Search

PURPOSE: The TOPGEAR phase 3 trial hypothesized that adding preoperative chemoradiation therapy (CRT) to perioperative chemotherapy will improve survival in patients with gastric cancer. Owing to the complexity of gastric irradiation, a comprehensive radiation therapy quality assurance (RTQA) program was implemented. Our objective is to describe the RTQA methods and outcomes. METHODS AND MATERIALS: RTQA was undertaken in real time before treatment for the first 5 patients randomized to CRT from each center. Once acceptable quality was achieved, RTQA was completed for one-third of subsequent cases. RTQA consisted of evaluating (1) clinical target volume and organ-at-risk contouring and (2) radiation therapy planning parameters. Protocol violations between high- (20+ patients enrolled) and low-volume centers were compared using the Fisher exact test. RESULTS: TOPGEAR enrolled 574 patients, of whom 286 were randomized to receive preoperative CRT and 203 (71%) were included for RTQA. Of these, 67 (33%) and 136 (67%) patients were from high- and low-volume centers, respectively. The initial RTQA pass rate was 72%. In total, 28% of cases required resubmission. In total, 200 of 203 cases (99%) passed RTQA before treatment. Cases from low-volume centers required resubmission more often (44/136 [33%] vs 13/67 [18%]; P = .078). There was no change in the proportion of cases requiring resubmission over time. Most cases requiring resubmission had multiple protocol violations. At least 1 aspect of the clinical target volume had to be adjusted in all cases. Inadequate coverage of the duodenum was most common (53% major violation, 25% minor violation). For the remaining cases, the resubmission process was triggered secondary to poor contour/plan quality. CONCLUSIONS: In a large multicenter trial, RTQA is feasible and effective in achieving high-quality treatment plans. Ongoing education should be performed to ensure consistent quality during the entire study period.

To foster children and young people’s skills, dispositions and understanding that underpin a voice agenda, practices need to be developed that support this from the earliest age. This article explores issues relating to this complex, challenging and under-researched area from the perspective of practitioners working with children aged from birth to seven. Using vignettes of practice, we explore practical and pedagogical examples and take the opportunity to deepen our understanding of the elicitation of voice through the lens of the eight factors previously identified in the Look Who’s Talking Project. Through this approach we highlight practices that elicit voice as a key element of children’s rights in a localised way, and exemplify productive connections between theory and practice.

The chapter offers practical examples of what pedagogical documentation could entail when used in a research project. In this chapter we show how pedagogical documentation can be used as a methodology with arts-informed methods as a play based approach for participatory research with children. Thus, this chapter aims to explore: - the nature of pedagogical documentation for capturing the educational experiences of children; - the nature of pedagogical documentation as a methodology for participatory research; - the use of arts in research as a method of involving children in their meaning-making that words sometimes cannot achieve.

Grounded in children’s rights, this article advances understanding of the affordances and constraints in implementing Article 12 of the United Nations Convention on the Rights of the Child in educational settings with young children – those under 7. It starts from the premise that if we are to foster democratic skills and understanding in children and young people, we need to develop practices that support this from the earliest age. The article presents the outcomes of a seminar series facilitating dialogue among international academics working in the field and a range of early years practitioners. This opportunity for extended dialogue led to the development of a rich and sophisticated conceptual clarity about the factors that need to be considered if Article 12 is to be realised with very young children. Eight factors were identified as pivotal for consideration when facilitating voices with this age group: definition; power; inclusivity; listening; time and space; approaches; processes; and purposes. This article explores each in turn and proposes a series of provocations and questions designed to support practitioners in their endeavour to elicit young children’s voices.