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COVID-19 has resulted in significant disruptions in cancer care. The Illinois Cancer Collaborative (ILCC), a statewide multidisciplinary cancer collaborative, has developed expert recommendations for triage and management of colorectal cancer when disruptions occur in usual care. Such recommendations would be applicable to future outbreaks of COVID-19 or other large-scale disruptions in cancer care.

Background The introduction of hybrid SPECT/CT devices enables quantitative imaging in SPECT, providing a methodological setup for quantitation using SPECT tracers comparable to PET/CT. We evaluated a specific quantitative reconstruction algorithm for SPECT data using a 99mTc-filled NEMA phantom. Quantitative and qualitative image parameters were evaluated for different parametrizations of the acquisition and reconstruction protocol to identify an optimized quantitative protocol. Results The reconstructed activity concentration (ACrec) and the signal-to-noise ratio (SNR) of all examined protocols (n = 16) were significantly affected by the parametrization of the weighting factor k used in scatter correction, the total number of iterations and the sphere volume (all, p < 0.0001). The two examined SPECT acquisition protocols (with 60 or 120 projections) had a minor impact on the ACrec and no significant impact on the SNR. In comparison to the known AC, the use of default scatter correction (k = 0.47) or object-specific scatter correction (k = 0.18) resulted in an underestimation of ACrec in the largest sphere volume (26.5 ml) by − 13.9 kBq/ml (− 16.3%) and − 7.1 kBq/ml (− 8.4%), respectively. An increase in total iterations leads to an increase in estimated AC and a decrease in SNR. The mean difference between ACrec and known AC decreased with an increasing number of total iterations (e.g., for 20 iterations (2 iterations/10 subsets) = − 14.6 kBq/ml (− 17.1%), 240 iterations (24i/10s) = − 8.0 kBq/ml (− 9.4%), p < 0.0001). In parallel, the mean SNR decreased significantly from 2i/10s to 24i/10s by 76% (p < 0.0001). Conclusion Quantitative SPECT imaging is feasible with the used reconstruction algorithm and hybrid SPECT/CT, and its consistent implementation in diagnostics may provide perspectives for quantification in routine clinical practice (e.g., assessment of bone metabolism). When combining quantitative analysis and diagnostic imaging, we recommend using two different reconstruction protocols with task-specific optimized setups (quantitative vs. qualitative reconstruction). Furthermore, individual scatter correction significantly improves both quantitative and qualitative results.

Objectives To evaluate patient, provider, and facility factors associated with variation in opioid prescribing after endoscopic procedures for benign prostatic hyperplasia across a large academic health system to drive improvement efforts. Methods Opioids prescribed at discharge for patients who underwent an endoscopic prostate procedure March 2018-November 2019 were analyzed. Multivariable logistic and linear regression were used to evaluate the relationship between patient, provider, and facility factors and the receipt of any opioid prescription and the quantity prescribed. Results We included 724 patients who had surgery with one of 26 urologists across five facilities. 222 (30.7%) received an opioid prescription, and the average morphine milligram equivalents (MMEs) prescribed was 97.9±33.5. We found wide variation in the proportion of patients who received an opioid prescription across surgeons (range 0%-88.9%) and facilities (range 19.9%-66.7%) and the average MMEs prescribed (range 25-188.5). Outpatient surgery (OR 2.32; 95% confidence interval [CI] 1.22-4.40, P = .010) and preoperative opioid use (OR 15.04; CI 9.65-23.45, P Conclusions Opioid prescribing following endoscopic prostate procedures varied widely. Targeted interventions tailored to younger patients, those taking opioids preoperatively, recipients of outpatient surgery and those undergoing surgery at satellite facilities may be particularly high yield given the association between these factors and increased postoperative prescribing.

BACKGROUND: Cytoreductive surgery (CRS) for ovarian cancer with peritoneal metastases (OPM) is an established treatment, yet access-related racial and socioeconomic disparities are well documented. CRS for colorectal cancer with peritoneal metastases (CRPM) is garnering more widespread acceptance, and it is unknown what disparities exist with regards to access. METHODS: This retrospective cross-sectional multicenter study analyzed medical records from the National Cancer Database from 2010–2015. Patients diagnosed with CRPM or ORP only and either no resection or confirmed resection were included. Patient-level and facility-level characteristics were analyzed using univariate and multivariable logistic regressions to identify associations to receipt of CRS. RESULTS: A total of 6,634 patients diagnosed with CRPM and 14,474 diagnosed with OPM were included in this study. Among patients with CRPM, 18.1% underwent CRS. In the multivariable analysis, female gender (odds ratio [95% CI]; 2.04 [1.77—2.35]; P

ERAS protocols may reduce length of stay and return to full functional recovery after cytoreductive surgery and HIPEC. Prehabilitation programs and post-operative goal directed pathways, along with other essential components of ERAS are discussed with supporting evidence.

