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Background: To evaluate the relation between serum-25-hydroxy Vitamin-D levels (S25OHVDL) and concurrent chemoradiation therapy (CTRT) toxicities in patients of head and neck squamous cell cancer (HNSCC). Methods: After an institutional ethics committee approval, consecutive HNSCC patients who received radical/adjuvant CTRT were prospectively evaluated. Patients were assessed for CTRT toxicities using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE-v5.0) and the response was evaluated according to Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST-1.1). S25OHVDL was assessed at the time of the first follow-up. Patients were divided into group A (Optimal) and group B (suboptimal) according to S25OHVDL. The treatment toxicities were correlated with S25OHVDL. Results: Twenty-eight patients were evaluated for the study. S25OHVDL was optimal in eight (28.57%) and suboptimal in 20 patients (71.42%). Mucositis and radiation dermatitis were significantly more in subgroup B (P-value 0.0011 and 0.0505, respectively). Relatively lower but nonsignificant hemoglobin and peripheral white blood cell counts were observed in subgroup B. Conclusion: Suboptimal S25OHVDL was associated with significantly more skin and mucosal toxicities in HNSCC patients treated with CTRT. Keywords: 25-hydroxy vitamin-D, head and neck squamous cell cancer, radiation toxicities, Author(s): Arya Bhanu [1]; Chaitali M. Waghmare (corresponding author) [1]; Vandana S. Jain [1]; Hemant J. Pawar [2] Introduction Head and neck squamous cell cancers (HNSCC) account for a major [...]

Squamous cell carcinoma (SCC) of skin is an uncontrolled growth of cells of epithelium commonly seen in males in fifth to sixth decade of life. Risk factors include fair skin, blonde hair, exposure to sunlight (ultraviolet B), immunosuppression, human papillomavirus, and genetics. Surface mold brachytherapy (SMB) is a well-established treatment for early stage head and neck cancers involving accessible sites. It has evolved from the radium era to low-dose rate and now to high-dose rate intensity-modulated interventional brachytherapy. We present a 50-year-old male patient with squamous carcinoma of the left lower eyelid and was operated for the same. Histopathology was well-differentiated SCC with all positive margins. The patient was then treated by SMB and evaluated for toxicity, local control, and survival.

Byline: Chaitali. Waghmare, Vasundhara. Aggarwal, Anup. Kharde, Vandana. Jain, Pradeep. Thakur Background: Patient reported treatment outcomes is a better way to measure the quality of life (QOL). This study was [...]

Primitive Neuroectodermal Tumour (PNET) is a member of small round cell "Blue tumour" family. The overall incidence of PNET is <1%. PNET of kidney is uncommon and was first reported in 1975. Since the first report around 150 cases have been published in medical literature. It exhibits highly aggressive behaviour. It usually affects young adults and has a male predominance of 3:1. Only six cases of PNET of kidney have been reported in older patients and PNET of kidney as a second new primary has rarely been reported, only three cases of renal PNET with history of an earlier or synchronous primary cancer were reported in literature from the USA, Germany and China. Here, the author reported a case of renal PNET in a 48-year-old female who has been treated for right breast cancer by surgery, adjuvant chemotherapy and radiotherapy three years (July 2015) prior to diagnosis of PNET of left kidney. Upon diagnosis, patient underwent left nephrectomy. Postoperatively, patient was started on Ewing's Family of Tumours (EFT) 2001 protocol. Patient completed induction therapy followed by radiation to tumour bed with concurrent weekly single agent vincristine and was planned for maintenance chemotherapy. After one cycle of maintenance chemotherapy, patient developed severe febrile pancytopenia and was admitted in the ICU, even after aggressive medical line of management, patient could not be revived. Although, the patient tolerated the treatment protocol for breast malignancy well and the primary was under control but after three years, with the diagnosis of a very rare second new primary PNET of left kidney which has a very aggressive nature and poor prognosis, the patient could not tolerate the multimodality treatment which was required. [ABSTRACT FROM AUTHOR]

