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Background: Metabolic differences between human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) and smoking-associated HNSCC may partially explain differences in prognosis. The former relies on mitochondrial oxidative phosphorylation (OXPHOS) while the latter relies on glycolysis. These differences have not been studied in blood. Methods: We extracted metabolites using untargeted liquid chromatography high-resolution mass spectrometry from pretreatment plasma in a cohort of 55 HPV-associated and 82 smoking-associated HNSCC subjects. Metabolic pathway enrichment analysis of differentially expressed metabolites produced pathway-based signatures. Significant pathways (P < 0.05) were reduced via principal component analysis and assessed with overall survival via Cox models. We classified each subject as glycolytic or OXPHOS phenotype and assessed it with survival. Results: Of 2,410 analyzed metabolites, 191 were differentially expressed. Relative to smoking-associated HNSCC, bile acid biosynthesis (P < 0.0001) and octadecatrienoic acid beta-oxidation (P = 0.01), were upregulated in HPV-associated HNSCC, while galactose metabolism (P = 0.001) and vitamin B6 metabolism (P = 0.01) were downregulated; the first two suggest an OXPHOS phenotype while the latter two suggest glycolytic. First principal components of bile acid biosynthesis [HR = 0.52 per SD; 95% confidence interval (CI), 0.38-0.72; P < 0.001] and octadecatrienoic acid beta-oxidation (HR = 0.54 per SD; 95% CI, 0.38-0.78; P < 0.001) were significantly associated with overall survival independent of HPV and smoking. The glycolytic versus OXPHOS phenotype was also independently associated with survival (HR = 3.17; 95% CI, 1.07-9.35; P = 0.04). Conclusions: Plasma metabolites related to glycolysis and mitochondrial OXPHOS may be biomarkers of HNSCC patient prognosis independent of HPV or smoking. Future investigations should determine whether they predict treatment efficacy. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic altered the workplace for medical education. As restrictions ease, the opportunities provided by virtual rotations remain. Radiation oncology rotations based on virtual participation with patients (consultations, follow-ups, and brachytherapy), contouring and reviewing external beam plans, didactics, and unstructured office hours have been well received at multiple institutions. Virtual rotations decrease barriers to access including lack of a radiation oncology department at one's home institute and the high cost of travel and housing. Furthermore, rotations can be adapted to preclinical students and those with prior radiation oncology rotation experience. However, the virtual format creates and exacerbates several challenges including technical difficulties with electronic medical record or treatment planning software, lack of the spontaneous interactions common to in-person rotations, and unexpected delays in the clinic. We recommend early scheduled time with information technology services to troubleshoot any potential issues, scheduled office hours with faculty and videoconferencing with nonphysician team members to mitigate omission of in-person introductions, and provision of complete contact information for all staff scheduled to meet with students to facilitate communication when unexpected clinic issues arise. Although we are all excited for quarantine restrictions to safely be lifted, we support the continued development of virtual away rotations as a flexible, more affordable option to increase exposure to the field. [ABSTRACT FROM AUTHOR]

Background: Although genome-wide association studies (GWAS) have identified many genetic variants that are strongly associated with lung cancer, these variants have low penetrance and serve as poor predictors of lung cancer in individuals. We sought to increase the predictive value of germline variants by considering their cumulative effects in the context of biologic pathways. Methods: For individuals in the Environment and Genetics in Lung Cancer Etiology study (1,815 cases/1,971 controls), we computed pathway-level susceptibility effects as the sum of relevant SNP variant alleles weighted by their log-additive effects from a separate lung cancer GWAS meta-analysis (7,766 cases/37,482 controls). Logistic regression models based on age, sex, smoking, genetic variants, and principal components of pathway effects and pathway-smoking interactions were trained and optimized in cross-validation and further tested on an independent dataset (556 cases/830 controls). We assessed prediction performance using area under the receiver operating characteristic curve (AUC). Results: Compared with typical binomial prediction models that have epidemiologic predictors (AUC = 0.607) in addition to top GWAS variants (AUC = 0.617), our pathway-based smokinginteractive multinomial model significantly improved prediction performance in external validation (AUC = 0.656, P < 0.0001). Conclusions: Our biologically informed approach demonstrated a larger increase in AUC over nongenetic counterpart models relative to previous approaches that incorporate variants. Impact: This model is the first of its kind to evaluate lung cancer prediction using subtype-stratified genetic effects organized into pathways and interacted with smoking. We propose pathway-exposure interactions as a potentially powerful new contributor to risk inference. [ABSTRACT FROM AUTHOR]