The presence of detrusor muscle is essential for accurate staging of T1 cancers. Detrusor muscle presence can be a quality indicator of transurethral resection of bladder tumor for nonmuscle invasive bladder cancer. We hypothesized that increasing surgeon awareness of personal and institutional detrusor muscle sampling rates could improve resection quality and long-term oncologic outcomes.A retrospective review of transurethral resections of bladder tumor from 1/2006 to 2/2018 was performed. The presence of detrusor muscle in the pathology report and transurethral resection specimen were extracted from records. Individual surgeon scorecards were created and distributed. Rates of detrusor muscle sampling were compared prior to and 12 months after distribution. Chart review was done to compare 3-year recurrence and progression outcomes before and after distribution of scorecards.The rate of detrusor muscle sampling increased from 36% (1,250/3,488) to 54% (202/373) (p=0.001) in the 12 months after scorecard distribution, ie from 30% (448/1,500) to 55% (91/165) (p0.001) in Ta tumors and from 47% (183/390) to 72% (42/58) (p0.001) in T1 tumors. Pathological reporting of muscle also improved for all samples (73%, 2,530/3,488 to 90%, 334/373, p0.001), Ta (75%, 1,127/1,500 to 94%, 155/165, p0.001) and T1 (93%, 362/390 to 100%, 58/58, p=0.04). On multivariate Cox regression analysis, the surgeon scorecard was associated with decreased 3-year risk of recurrence (HR 0.63, 95% CI 0.40-0.99).Creation and distribution of individual surgeon scorecards improved detrusor muscle sampling on transurethral resection and was associated with decreased risk of disease recurrence. Quality evaluation of transurethral resection of bladder tumor may contribute to improved outcomes of patients with nonmuscle invasive bladder cancer.

The one-year and median overall survival (mOS) rates of advanced gastroesophageal adenocarcinomas (GEA) are ∼50% and Significance:This study highlights excellent outcomes achieved by individually optimizing chemotherapy, biomarker profiling, and matching of targeted therapies at baseline and over time for GEA. Testing a predefined treatment strategy resulted in improved outcomes versus historical controls. Therapeutic resistance observed in correlative analyses suggests that dual targeted inhibition may be beneficial.This article is highlighted in the In This Issue feature, p. 211

The authors hypothesized that cytoreductive surgery (CRS, comprising gastrectomy combined with metastasectomy) in addition to systemic chemotherapy (SC) is associated with a better survival than chemotherapy alone for patients with metastatic gastric adenocarcinoma (MGA). Patients with MGA who received SC between 2004 and 2016 were identified using the National Cancer Database (NCDB). Nearest-neighbor 1:1 propensity score-matching was used to create comparable groups. Overall survival (OS) was compared between subgroups using Kaplan–Meier analyses. Immortal bias analysis was performed among those who survived longer than 90 days. The study identified 29,728 chemotherapy-treated patients, who were divided into the following four subgroups: no surgery (NS, n = 25,690), metastasectomy alone (n = 1170), gastrectomy alone (n = 2248), and CRS (n = 620) with median OS periods of 8.6, 10.9, 14.8, and 16.3 months, respectively (p

This paper presents a multilevel framework and initial definition of Regional Human Resource Development (Regional HRD) via an examination of the role of human resource development (HRD) in the reg...

