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In the context of the COVID-19 pandemic, there has been a scarcity of resources with various effects on the care of cancer patients. This paper provides an English summary of a German guideline on prioritization and resource allocation for colorectal and pancreatic cancer in the context of the pandemic. Based on a selective literature review as well as empirical and ethical analyses, the research team of the CancerCOVID Consortium drafted recommendations for prioritizing diagnostic and treatment measures for both entities. The final version of the guideline received consent from the executive boards of nine societies of the Association of Scientific Medical Societies in Germany (AWMF), 20 further professional organizations and 22 other experts from various disciplines as well as patient representatives. The guiding principle for the prioritization of decisions is the minimization of harm. Prioritization decisions to fulfill this overall goal should be guided by (1) the urgency relevant to avoid or reduce harm, (2) the likelihood of success of the diagnostic or therapeutic measure advised, and (3) the availability of alternative treatment options. In the event of a relevant risk of harm as a result of prioritization, these decisions should be made by means of a team approach. Gender, age, disability, ethnicity, origin, and other social characteristics, such as social or insurance status, as well as the vehemence of a patient's treatment request and SARS-CoV-2 vaccination status should not be used as prioritization criteria. The guideline provides concrete recommendations for (1) diagnostic procedures, (2) surgical procedures for cancer, and (3) systemic treatment and radiotherapy in patients with colorectal or pancreatic cancer within the context of the German healthcare system. [ABSTRACT FROM AUTHOR]

Despite the development of new technologies and multimodal therapies, improving the prognosis of patients with UICC stage III right colon adenocarcinoma remains challenging. Several randomized controlled trials have shown the oncological non-inferiority of minimally invasive surgery compared to open surgery for colon cancer patients. However, for UICC stage III patients, carrying the highest risk for local recurrence and the worst survival, the evidence remains inconclusive. The aim of this systematic review and individual patient data meta-analysis is to improve the scarce evidence regarding minimally invasive surgery for this subgroup of patients. Data from adult patients with pathologically UICC stage III right adenocarcinoma of the colon will be included. The intervention to be assessed is the minimally invasive right hemicolectomy in comparison with the open procedure. The primary outcome will be the 5-year overall survival. Secondary outcomes will include further long-term outcomes, such as disease-free survival, short term, and histological outcomes. Only randomized controlled trials and quasi-randomized controlled clinical trials will be included. The literature search will be conducted in the following databases: PubMed, CINAHL, Cochrane Trials, ClinicalTrials.gov, and Web of Science. The review will be performed using the Cochrane methodology including GRADE tools. The findings of this meta-analysis will be important for choosing optimal treatment pathways and tailoring of surgical therapy in patients with locally advanced UICC stage III right colon cancer. [ABSTRACT FROM AUTHOR]

Purpose: Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. Methods: The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien–Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. Discussion: The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. Trial registration: ClinicalTrials.gov: NCT04889456, May 2021. [ABSTRACT FROM AUTHOR]

Aim: The complete mesocolic excision competency assessment tool (CMECAT) is a novel tool designed to assess technical skills in minimally invasive complete mesocolic excision (CME) surgery. The aim of this study was to assess construct validity and reliability of CMECAT in a clinical context. Method: Colorectal surgeons were asked to submit video recorded laparoscopic CME resections for independent assessment of their technical abilities. The videos were grouped by surgeons' training level, and four established CME experts were recruited as CMECAT assessors. Extended reliability analysis (G‐theory) was applied to describe assessor agreement. Results: A total of 19 videos and 72 assessments were included in the analysis. Overall, technical skills assessed by CMECAT improved with increased training level: the experts scored significantly better than the untrained surgeons (3.3 vs. 2.5 points; p < 0.01). On right‐sided resections, significantly higher scores were reported with increased training level for all categories and sections, while for left‐sided resections, the variance across groups was smaller and significantly higher scores were only reported for oncological safety describing items. Overall, assessor agreement was high (G‐coefficient: 0.81). Conclusion: This study confirms that CMECAT can be applied to video recorded CME cases for technical skill assessment. Further, it can reliably assess technical performance in right sided CME surgery, where construct validity has now been established. More videos are required to evaluate its validity on left colonic CME. In the future, we hope CMECAT can improve feedback during CME training, serve as a tool in certification processes and contribute to distinguishing CME from conventional surgery in future research. [ABSTRACT FROM AUTHOR]

