+, age 54 ± 18 years, 75 females [49%]); 190 COVID−, age 52 ± 16 years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74–15.97) and dyspnoea (OR 2.21, 95% CI 1.14–4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19–0.89). Conclusions: Neither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID− participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8 months after illness with between-group differences no longer evident at 1 year. What is known about the topic? COVID-19 evokes multi-system sequelae including persistent physical and mental health symptoms, functional impairments and poorer quality of life. What does this paper add? A COVID+ group had equivalent physical recovery over 12 months; but higher prevalence of fatigue, dyspnoea and anxiety/depression symptoms at ~8 months compared to a COVID− group. What are the implications for practitioners? Health authorities and employers should know that while adequate physical function may return within months, post-acute sequelae of COVID-19 impair sufferers for over 6 months, likely necessitating healthcare support and workplace adjustments to optimise timely return to participation. [ABSTRACT FROM AUTHOR]

In this paper, we undertake a brief review of the ‘conventional’ research into the problems of early career teachers to create a juxtaposed position from which to launch an alternative approach based on resilience theory. We outline four reasons why a new contextualised, social theory of resilience has the potential to open up the field of research into the professional lives of teachers and to produce new insights into the social, cultural and political dynamics at work within and beyond schools. We then move from these theoretical considerations to explain how we used them in a recent Australian research project that examined the experiences of 60 graduate teachers during their first year of teaching. This work led to the development of a Framework of Conditions Supporting Early Career Teacher Resilience which we outline, promote and advocate as the basis for action to better sustain our graduate teachers in their first few years of teaching. Finally, we reflect on the value of our work so far and outline our practical plans to ‘mobilise’ this knowledge in ways that will make it available to a variety of audiences concerned with the welfare of this group of teachers. [ABSTRACT FROM PUBLISHER]