Sb2Se3 is a promising material for use in photovoltaics, but the optimum device structure has not yet been identified. This study provides band alignment measurements between Sb2Se3, identical to that used in high-efficiency photovoltaic devices, and its two most commonly used window layers, namely, CdS and TiO2. Band alignments are measured via two different approaches: Anderson’s rule was used to predict an interface band alignment from measured natural band alignments, and the Kraut method was used in conjunction with hard X-ray photoemission spectroscopy to directly measure the band offsets at the interface. This allows examination of the effect of interface formation on the band alignments. The conduction band minimum (CBM) of TiO2 is found by the Kraut method to lie 0.82 eV below that of Sb2Se3, whereas the CdS CBM is only 0.01 eV below that of Sb2Se3. Furthermore, a significant difference is observed between the natural alignment- and Kraut method-determined offsets for TiO2/Sb2Se3, whereas there is little difference for CdS/Sb2Se3. Finally, these results are related to device performance, taking into consideration how these results may guide the future development of Sb2Se3 solar cells and providing a methodology that can be used to assess band alignments in device-relevant systems.

Purpose The purpose of this paper is to understand the process of large-scale organizational change in a community-based enterprise in Myanmar. Design/methodology/approach A qualitative case study methodology was selected to understand the phenomenon of change in a community-based enterprise in Myanmar. Data were collected over a four-week period of fieldwork through individual interviews, focus groups, observations and document collection. Data were analyzed via a modified inductive analytic strategy using constant comparative analysis. Findings Findings revealed the processes used in this large-scale organizational change as impacted by the national cultural dimensions of Myanmar and the social learning experienced by the participants. Learning about organization development and change and sharing that learning in the organization by its members who participated in a certificate program in organizational development designed by Payap University (Thailand) and the International Rescue Committee had a major role in the change processes. Myanmar’s high power distance and collectivist culture facilitated social learning by highlighting authority figures as role models and providing high interaction environments conducive to learning. Originality/value This study illuminates the change process in a community-based organization in the emerging economy of Myanmar where no roadmaps for change in these types of organizations exist. The findings of this study are transferrable to community-based organizations in emerging economies with similar national cultural characteristics and call for future case studies to understand the complexities of change in these unique organizations and environments.

Peritoneal metastases (PMs) from appendiceal ex-goblet adenocarcinoma (AEGA) are associated with a poor prognosis. While cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong survival, the majority of patients are ineligible for complete cytoreduction. We describe a novel approach to the management of such patients with iterative HIPEC (IHIPEC). Patients with signet ring/poorly differentiated AEGA with high Peritoneal Cancer Index (PCI) and extensive bowel involvement underwent IHIPEC with mitomycin C at 6-week intervals for a total of three cycles. Survival outcomes for these patients were compared with patients with high-grade appendiceal tumors matched for tumor burden who were treated with other conventional approaches, i.e. systemic chemotherapy only (SCO) or complete CRS + HIPEC. Between 2016 and 2019, seven AEGA patients with high PCI (median 32.5 [range 21–36]) underwent 18 IHIPEC cycles (median cycles per patient 3 [2–3]) in combination with systemic chemotherapy (median 2 lines [1–3], 12 cycles [10–28]). IHIPEC was delivered laparoscopically in 14/18 cases. Postoperatively, the median length of stay was 1 day (1–8 days), no procedure-related complications were reported, and five (28%) 90-day readmissions for bowel obstruction were documented. Median overall survival after IHIPEC was better compared with a matched group of patients (n = 16) receiving SCO (24.6 vs. 7.9 months; p = 0.005), and similar to those (n = 7) who underwent CRS + HIPEC (24.6 vs. 16.5 months; p = 0.62). IHIPEC in combination with systemic chemotherapy is tolerable, safe, and may be associated with encouraging survival outcomes compared with SCO in selected patients with high-grade, high-burden AEGA PM.

Upfront chemotherapy prolongs overall survival for men with metastatic, hormone-sensitive prostate cancer (mHSPC) based on data from clinical trials. We sought to assess the association between upfront chemotherapy and overall survival in men with mHSPC in a real-world cohort. We performed a retrospective cohort study of men with de novo, treatment-naive metastatic prostate cancer from a large, national cancer database in the United States (2014–2015). Men in the upfront chemotherapy group received chemotherapy within 4 months of diagnosis (n = 1033, 28%) versus no chemotherapy or chemotherapy later than 12 months after diagnosis (controls; n = 2704, 72%). Overall survival was assessed using Kaplan–Meier estimates and compared using multivariable Cox regression analysis. After a median follow-up of 23 months, median overall survival was 35.7 months in the upfront chemotherapy group and 32.5 months for controls (log-rank p 0.2). In this real-world cohort, upfront chemotherapy for mHSPC was associated with longer overall survival. These data support the continued use of chemotherapy for men with mHSPC regardless of race or age if they are fit for chemotherapy and underscore the importance of evaluating cancer therapeutics outside of clinical trials to demonstrate treatment efficacy in populations that may be underrepresented in clinical trials.

