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Relying on the social cognitive theory, which postulates that human behaviour is due to social experiences and cognitive interpretation, the current study seeks to investigate the mediating role of collective teacher efficacy (CTE) in the relationship between principals' systems thinking (PST) and school effectiveness in terms of academic emphasis and student academic achievement after accounting for students' socioeconomic backgrounds. A three-source survey design with self-report and non-self-report data was used, from a sample of 423 participants from 71 elementary schools in Israel. The sample included school management team (SMT) members and teachers who were not SMT members. Data were aggregated at the school level of analysis. The results from structural equation modelling and bootstrapping analysis indicated that CTE partially mediates the relationship between PST and academic emphasis, irrespective of the students' socioeconomic backgrounds. Theoretical and practical implications are discussed.

This research explored teachers' readiness for teaching in times of uncertainty and in global crisis situations through the perspective of teacher agency. Understanding the mechanisms by which teachers exercise their transformative agency was the main research aim. Teacher agency is conceptualized as a phenomenon that emerges ecologically from the interactions of individuals' capacities with the contexts and conditions in which they act. Thus, teachers are key figures upon which the possibility for transformation rests. The current research yielded three major mechanisms: (1) personal beliefs, emotions, values and attributes; (2) technical infrastructure, digital skills and teaching resources; (3) organizational infrastructure. This study highlights the importance of understanding the significance of teachers' transformative agency in times of crisis, as it applies to crisis situations in which means of transcending contradictory and conflicting impasses to transformative growth are sought.

The global COVID-19 outbreak has disrupted schooling worldwide. Remote and limited face-to-face school management during the pandemic brought to bear the numerous challenges facing schools and principals throughout the crisis, which, in turn, gave rise to changes in their leadership practices and roles. The professional literature needs conceptual and empirical frameworks concerning the challenges facing principals, their role perceptions, and their behaviors when coping with a health crisis such as the coronavirus pandemic. This paper draws on extant literature about school leadership during diverse crisis situations to advise principals facing the current pandemic. Eight guidelines for pandemic leadership are discussed, as well as practical and research implications.

This study examines how teachers' perceptions of academic emphasis moderate the relationship between their middle leaders' transformational leadership and organizational resilience subdimensions (principal organizational resilience and faculty organizational resilience). Academic emphasis in schools prioritizes academic excellence in teaching and is crucial in evaluating school effectiveness. The study used a two-source survey design with self-report data from 609 participants in 103 secondary schools in Israel. The results indicate that academic emphasis moderates the relationship between transformational leadership's sub-dimensions ("idealized influence," "inspirational motivation," "individualized consideration" and "intellectual stimulation") and principal organizational resilience but not faculty organizational resilience. The findings suggest that middle leaders can create a positive academic emphasis to optimize their transformational leadership's effects on organizational resilience. Theoretical and practical implications are discussed.

PURPOSE: This practice parameter for the performance of proton beam radiation therapy was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter was developed to serve as a tool in the appropriate application of proton therapy in the care of cancer patients or other patients with conditions in which radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance (QA) standards, indications, and suggested documentation. MATERIALS AND METHODS: This practice parameter for the performance of proton beam radiation therapy was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS: The qualifications and responsibilities of personnel, such as the proton center Chief Medical Officer or Medical Director, Radiation Oncologist, Radiation Physicist, Dosimetrist and Therapist, are outlined, including the necessity for continuing medical education. Proton therapy standard clinical indications and methodologies of treatment management are outlined by disease site and treatment group (e.g. pediatrics) including documentation and the process of proton therapy workflow and equipment specifications. Additionally, this proton therapy practice parameter updates policies and procedures related to a quality assurance and performance improvement program (QAPI), patient education, infection control, and safety. CONCLUSION: As proton therapy becomes more accessible to cancer patients, policies and procedures as outlined in this practice parameter will help ensure quality and safety programs are effectively implemented to optimize clinical care.