Objective : Early stage carcinoma of the true vocal cord, can be effectively treated with surgery or radiation therapy. This article aims to find out the best management option for patients of early stage cancer of the true vocal cord. Data source and review method : The data collection was done using MEDLINE and PubMed database along with hand search of books using key words vocal cord cancer, early stage, management and true cord. Results : No single treatment modality was found to be superior over other (surgery versus radiation therapy). Conclusion : Choice of treatment should depend on the patient specific factors, tumor related factors and an expertise of treating physician or surgeon. [ABSTRACT FROM AUTHOR]

Pattern of palliative radiotherapy delivered using Telecobalt machine for different malignant sites. Dr. Shreya Dwivedi, Post Graduate Student, Under the guidance of Dr. Vandana Jain, M.D, Professor & HOD Dr.Chaitali Waghmare, M.D, Dr.Gopal Pemmaraju, Dr.Mayuresh Virkar Department of Radiotherapy & Oncology, Rural Medical College, Pravara Institute of Medical Sciences, Loni 413736, Dist. Ahmednagar (M.S.) E-mail : oncology@pmtpims. org Abstract: Background : Majority of the patients with advanced or metastatic cancer need palliative radiotherapy for palliation of their symptoms. The purpose of this study was to assess pattern of palliative radiotherapy (PRT) delivered using Telecobalt machine for different malignances. Material and method: This was a retrospective analytical study. The case records of all patients who received radiotherapy (RT) on Telecobalt machine from 1st July 2015 to 31st July 2016 were screened. Patients receiving PTV on Telecobalt were included in the study. All patient and treatment related details were filled in a preformed proforma. Data entry was done in X-cel. Result: The study cohort was comprised of 61 patients. The median age was 56.11 years and male to female ratio was 1:1.4. Most common primary malignancy treated with PRT was head and neck cancer (24.59%), followed by genitourinary and gynecological (21.31%) and breast (16.39%). Squamous cell carcinoma (39.34%) was most common histopathology type followed by adeocarcinoma (34.42%). The disease was non-metastatic in 36.06% (22) and metastatic in 63.93% (39) cases. Majority (86.36%) were multiple metastasis and only three (13.63%) were oligometastasis. Twenty eight patients received RT at primary and or local lymph node site while 33 patients received PRT at metastatic site. Head and neck cancer (12) was the most common primary site receiving local RT for palliation followed by oesophagus (05) and cervix (04). Among the metastatic site bone metastasis was most commonly treated (72.72%). All patients received RT on daily basis. Two patients (3.27%) were treated with single fraction RT while 59 (96.72%) patients received fractionated RT. Commonly used dose fractionation schedule was 20 Gy in five fractions over a week (57.37%). Conclusion: RT is an effective treatment modality for palliation of both the primary and metastatic lesion. Short fractionation schedule is proffered over long. [ABSTRACT FROM AUTHOR]

CASE REPORT SECOND NEW PRIMARY OESOPHAGEAL CARCINOMA INCIDENTALLY DIAGNOSED IN A KNOWN CASE OF CARCINOMA CERVIX Dr mayuresh virkar post graduate in department of radiation and oncology, pravara medical trust, loni UNDER GUIDECE OF Dr vandana jain (HOD), MD DR CHAITALI WAGHMARE(MD) Dr. GOPAL PEMMARAJU(MD PG STUDENT) DR SHREYA DWIVEDI (PG STUDENT) DR NAMRATA BHAGAT (PG STUDENT ) Abstract Carcinoma oesophagus in a known case of carcinoma cervix (treated) is extremely rare. We report a case of carcinoma oesophagus incidentally diagnosed on OGD scopy with history of accidental straw ingestion while drinking juice in a treated case of carcinoma cervix. The patient was successfully treated with radical radiation therapy considering as second new primary. Introduction Oesophageal carcinoma is the eight most common cancers and sixth cause of all cancer deaths worldwide.[2] Most of the cases is seen in males with ratio of 4:1 in relation to females[6] Highest incidence is seen in china, Russia, Caspian region of Iran[6]. Squamous cell carcinoma and adenocarcinoma comprise of 95% of all oesophageal cancer, of which 90 percent are squamous cell carcinoma.[1] Over last 20 years there has being increase in the incidence of adenocarcinoma at a rate of 5 % to 10% per year due to exposure to air pollutants. Associated risk factors with carcinoma oesophagus is tobacco, smoking,, alcohol which is associated 80% to90% cases of squamous cell carcinoma [4] Other associated risk factors are Barrett's oesophagus, cardiac achalasia, tylosis. CASE REPORT • A 71 year old lady who was a diagnosed case of carcinoma cervix III B treated in 1997 who was treated with radical chemoradiotherapy at our rural centre. She was on regular follow up for five years. On January 2017 she accidently ingested straw while drinking juice, for which DL scopy and removal of straw was done and DL scopy was done