Hospitality organizations rely on employees' service innovative behavior to improve existing service products and develop new service products to achieve customer satisfaction and loyalty as well as attract new customers. Nevertheless, whether and how team culture facilitates service innovative behavior has been rarely investigated. The purpose of this study is to validate a model of multilevel effect of adhocracy culture on service innovative behavior. Data were collected from 34 Chinese hospitality organizations. Multilevel structural equation modeling was employed for model validation. Results revealed that adhocracy culture fostered service innovative behavior via group diversity in terms of extroversion and openness. Task interdependence interacted with group extroversion diversity to enhance service innovative behavior, but did not interact with group openness diversity. These findings advance the culture-innovation research in the hospitality discipline, and provide hospitality practitioners with recommendations to enhance service innovative behavior through building adhocracy culture and increasing group diversity. • Adhocracy culture and service innovative behavior. • Group diversity as a mediator. • Task interdependence as a moderator. • Multilevel analysis. [ABSTRACT FROM AUTHOR]

This paper has emerged from ongoing research into the policy, behavioral and curricular issues associated with the online educational experience of Chinese university students studying onshore in Australia. It examines these international students' attitudes toward online learning, covering both positive and negative perspectives. It also provides an insight into methods that are being explored to provide greater engagement with these students, allowing them to feel more confident within the online learning environment. Earlier, preliminary research by the authors indicated that many Chinese students are uncomfortable with learning in online mode, and achieve more satisfactory results when participating in face-to-face classes. Arguably, these concerns are symptoms of a broader problem. To some extent, these concerns are exacerbated by cultural and behavioral considerations in both Australia and the home country. This is hardly surprising and is well-documented in the literature. However, the study described here identified another and perhaps more significant dimension to the problem: that issues of online versus face-to-face learning were in fact secondary to the core activity and outcomes of learning. The research findings suggest that a more considered and consultative approach that takes account of both cultural issues and 'learning as learning' could help provide a more meaningful learning experience not only for Chinese students but for other Asian students in Australia, which would manifest itself, in all likelihood, as a blend of online and face-to-face modes. [ABSTRACT FROM AUTHOR]

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Service innovation from hospitality employees can contribute to improving service quality and further facilitating hospitality organisations to gain competitive advantage and maintain prosperity. Drawing upon social exchange theory and social cognitive theory, we developed a multilevel model of the relationships between dual-focused transformational leadership (TFL) and service innovation at the team and individual levels, as well as mediating and moderating mechanisms behind the relationships. Data were collected from team leaders and their employees from hospitality organisations in Henan Province, China. Multilevel structural equation modelling (MSEM) was employed to validate the model. The results showed that team-focused TFL promoted team service innovation via developmental culture while individual-focused TFL promoted employee service innovative behaviour via creative self-efficacy. Group openness diversity concurrently moderated the relationship between developmental culture and team service innovation, and the relationship between individual-focused TFL and creative self-efficacy. Enlightened by the research findings, theoretical and practical implications are drawn. • Dual-focused transformational leadership and service innovation. • Developmental culture as a contextual mediator. • Creative self-efficacy as an individual-level mediator. • Group openness diversity as a moderator. [ABSTRACT FROM AUTHOR]