The absence of health insurance coverage has been associated with worse outcomes for patients with metastatic renal cell carcinoma (mRCC). Medicaid expansion in the United States was an important provision of the Affordable Care Act, which increased the number of low-income individuals eligible for Medicaid starting in January 2014 in several states. The effect of Medicaid expansion on access to healthcare for patients with mRCC is unknown.We performed a retrospective cohort study of 6844 patients aged 65 years with mRCC at diagnosis within the National Cancer Database. We compared the time to treatment and the rates of no insurance before (2012-2013) and after (2015-2016) expansion between patients living in states that had and had not expanded Medicaid using difference-in-difference (DID) analyses. DIDs were calculated using linear regression analysis with adjustment for sociodemographic covariates.The rate of no insurance did not change in the expansion states compared with the nonexpansion states (DID, -0.55%; 95% confidence interval, -3.32% to 2.21%; P = .7). The percentage of patients receiving treatment within 60 days of diagnosis had increased in the expansion states from 43% to 49% and in the nonexpansion states from 42% to 46% after expansion. No change was found in treatment within 60 days of diagnosis among all patients (DID, 2.81%; 95% confidence interval, -2.61% to 8.22%; P = .3).Medicaid expansion was not associated with improved healthcare access for patients with mRCC as reflected by timely treatment. Future work should assess the association between Medicaid expansion and oncologic outcomes.

Understanding variation and heterogeneity in practice patterns allows programs to develop effective strategies to improve patient outcomes. Cytoreductive surgery is a potentially highly morbid operation that could benefit from systematic assessments directed towards quality improvement. We describe the hospital-level variation and benchmarks for programs performing cytoreductive surgery. Cytoreductive and tumor debulking operations with or without hyperthermic intraperitoneal chemotherapy performed for cancer between January 1, 2013 and June 30, 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Risk-adjusted hospital-level variation in 30-day death, serious morbidity, reoperation, readmission, and a composite of death or serious morbidity (DSM) were evaluated using hierarchical models. National Cancer Institute (NCI)-designated cancer center (NCI-CC) status was also explored. A total of 6203 operations across 589 hospitals were included, of which 56 were at NCI-CCs. Unadjusted rates of death, serious morbidity, reoperation, readmission, and DSM were 1.4%, 12.9%, 3.6%, 8.6%, and 13.4%, respectively. The coefficients of variation for hospital-level performance were 4.7%, 2.1%, 4.6%, 14.4%, and 1.0% for DSM, death, serious morbidity, unplanned reoperation, and unplanned readmissions, respectively. When compared with other hospitals, NCI-CCs had better risk-adjusted 30-day mortality (median odds ratio 0.984 versus 0.998, p

OBJECTIVES To determine the use of surgical resection of metastatic disease in a large national sample and its association with overall survival. METHODS The National Cancer Database was queried for patients with metastatic bladder cancer (2004-2016). Overall survival was assessed using Kaplan-Meier and multivariable Cox analyses. The associations between covariates and use of metastasectomy were assessed with multivariable logistic regression. RESULTS Of the 16 382 patients with metastatic bladder cancer included, 6.8% underwent metastasectomy. Its use increased over time (4.7% in 2004 to 6.6% in 2016; per year odds ratio 1.02, 95% confidence interval 1.00-1.04, P = 0.019). Median survival was 7.0 months for patients who received metastasectomy and 5.1 months for those who did not (hazard ratio 0.85, 95% confidence interval 0.79-0.91, P