Simple Summary: Certification in oncology aims to establish structural and procedural standards according to evidence-based guidelines. The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. Based on clinical cancer registry data of 47.440 colorectal cancer patients treated between 2009 and 2017, the present study shows that treatment at colorectal cancer centers has been associated with significantly better outcomes. Patients treated at certified facilities had an eleven percent (colon)/nine percent (rectum) lower risk of dying within the first five years after diagnosis. These findings support the shift towards a more structured cancer care system. (1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan–Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I–III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers. [ABSTRACT FROM AUTHOR]

This article studies the ways in which Snotty Nose Rez Kids (2017), the debut album of First Nations rap duo Snotty Nose Rez Kids (Haisla), uses hip hop to present an extensive critique of interlocked settler colonialism and racial capitalism. I argue that the genre-specific aesthetics of hip hop--its sonic, visual, and, above all, its lyric potential--lend themselves particularly to SNRK's project of formulating both political and linguistic resistance against the oppressive practices of the settler-colonial-capitalist state and the ideologies that undergird it. These aesthetics allow them to creatively reclaim settler colonial, racist-classist stereotypes of Indigenous people to subvert settler colonial rhetoric by channeling hip hop's potential as a "resistance vernacular" (Potter; Mitchell), and to claim iconic symbols of mainstream pop culture in order to reappropriate them in a distinctly Indigenous cultural context. Within a contemporary moment fraught with racialized capitalist crises, their rendition of Indigenous hip hop thus not only participates in an "assertion of Indigenous sovereignty," but it further renegotiates Indigenous people as "modern subjects" (Mays). [ABSTRACT FROM AUTHOR]

This introductory chapter explores the lyric's potential as an active agent of change and offers an overview of contemporary discourses on the status of poetry in late capitalist contexts. Our approach synthesizes recent theoretical, philosophical, and poetic scholarship to facilitate a more comprehensive and nuanced analysis of the numerous aesthetic and conceptual agendas of twenty-first-century lyric writing. We re-theorize the nexus between lyric poetry, politics, and neoliberal capitalism in order to think through the ways in which different poetic forms as well as lyric language and practices shape, transform, or resist political and capitalist discourses--but also to reflect on how the lyric and the theory of the lyric have themselves been shaped by these discourses. We propose lyricism as a compelling analytical tool with which to grasp effective and affective dynamics of poetic production and reception, and as a space where the poem can resist simple classification and straightforward commodification. In taking seriously interventionist strategies employed in poetry to tackle the crises triggered or exacerbated by neoliberal capitalism, this chapter is a springboard for contemporary poetics interested in readings of poetry beyond a reductive analysis that focuses either solely on formal features or on content. It is thus of immediate relevance to literary and cultural studies, as well as the social and political sciences. [ABSTRACT FROM AUTHOR]

Aim: Right hemicolectomy with complete mesocolic excision (CME) requires the removal of an intact mesocolic envelope. The study aimed to determine, on the basis of macroscopic and microscopic anatomical studies, the optimal surgical dissection planes for CME to preserve fascial integrity. Unequivocal anatomical nomenclature was applied to describe the retrocolic fascial system and compared to frequently used eponyms (Toldt, Gerota, Fredet, Treitz). Method: Stepwise macroscopic dissections, cross‐section studies and histological analysis were performed on body donors to identify the components of the retrocolic fascial system. Based on these anatomical findings, the optimal surgical dissection planes for CME were validated in laparoscopic training courses on body donors and in robot‐assisted surgical procedures in patients. Results: The mesocolic tissue and lymphovascular pedicles were enveloped by the ventral and dorsal mesocolic leaf (mesocolic fascia). The mesocolic fascia was attached to the parietal peritoneal fascia ('fascia of Toldt') along the parieto–mesocolic interface, and further cranially to the pre‐duodenopancreatic fascia along the mesocolic–duodenopancreatic interface ('space of Fredet'). Dorsally, the parietal peritoneal fascia was separated from the anterior renal fascia ('fascia of Gerota') by the parieto–renal interface. Dissection along this interface in front of the anterior renal fascia followed by incision of the parietal peritoneal fascia at the duodenal border and opening the mesocolic–duodenopancreatic interface yielded the best macroscopic appearance of specimens and was considered optimal for CME. Conclusion: The retrocolic fascial system as well as the surgical dissection planes for CME can be described by clearly defined anatomical terms rather than potentially confusing eponyms. [ABSTRACT FROM AUTHOR]