Ewing sarcoma (ES) is an uncommon mesenchymal neoplasm that typically develops as a bone mass, although up to 30% arise in extraskeletal sites. ES of the gastrointestinal (GI) and hepatobiliary tract is rare and may be misdiagnosed as other, more common neoplasms that occur in these sites. However, the correct classification of extraskeletal ES is important for timely clinical management and prognostication. We reviewed our experience of ES in the GI and hepatobiliary tract in order to further highlight the clinicopathologic features of these neoplasms and document the potential for misdiagnosis in this setting. The archives and consultation files of 6 academic institutions were retrospectively queried for cases of ES occurring in the GI and hepatobiliary tract. The histologic slides and ancillary studies were reviewed and clinical data were retrieved for each case through the electronic medical records, when available. Twenty-three patients with ES in the GI and/or hepatobiliary tract were identified from 2000 to 2022. Of these, 11 were women and 12 were men with a median age of 38 years (range, 2 to 64). Tumor locations included the pancreas (n=5), liver (n=2), stomach (n=3), colorectum (n=3), and small intestine (n=5), as well as tumors involving multiple organs, pelvis and retroperitoneum (n=5). Tumor size varied between 2 cm and 18 cm. Twenty were primary and 3 were metastases. Of the 23 cases, only 17% were initially diagnosed as ES. The most common misdiagnoses involved various forms of neuroendocrine neoplasia due to expression of synaptophysin and other neuroendocrine markers (22%). A wide variety of diagnoses including GI stromal tumor was considered due to aberrant CD117 expression (4%). The diagnosis of ES was ultimately confirmed by detection of the EWSR1 rearrangement in 22 cases. The remaining case was diagnosed using traditional immunohistochemistry. Follow-up information was available in 20 cases, with follow-up time varying between 2 and 256 months. Six patients with follow-up died of disease between 6 and 60 months following initial presentation. Our data indicate ES in the GI and hepatobiliary tract is commonly misdiagnosed leading to a delay in therapy. In light of the attendant therapeutic and prognostic implications, ES should be considered in the differential diagnosis of any GI or hepatobiliary tumor with epithelioid and/or small round cell morphology.

Meta-analyses are systematic summaries of research that use quantitative methods to find the mean effect size (standardized mean difference) for interventions. Critics of meta-analysis point out that such analyses can conflate the results of low- and high-quality studies, make improper comparisons and result in statistical noise. All these criticisms are valid for low-quality meta-analyses. However, high-quality meta-analyses correct all these problems. Critics of meta-analysis often suggest that selecting high-quality RCTs is a more valid methodology. However, education RCTs do not show consistent findings, even when all factors are controlled. Education is a social science, and variability is inevitable. Scholars who try to select the best RCTs will likely select RCTs that confirm their bias. High-quality meta-analyses offer a more transparent and rigorous model for determining best practices in education. While meta-analyses are not without limitations, they are the best tool for evaluating educational pedagogies and programs.

Tuberculosis (TB) is a leading cause of death globally (1). However, TB-related mortality rate estimates usually do not account for posttreatment deaths (1). TB survivors are at increased risk for [...]

This research aimed to examine school principals' perceptions and practices during the COVID-19 period through the perspective of school leaders' agency and proactive coping role when facing adversity and crisis. For this purpose, we interviewed 60 principals of elementary, middle, and high schools. Interview analysis yielded five categories of leaders' agency during the COVID-19 crisis pertaining to principals' proactive creation of opportunities in the following fields: (1) principalship; (2) pedagogy; (3) professional development; (4) role autonomy; and (5) relationships and connections with various communities. The study expands knowledge identifying the perceptions and practices embodied in leadership agency.

The concept of agency has become widely used in education, social sciences, psychology, and more. This article explores the concept of agency and provides a critical review from two main bodies of work: The social cognitive theory and the structure agency theory. The two are not the same. Structure agency theory was used to illuminate agency from an organizational perspective. Social-cognitive theory was used to better understand leader agency from a social perspective. In order to understand the relationship between structure agency and leader agency, both of these theories are reviewed through the same lens: agency within the workplace, mainly in school structure and school leadership. Conclusions are drawn to a better understanding of how to develop a school leadership agency. We can summarize that the implications of agency in school are the key to effective school leadership.

Coherence is highly important in teacher education and professional development programs--the extent of shared vision between position holders contributes to the program's success. Nevertheless, the research on shared vision and coherence has primarily focused on teacher training programs. Hence, in this study, we conducted 29 interviews with teachers, principals, and district and national superintendents of professional development to explore various perspectives among position holders in the education system. Teachers and principals stress the atmosphere in schools and the wholistic experience of a teacher within school, whereas the national and district superintendents focus on building personalized courses for each teacher. There are agreements regarding the significance of teacher motivation, peer learning and study of practice. This study explores the notion of coherence in professional development through a holistic perspective, providing practical implications for improving the way education systems promote teachers' professional development.