to see the extent of trauma caused by straw. But on DL scopy growth was seen present at 25 cm from incisors. Biopsy from the growth shows moderately differentiated squamous cell carcinoma. On February 2017, after the positive report, patient reported in the department for further management. • Patient was examined for her primary which was under control and all routine haematological and radiological investigations were done. Barium swallow (27/02/2017)- Narrowing of segment seen at thoracic level at T7-T8 VERTEBRA showing shouldering sign with proximal dilatation of oesophagus with mucosal irregularity s/o neoplastic lesion. CT Thorax - neoplastic mass lesion extending from T6 vertebra to GE junction with mediastinal lymphadenopathy • After clinical and radiological work up patient was treated by radiotherapy by 3DCRT to the total dose of 60GY in 30# with concurrent weekly chemotherapy (cisplatin 30 mg/m2). Patient tolerated treatment well. After completion of treatment in April 2017, patient is on follow up CONCLUSION • It has been observed at our rural centre that cancer disease remain unreported in most of the cases as most of them are asymptomatic, neglected and lack of awareness. This case is unique as this patient already had cancer of cervix for which she had taken treatment at our centre in 1997, now she being incidentally diagnosed with second new primary with carcinoma oesophagus and treated well. [ABSTRACT FROM AUTHOR]

Various addiction patterns, dietary habits, associated medical problems and socioeconomic status in gastro-intestinal malignancies: A prospective study in rural area of Maharashtra, India. Jain Vandana S., MD, Professor & Head Kawale Darshana, MBBS, Senior Resident Jain Shailendra M., MD, Professor Waghmare Chaitali, MD, Associate Professor Pemmaraju Gopal, MBBS, Senior Resident Abstract Background: Gastro intestinal (GI) malignancies (from Esophagus to anus) are increasing with advancing age, various addictions and poor dietary habits. Early detection is difficult till patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in the healthier outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems and socioeconomic status with various sites involved in GI malignancies, in a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: This prospective study is designed to know about various addiction patterns, dietary habits, associated medical problems and socioeconomic status, along with age, sex, various sites and the stage at first visit of all histopathologically proven cases of gastrointestinal malignancies reporting in the Department of Radiotherapy & Oncology for treatment. Oral cavity to cricopharyngeal carcinomas is included in head and neck malignancies. Carcinoma esophagus, carcinoma stomach, carcinoma small intestine, colorectal (colon and Rectum) and anal canal carcinomas are considered in gastrointerstitial malignancies (and for this study). Data collection was done from Feb 2016 to Dec 2016 for the period of eleven months. A detailed questionnaire was filled after taking written informed consent from the patient. Once the target of 100 patients was achieved all the data was compiled and analyzed for the study. Patients unable to provide or not willing to give desired information are excluded from the study. Results and Conclusions: In this study out of total 100 registeredcases of GI malignancy, 61 were males and 39 were females, which show male preponderance. Most of the patients belonged to lower and upper lower class (64%) as per modified B G Prasad classification. Various histopathological types recorded were Squamous cell carcinoma (35), Adenocarcinoma (60), Adenosquamous carcinoma (2), Basaloid carcinoma (2) and Gastro intestinal stromal tumor (GIST (2)). Associated medical illnesses were rarely observed (only two cases with Diabetes Mellitus and three with Hypertension) and they were on regular treatment. One patient was on anti- retroviral therapy for HIV, two were positive for HBsAg and one for VDRL. The commonest site involved was Esophagus (41) followed by Recto sigmoid, colon & caecum, stomach & anal canal (29, 14, 13 & 2 respectively). Mean age was 59.1 years. The youngest patient was 28 years and oldest was 86 years old. 45 cases were above 60 years and only five were below 30 years of age. 85% of cases were in advanced stage of disease (III & IV). Details of various addictions alone and in combinations with duration of consumption are shown in table no-1. Commonest addiction for all sites was smokeless tobacco (SLT). 