The road network is an essential feature class in topographic maps and databases. Road network selection for smaller scales forms a prerequisite for all other generalization operators and is thus a fundamental operation in the overall process of topographic map and database production. The objective of this paper was to develop an algorithm for automated road network selection from a large-scale (1:10,000) to a medium-scale database (1:50,000). The project was pursued in collaboration with swisstopo, the national mapping agency of Switzerland. Three algorithms (a stroke-based, a mesh-based, and a combined stroke-mesh algorithm) were implemented from the literature and analyzed using swisstopo's large-scale TLM3D spatial database, with requirements set forth by expert cartographers. Initial experiments showed that the combination algorithm performed best, yet still it could not meet all requirements. Therefore, extensions to the basic strokemesh algorithm were developed, significantly improving the selection result with real-world, large test databases. Three extensions introduce modifications to the stroke-mesh combination algorithm. Furthermore, two extensions include external feature classes, ensuring accessibility of points of interest and appropriate network density representation in settlement areas, respectively. The results were evaluated by expert cartographers, who concluded that the proposed approach is ready to be deployed in production at swisstopo. Keywords: map generalization; road network selection; stroke; mesh; stroke-mesh combination, Introduction The road network is an essential part of topographic maps and databases (Zhang 2004; Touya 2010), and its generalization is considered to be complex. Roads are connected to each [...]

Background: Complete mesocolic excision (CME) for right colonic cancer is a more complex operation than standard right hemicolectomy but evidence to support its routine use is still limited. This prospective multicentre study evaluated the effect of CME on long-term survival in colorectal cancer centres in Germany (RESECTAT trial). The primary hypothesis was that 5-year disease-free survival would be higher after CME than non-CME surgery. A secondary hypothesis was that there would be improved survival of patients with a mesenteric area greater than 15 000 mm2. Methods: Centres were asked to continue their current surgical practices. The surgery was classified as CME if the superior mesenteric vein was dissected; otherwise it was assumed that no CME had been performed. All specimens were shipped to one institution for pathological analysis and documentation. Clinical data were recorded in an established registry for quality assurance. The primary endpoint was 5-year overall survival for stages I-III. Multivariable adjustment for group allocation was planned. Using a primary hypothesis of an increase in disease-free survival from 60 to 70 per cent, a sample size of 662 patients was calculated with a 50 per cent anticipated drop-out rate. Results: A total of 1004 patients from 53 centres were recruited for the final analysis (496 CME, 508 no CME). Most operations (88.4 per cent) were done by an open approach. Anastomotic leak occurred in 3.4 per cent in the CME and 1.8 per cent in the non-CME group. There were slightly more lymph nodes found in CME than non-CME specimens (mean 55.6 and 50.4 respectively). Positive central mesenteric nodes were detected more in non-CME than CME specimens (5.9 versus 4.0 per cent). One-fifth of patients had died at the time of study with recorded recurrences (63, 6.3 per cent), too few to calculate disease-free survival (the original primary outcome), so overall survival (not disease-specific) results are presented. Short-term and overall survival were similar in the CME and non-CME groups. Adjusted Cox regression indicated a possible benefit for overall survival with CME in stage III disease (HR 0.52, 95 per cent c.i. 0.31 to 0.85; P=0.010) but less so for disease-free survival (HR 0.66; P= 0.068). The secondary outcome (15 000 mm2 mesenteric size) did not influence survival at any stage (removal of more mesentery did not alter survival). Conclusion: No general benefit of CME could be established. The observation of better overall survival in stage III on unplanned exploratory analysis is of uncertain significance. [ABSTRACT FROM AUTHOR]

Background: In this observational study, patient-reported outcomes and short-term clinical outcome parameters in patients with colorectal cancer were studied 12 months after the start of treatment. Outcomes were also compared across German Certified Colorectal Cancer Centers. Methods: Data were collected from 4239 patients with colorectal cancer who had undergone elective tumor resection in one of 102 colorectal cancer centers and had responded to a quality-of-life questionnaire before treatment (EORTC QLQ-C30 and -CR29). 3142 (74.1%) of these patients completed a post-treatment questionnaire 12 months later. Correlation analyses were calculated and case-mix adjusted comparisons across centers were made for selected patient-reported outcomes, anastomotic insufficiency, and 30-day mortality. Results: At 12 months, mild improvements were seen in mean quality-of-life scores (66 vs. 62 points), constipation (16 vs. 19), and abdominal pain (15 vs. 17). Worsening was seen in physical function (75 vs. 82) and pain (22 vs. 19). Better patient-reported outcomes at 12 months were associated with better scores before treatment. Better results in at least three of the five scores were associated with male sex, higher educational level, higher age, and private health insurance. Major worsening of fecal incontinence was seen among patients with rectal cancer without a stoma. The largest differences across centers were found with respect to physical function. Anastomotic insufficiency was found in 4.3% of colon cancer patients and 8.2% of rectal cancer patients. 1.9% of patients died within 30 days after their resection. Conclusion: Clinicians can use these findings to identify patients at higher risk for poorer patient-reported outcomes. The differences among cancer centers that were found imply that measures for quality improvement would be desirable. [ABSTRACT FROM AUTHOR]