Introduction There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.Research design and methods We used visit-level data from the Georgia 2016–2019 Healthcare Cost and Utilization Project database and obtained transportation variables from open sources. Using Bayesian spatial-temporal models, we assessed the associations between transportation and DFU-related amputations within each quartile of poverty status indicators at the ZIP code tabulation area (ZCTA) level. We used the proportion of adults who use public transportation to commute, distance to nearest transit stop, and per capita expense on public transportation as proxies for public transportation reliance, availability, and both, respectively.Results Of 114 606 DFUs, 21 388 (19%) were associated with a major or minor amputation. Among ZCTAs at the highest income quartile, reduced amputation risk was associated with the proportion of adults who use public transportation to commute to work (relative risk (RR)=0.29, 95% CI 0.09 to 0.97 per IQR increase of 1.13%) and per capita expense on public transportation (RR=0.78, 95% CI 0.63 to 0.78 per IQR increase of 6 cents). In metropolitan Georgia, a 1 IQR (261 m) increase in distance to the nearest transit stop was associated with lower amputation risk among ZCTAs at the lowest income quartile (RR=0.47, 95% CI 0.26 to 0.85).Conclusion In Georgia, public transportation reliance and availability are protective against DFU-related amputations in high-income but not among low-income ZCTAs. Reducing disparities in DFU-related amputations requires interventions to mitigate transportation barriers to care.

BACKGROUND: Multitargeted tyrosine kinase inhibitors (TKIs) of the vascular endothelial growth factor receptor (VEGFR) pathway have activity in differentiated thyroid cancer (DTC). Lenalidomide demonstrated preliminary efficacy in DTC, but its safety and efficacy in combination with VEGFR-targeted TKIs is unknown. We sought to determine the safety and efficacy of cediranib, a VEGFR-targeted TKI, with or without lenalidomide, in the treatment of iodine 131-refractory DTC. PATIENTS AND METHODS: In this multicenter, open-label, randomized, phase II clinical trial, 110 patients were enrolled and randomized to cediranib alone or cediranib with lenalidomide. The primary endpoint was progression-free survival (PFS). Secondary endpoints included response rate, duration of response, toxicity, and overall survival (OS). Patients (≥18 years of age) with DTC who were refractory to further surgical or radioactive iodine (RAI) therapy as reviewed at a multispecialty tumor board conference, and evidence of disease progression within the previous 12 months and no more than one prior line of systemic therapy were eligible. RESULTS: Of the 110 patients, 108 started therapy and were assessable for efficacy. The median PFS was 14.8 months [95% confidence interval (CI) 8.5-23.8 months] in the cediranib arm and 11.3 months (95% CI 8.7-18.9 months) in the cediranib with lenalidomide arm (P = 0.36). The 2-year OS was 64.8% (95% CI 43.3% to 86.4%) and 75.3% (95% CI 59.4% to 91.0%), respectively (P = 0.80). The serious adverse event rate was 41% in the cediranib arm and 46% in the cediranib with lenalidomide arm. CONCLUSIONS: Single-agent therapy with cediranib showed promising efficacy in RAI-refractory DTC similar to other VEGFR-targeted TKIs, while the addition of lenalidomide did not result in clinically meaningful improvements in outcomes.

ObjectivesThis practice parameter was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter provides updated reference literature regarding both clinical-based conventional total body irradiation and evolving volumetric modulated total body irradiation.MethodsThis practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS.ResultsThis practice parameter provides a comprehensive update to the reference literature regarding conventional total body irradiation and modulated total body irradiation. Dependence on dose rate remains an active area of ongoing investigation in both the conventional setting (where instantaneous dose rate can be varied) and in more modern rotational techniques, in which average dose rate is the relevant variable. The role of imaging during patient setup and the role of inhomogeneity corrections due to computer-based treatment planning systems are included as evolving areas of clinical interest notably surrounding the overall dose inhomogeneity. There is increasing emphasis on the importance of evaluating mean lung dose as it relates to toxicity during high-dose total body irradiation regimens.ConclusionsThis practice parameter can be used as an effective tool in designing and evaluating a total body irradiation program that successfully incorporates the close interaction and coordination among the radiation oncologists, medical physicists, dosimetrists, nurses, and radiation therapists.

Using an information-processing approach, the current innovative study examines a model for the prediction of organizational learning mechanisms (OLMs), linking school principals' cognitive complexity and OLMs through the mediating effect of an innovative climate. The model was examined for three levels of principals' cognitive complexity (high, intermediate, and low). Study participants were 131 principals and 1,279 teachers from 131 elementary schools in Israel. Results indicated that principals' cognitive complexity promotes organizational learning mechanisms through a climate for innovation. The model with a high level of cognitive complexity showed a better fit to the data than those with intermediate (average) and low levels of cognitive complexity.