81% of cases were non-vegetarian; only 16% were pure vegetarian, details of dietary habits is shown in table-2. Gastrointestinal malignancy is showing increasing trends in India. This study gives an idea about various risk factors for the increasing trends of gastro-intestinal malignancy. The present study shows that carcinoma Esophagus is the commonest & cancer recto sigmoid in second commonest GI malignancy. Mostly the cases were addicted to one or other addiction and were taking regularly nonvegetarian diet. Awareness program for harmful effects of various addictions, the importance of vegetarian diet (high fiber) and about the early symptoms of GI malignancy will help in health promotion, prevention of various malignancies & early diagnosis of disease as well as better treatment outcome. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim and Objectives: To study the treatment outcome with brachytherapy and intensity modulated radiotherapy boost in carcinoma cervix patients in stage II &III, to assess the local control and disease free survival in the above mentioned modalities of treatment, asses acute & late side effects. Materials and Methods: 100 patients were enrolled in this study. This included women who were histologically proven carcinoma cervix satisfying the inclusion criteria. Patients selected randomly until a sample size of 100 was attained. Patients was evaluated by detailed history, followed by general and systemic examination. They were then assessed by hematological and relevant radiological investigations. All selected patients were given External Beam Radiotherapy (EBRT) by 3-dimensional conformal radiotherapy (3D-CRT) up to 50Gy in 25 fractions with concurrent weekly inj.cisplatin. Boost dose is planned with Intracavitary Brachytherapy (ICRT) 21 Gy in three weekly fractions (7Gy each fraction). Patients who were not fit for ICRT were planned for boost dose by Intensity Modulated Radiotherapy (IMRT) 2.5 gy/# for 10#. After this the patients were followed in both the two groups and then were assessed for response to treatment. On follow up; first after 1 month of treatment completion and then every 3 months (for a period of 6 months-1 year), patients undergone Per vaginal examination along with radiological investigations. They were also be subjected to Pap smear and biopsy if needed/indicated (clinically). Results: 100 patients were studied of which 83 patients were given External RT plus chemotherapy followed by ICRT & 17 pts who were not fit for ICRT were considered for IMRT boost. At the end of the study, all the data collected will be compiled and subjected to statistical analysis to derive to a conclusion. Follow up analysis for loco regional control & radiation side effects will be presented at the time of presentation. Conclusion : EBRT with HDR brachytherapy is the standard treatment in carcinoma cervix. Patients who are not fit for ICRT brachytherapy can be very well planned for IMRT boost .Conclusions will be presented at the time of presentation as data analysis for final follow up not yet complete for some patients. REFERENCES- ? Marianne S. Assenholt, Jorgen B.Petersen, Soren k.Nielsen, Jacob C Lindegard & Karen Tanderup. ; A dose planning study on applicator guided stereotactic IMRT boost in comparision with 3D MRI based brachytherapy in locally advanced cervical cancer. Acta Oncologica, 2008;47:1337-1343 ? Mohammed Mahmoud, Hissen a.EL Hossieng, Nashaat A.Diab, M. Shosha ; Dorsimetry study study comparision intensity modulated & conformal pelvic RT boost plans in locally advanced carcinoma cervix . Journal of solid tumours, 2013, vol 3.no.4 ? Patricia J.Eifel, Intensity Modulated Radiation Therapy for carcinomas of uterine cervix & endometrium . Image guided IMRT, Part-3, chapter-10 ? Christopher Loiselle, MD, Wui Jin Koh, MD, Emerging use of IMRT for treatment of cervical cancer: JNCC-Journal of the National Cancer Network ? Akila Viswanathan; Brachytherapy to treat cervical cancer declines in US, Treatment Associated with higher survival. The International Journal of Radiation Oncology. [ABSTRACT FROM AUTHOR]

A STUDY ON TREATMENT OUTCOME WITH BRACHYTHERAPY & INTENSITY MODULATED RADIOTHERAPY BOOST IN STAGE II & III CARCINOMA CERVIX PATIENTS Dr. Gopal Pemmaraju, Post Graduate Student Under the guidance of Dr. Vandana Jain, M.D, Professor &HOD Mr. Mahendra More, RSO, Dr. Chaitali Waghmare M.D, Dr. Shreya Dwivedi, Dr. Mayuresh Virkar Department of Radiotherapy & Oncology, Rural Medical College, Pravara Institute of Medical Sciences, Loni 413736, Dist. Ahmednagar (M.S.) E-mail : oncology@pmtpims.org ABSTRACT Aim and Objectives: To study the treatment outcome with brachytherapy and intensity modulated radiotherapy boost in carcinoma cervix patients in stage II &III, to assess the local control and disease free survival in the above mentioned modalities of treatment, asses acute & late side effects. Materials and