We investigate hydrometeor habits at the AIDA chamber with a newly developed in-line holographic microscope HOLographic Imager for Microscopic Objects (HOLIMO). Sizes and habits of ice crystals and droplets in a mixed-phase cloud experiment are related to relative humidity with respect to ice ([RH.sub.ice]), temperature (T), and experiment time. This experiment is initiated with supercooled water drops. As a result, ice crystals within a maximum particle diameter size range of 2 to 118 [micro]m (average size of 19 [micro]m) are detected and 63% of them reveal regular habits. The observed particle habits match those predicted for a given [RH.sub.ice] and T. Two different growth modes emerge from this cloud. The first one appears during water injection and reveals mainly optical particle sizes in the range of 5 to 250 [micro]m. The second mode grows to sizes of 5 to 63 [micro]m, just after the particles of the first one fall out. It is found that an increasing aspect ratio Z of maximum length over thickness from 2 to 20 as obtained by HOLIMO corresponds to a decreasing linear depolarization ratio from 0.1 to 0.04, as independently obtained by depolarization measurements. OCIS codes: 090.1995, 010.2940.

An iterative approach to extract mid-infrared optical constants of supercooled water from measured extinction spectra of supercooled water droplets is presented. The new optical constants, revealing significant temperature-induced spectral variations in comparison with the room-temperature refractive indices, proved to be in good agreement with data sets obtained.

Homogeneous freezing of aqueous solution aerosol particles is an important process for cloud ice formation in the upper troposphere. There the air temperature is low, the ice supersaturation can be high and the concentration of ice-nucleating particles is too low to initiate and dominate cirrus cloud formation by heterogeneous ice nucleation processes. The most common description to quantify homogeneous freezing processes is based on the water activity criterion (WAC) as proposed by. The WAC describes the homogeneous nucleation rate coefficients only as a function of the water activity, which makes this approach well applicable in numerical models. In this study, we investigate the homogeneous freezing behavior of aqueous sulfuric acid aerosol particles by means of a comprehensive collection of laboratory-based homogeneous freezing experiments conducted at the AIDA (Aerosol Interaction and Dynamics in the Atmosphere) cloud simulation chamber, which were conducted as part of 17 measurement campaigns since 2007. The most recent experiments were conducted during October 2020 with special emphasis on temperatures below 200 K. Aqueous sulfuric acid aerosol particles of high purity were generated by particle nucleation in a gas flow composed of clean synthetic air and sulfuric acid vapor, which was added to the AIDA chamber. The resulting chamber aerosol had number concentrations from 30 cm-3 up to several thousand per cubic centimeter with particle diameters ranging from about 30 nm to 1.1 µm. Homogeneous freezing of the aerosol particles was measured at simulated cirrus formation conditions in a wide range of temperatures between 185 and 230 K with a steady increase of relative humidity during each experiment. At temperatures between about 205 K and about 230 K , the AIDA results agree well with the WAC-based predictions of homogeneous freezing onsets. At lower temperatures, however, the AIDA results show an increasing deviation from the WAC-based predictions towards higher freezing onsets. For temperatures between 185 and 205 K , the WAC-based ice saturation ratios for homogeneous freezing onsets increase from about 1.6 to 1.7, whereas the AIDA measurements show an increase from about 1.7 to 2.0 in the same temperature range. Based on the experimental results of our direct measurements, we suggest a new fit line to formulate the onset conditions of homogeneous freezing of sulfuric acid aerosol particles as an isoline for nucleation rate coefficients between 5×108 and 1013 cm -3 s -1. The potential significant impacts of the higher homogeneous freezing thresholds, as directly observed in the AIDA experiments under simulated cirrus formation conditions, on the model prediction of cirrus cloud occurrence and related cloud radiative effects are discussed. [ABSTRACT FROM AUTHOR]

The T-matrix method and the discrete dipole approximation method are used for computing the midinfrared extinction cross-sections of randomly oriented circular ice cylinders for aspect ratios of oblate and prolate particle shapes. The size/shape ambiguity in the spectral analysis has made it necessary to cross-check the infrared retrieval results of wavelength-sized ice particles with independent reference measurements of either the number of size distribution or the particle morphology.