Objective: Half of the world’s population is infected with Helicobacter pylori (H. pylori), which can cause gastric diseases and must be eradicated. The reinfection rate, the colonization rate with a new strain usually after more than 12 months of successful eradication, is considered higher in developing countries than developed countries due to lower investment in sanitation and hygiene or a higher population density. The study aimed to analyze and understand H. pylori recurrence rates in developed and developing countries and compare the results from 2013 to 2023 to those between 1992 and 2006. Patients and Methods: PubMed, Google Scholar, Embase, and Scopus databases were searched up to December 31, 2023, using the keywords “Helicobacter pylori” or “H. pylori” and “recurrence” or “recrudescence” or “reinfection”. Clinical studies examining the recurrence rate of H. pylori following successful eradication therapy were included, specifically those that provide clear, quantifiable results for comparison. Meta-analysis was performed with comprehensive meta-analysis software, version 4 (Biostat Inc., Englewood, NJ, USA). Results: 5,808 articles were screened and 20 articles (35 data sets with 16,785 participants) from 11 countries were finally enrolled for analysis. The annual recurrence rate ranged from 0% to 18.80%. The annual reinfection rates in developing and developed countries were 0.040, 95% CI 0.030 to 0.052, and 0.030, 95% CI 0.018 to 0.051, respectively. Conclusions: No significant change in the recurrence rate between developed and developing countries was demonstrated, possibly due to better hygiene status in developing countries as achieved in the last decade.

Summary:. Implant-based techniques have been the mainstay of gender-affirming breast augmentation (GABA). Here we describe a novel autologous technique for GABA. We provide a single-patient case report of gender-affirming deep inferior epigastric artery perforator (DIEP) flap breast augmentation. World Professional Association for Transgender Health guidelines were followed according to Standards of Care, version 8. Prepectoral tissue expanders were placed at the time of the patient’s facial feminization surgery. DIEP flaps were then used for bilateral breast augmentation. Planned revisions were made about 5 months later. Breast augmentation was performed successfully with DIEP flaps, and the patient was satisfied with her outcome. No complications occurred. Anatomic differences to cisgender women were noted, including relatively thick musculature of the abdominal wall and chest as well as tight anterior abdominal fascial closure. Advantages compared with implant-based GABA were also noted, including feminization of the abdomen and avoidance of potential implant related complications. We report a novel approach to GABA. Our approach borrows well-established techniques with demonstrated efficacy and high satisfaction in postmastectomy breast reconstruction and even cosmetic purposes. However, sex- and hormone-influenced anatomic differences required some modifications compared with postmastectomy DIEP flap reconstruction.

Differentiated vulvar intraepithelial neoplasia (dVIN) has been well accepted as a precursor lesion of human papillomavirus (HPV)-independent squamous cell carcinoma (SCC) of the vulva. (1,2) Recognition of dVIN and its [...], * Context.--Differentiated vulvar intraepithelial neoplasia (dVIN) is a human papillomavirus-independent lesion with the potential for rapid progression to invasive squamous cell carcinoma (SCC). The histopathologic features of dVIN are diverse, have overlapping characteristics with lichen sclerosus (LS) and lichen simplex chronicus (LSC), and may be diagnosed by dermatopathologists or gynecologic pathologists because of the vulva&apos;s anatomic location. Objectives.--To identify the salient histopathologic features of dVIN, particularly those that predict progression to SCC, and to evaluate interobserver agreement in diagnosing dVIN within the same subspecialty and across subspecialties. Design.--One general surgical pathologist, 2 pathology-trained dermatopathologists, and 1 gynecologic pathologist blinded to the final diagnoses were asked to record 20 histopathologic features and to provide their final interpretations on cases of dVIN (n = 65), LS (n = 126), LSC (n = 112), and LS with LSC (n = 6). Results.--Interobserver agreement for the 4 diagnoses and 10 histopathologic features was moderate. Logistic regression analysis indicated that keratin pearls, basal pleomorphism, and basal layer disarray were independent variables for diagnosing dVIN (coefficients 1.95,1.97, and 0.91, respectively; P < .001) and progression to SCC (coefficients 1.96,1.20, and 1.08, respectively; P < .001). Conclusions.--There is no single histopathologic feature pathognomonic for dVIN; however, the presence of keratin pearls, basal pleomorphism, and basal layer disarray should raise high suspicion for dVIN and concurrent SCC. Expertise in both dermatologic and gynecologic pathology is beneficial for diagnosing dVIN. (Arch Pathol Lab Med. 2023;147:1431-1437; doi: 10.5858/arpa.2022-0088-OA)