Methods: 100 patients were enrolled in this study. This included women who were histologically proven carcinoma cervix satisfying the inclusion criteria. Patients selected randomly until a sample size of 100 was attained. Patients was evaluated by detailed history, followed by general and systemic examination. They were then assessed by hematological and relevant radiological investigations. All selected patients were given External Beam Radiotherapy (EBRT) by 3-dimensional conformal radiotherapy (3D-CRT) up to 50Gy in 25 fractions with concurrent weekly inj.cisplatin. Boost dose is planned with Intracavitary Brachytherapy (ICRT) 21 Gy in three weekly fractions (7Gy each fraction). Patients who were not fit for ICRT were planned for boost dose by Intensity Modulated Radiotherapy (IMRT) 2.5 gy/# for 10#. After this the patients were followed in both the two groups and then were assessed for response to treatment. On follow up; first after 1 month of treatment completion and then every 3 months (for a period of 6 months-1 year), patients undergone Per vaginal examination along with radiological investigations. They were also be subjected to Pap smear and biopsy if needed/indicated (clinically). Results: 100 patients were studied of which 83 patients were given External RT plus chemotherapy followed by ICRT & 17 pts who were not fit for ICRT were considered for IMRT boost. At the end of the study, all the data collected will be compiled and subjected to statistical analysis to derive to a conclusion. Follow up analysis for loco regional control & radiation side effects will be presented at the time of presentation. Conclusion : EBRT with HDR brachytherapy is the standard treatment in carcinoma cervix. Patients who are not fit for ICRT brachytherapy can be very well planned for IMRT boost .Conclusions will be presented at the time of presentation as data analysis for final follow up not yet complete for some patients. REFERENCES- ? Marianne S. Assenholt, Jorgen B.Petersen, Soren k. Nielsen, Jacob C Lindegard & Karen Tanderup. ; A dose planning study on applicator guided stereotactic IMRT boost in comparision with 3D MRI based brachytherapy in locally advanced cervical cancer. Acta Oncologica, 2008;47:1337-1343 ? Mohammed Mahmoud, Hissen a. EL Hossieng, Nashaat A.Diab, M. Shosha ; Dorsimetry study study comparision intensity modulated & conformal pelvic RT boost plans in locally advanced carcinoma cervix . Journal of solid tumours, 2013, vol 3.no.4 ? Patricia J.Eifel, Intensity Modulated Radiation Therapy for carcinomas of uterine cervix & endometrium . Image guided IMRT, Part-3, chapter-10 ? Christopher Loiselle, MD, Wui Jin Koh, MD, Emerging use of IMRT for treatment of cervical cancer: JNCC-Journal of the National Cancer Network ? Akila Viswanathan; Brachytherapy to treat cervical cancer declines in US, Treatment Associated with higher survival. The International Journal of Radiation Oncology [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to perform a psychometric analysis of the Marathi version of an updated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N43) in patients of head and neck squamous cell carcinoma (HNSCC)., Material and Methods: After an institutional ethics committee approval and linguistic validation, the Marathi version of EORTC QLQ-H&N43 was served to consecutive eligible, Marathi-speaking HNSCC patients of oral cavity, oropharynx, hypopharynx and larynx, registered from August 2019 to March 2021 and who consented to the study. Performance status scale was used for perceptive assessment of organ function. Psychometric analysis was performed using SYSTAT v. 12 (Cranes software, Bengaluru)., Results: A total of 129 patients participated in the study with a median age of 67 years and the man-to-woman ratio of 100:29. The commonest sub-site reported was the oral cavity (61.24%) and the majority were in stage IV disease (69.76%). Ninety patients completed the questionnaire before being started on active oncology treatment at our center. 39 patients completed the questionnaire at pre-treatment and first follow-up. The questionnaire was filled on their own (module) by 32.55% of patients while 67.44% of patients required some kind of assistance (schedule). Internal consistency was moderate to high. The criterion and construct validities were acceptable. The questionnaire was sensitive to change with stage and time. No significant difference was observed in module versus schedule subgroup except for 2 out of 19 item-scales., Conclusion: Marathi translation of EORTC QLQ-H&N43 is a sensitive, reliable and valid tool when applied to patients of HNSCC. It can be considered as a schedule., (Copyright © 2024 Copyright: © 2024 Indian Journal of Cancer.)

Background: Self-reported treatment outcome is a better way to measure patient's quality of life (QOL). This study was undertaken to translate dysphagia-specific QOL questionnaire M. D. Anderson Dysphagia Inventory (MDADI) in Marathi language, its linguistic validation, and cross-cultural adaptation in patients of head and neck squamous cell cancer (HNSCC)., Methods: After Institutional ethics committee approval, MDADI was translated into Marathi with prior permission from the author of original English questionnaire (AOEQ). The translation procedure included - two forward translations (English to Marathi), formation of first intermediate Marathi translation (FIMT), two back translations (BT) (Marathi to English) of FIMT and interim Marathi translation (IMT) formation. Second intermediate Marathi translation (SIMT) was prepared after face validation of IMT by Marathi subject expert. Pretesting of SIMT was done in 10 patients of HNSCC for linguistic validation and cross-cultural adaptation. After incorporating the patients' suggestions, final Marathi translation was formulated and forwarded to primary author for approval., Results: The grammatically acceptable and conceptually equivalent face-validated SIMT was prepared and given to HNSCC patients. The questionnaire was well understood and unobjectionable reflecting its linguistic validity and cross-cultural adaptation. Some of the patients suggested changes in a few words which were then rectified, rechecked with BT, and the final Marathi translated questionnaire was prepared. The credit statement for AOEQ was used as a footnote in the translated questionnaire., Conclusion: Marathi translation of MDADI is well accepted and comprehensible. It can be used for future studies.

Aim  This study was aimed to translate an updated European Organization for Research and Treatment of Cancer (EORTC) quality of life module for head and neck (EORTC QLQ-H&N43) in grammatically and conceptually acceptable Marathi language and its linguistic validation. Materials and Methods  Approval was obtained from the Institutional Ethics Committee. The permission for translation was obtained from the EORTC translation unit (TU). The EORTC guidelines for the translation were followed to form a translation for pilot testing which was administered to 10 Marathi speaking head and neck squamous cell cancer (HNSCC) patients who gave informed written consent for the participation in the study. Patients were interviewed personally. The final Marathi translation was prepared and sent to EORTC TU for approval. Statistical analysis was performed using SYSTAT version 12 by Cranes software, Bengaluru, Karnataka, India. Results  After getting permission, the translation files were received from EORTC TU, including Marathi EORTC QLQ-H&N35 for reference. Two forward translations, reconciled translation, back translations, first interim translation, translation for proof editing, and second interim translation (SIT) were prepared. This SIT was pilot tested in 10 Marathi-speaking HNSCC patients. Each patient was interviewed regarding difficulty in answering, confusing or offensive word, and reframing sentence. The questionnaire was well understood by patients reflecting its linguistic validity. After incorporating the changes as per the patient's interview, updated translation was prepared and sent to EORTC TU which was accepted and approved by EORTC. The psychometric analysis of pilot testing showed that the questionnaire is acceptable. Conclusion  Marathi translation of EORTC QLQ-H&N43 is well accepted and understandable. It can be used for future studies., Competing Interests: Conflict of InterestFinancial Support and Sponsorship There are no conflict of interest to declare. Nil., (MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)