BACKGROUND: Bladder cancer patients who are insured experience improved outcomes. Medicaid expansion aimed to increase insurance coverage and improve access to care. However, the association between Medicaid expansion and stage at diagnosis or time to treatment for those with advanced bladder cancer is unknown. OBJECTIVE: We sought to determine to association of Medicaid expansion with stage at diagnosis, and time to treatment for patients with muscle-invasive bladder cancer. METHODS: A US-based cancer registry was utilized to evaluate the association between Medicaid expansion and cancer stage at diagnosis, insurance rates, and time to treatment (>60 days from diagnosis) for those diagnosed with bladder cancer. We compared outcomes in non-Medicare-aged patients in non-expansion states (n = 16,602) and expansion states (n = 15,921) before (years 2012-2013) and after (years 2015-2016) Medicaid expansion with adjusted difference-in-differences (DIDs) using multivariable linear regression. RESULTS: The DIDs of percentage of bladder cancer patients with Stage≥II disease (0.02%; 95% confidence interval [CI] –1.91 to 1.95%, p = 0.9), without insurance (–0.65%; 95% CI –1.71 to 0.41), and with metastatic disease at diagnosis (–0.07%; 95% CI –1.14 to 1.00, both p > 0.10) did not change following insurance expansion despite an increase in Medicaid coverage (6.03%; 95% CI 4.79 to 7.29, p 60 days after diagnosis of stage≥II disease did not change (DID 1.48%; 95% CI –3.29 to 6.25%, p = 0.50). On subgroup analysis of patients living in low-income regions, the rates of stage≥II disease, no insurance, metastatic disease, and time to treatment did not significantly change. CONCLUSION: Medicaid expansion was not associated with changes in advanced cancer stage at diagnosis or time to treatment in newly diagnosed bladder cancer patients.

Over the past decade, there has been a considerable increase in the utilization of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of patients with peritoneal metastases. This is due to improved safety and favorable oncologic outcomes, including curative potential. CRS/HIPEC has a steep learning curve and requires familiarity with peritonectomy procedures. This review will outline the technical aspects and learning curve of CRS/HIPEC.

Background The COVID-19 pandemic has overlapped with the scheduled interview periods of over 20 surgical subspecialty fellowships, including the Complex General Surgical Oncology (CGSO) fellowships in the National Resident Matching Program and the Society of Surgical Oncology’s Breast Surgical Oncology fellowships. We outline the successful implementation of and processes behind a virtual interview day for CGSO fellowship recruitment after the start of the pandemic. Methods The virtual CGSO fellowship interview process at the University of Chicago Medicine and NorthShore University Health System was outlined and implemented. Separate voluntary, anonymous online secure feedback surveys were email distributed to interview applicants and faculty interviewers after the interview day concluded. Results Sixteen of 20 interview applicants (80.0%) and 12 of 13 faculty interviewers (92.3%) completed their respective feedback surveys. Seventy-five percent (12/16) of applicants and all faculty respondents (12/12) stated the interview process was ‘very seamless’ or ‘seamless’. Applicants and faculty highlighted decreased cost, time savings, and increased efficiency as some of the benefits to virtual interviewing. Conclusions Current circumstances related to the COVID-19 pandemic require fellowship programs to adapt and conduct virtual interviews. Our report describes the successful implementation of a virtual interview process. This report describes the technical steps and pitfalls of organizing such an interview and provides insights into the experience of the interviewer and interviewee.

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumor specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

The Chicago Consensus Working Group provides multidisciplinary recommendations for palliative care specifically related to peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of neuroendocrine tumors specifically related to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

Primary tumor location has emerged as an important surrogate for tumor biology in metastatic colorectal cancer treated with systemic chemotherapy. It is unclear if primary tumor location is associated with survival after cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) for colorectal carcinomatosis.Study of a contemporary cohort merged data from the California Cancer Registry, 2004-2012, and the Office of Statewide Health Planning and Development inpatient database. For patients undergoing CRS/HIPEC, clinicopathologic variables, treatment characteristics, and survival were compared by right versus left colon primary site. Survival was analyzed by Cox proportional hazards.Of 272 patients identified, 128 (47.1%) had right-sided tumors. Left- and right-sided cohorts had similar patient, tumor, and treatment factors. Patients with left-sided primary tumors had significantly prolonged overall survival (mean 34 versus 15.5 mo, P = 0.0010). Factors independently associated with decreased overall survival included age80 (HR 7.0, P 0.0001), advanced T4 stage (HR 3.6, P = 0.0031), and positive lymph nodes (HR 2.2, P = 0.0004). Metachronous peritoneal involvement (HR 0.38, P 0.0001) and left-sided primary tumors (HR 0.72, P = 0.041) were independently associated with improved overall survival.This study identifies location of primary tumor as an important determinant of long-term survival after CRS/HIPEC. Patients with left-sided tumors have a more favorable prognosis.

The study examined the local dose distribution as well as the time course of skin exposure of hand and fingers from [ A compact calibrated electronic dosimeter (ED) with a miniaturized probe was used for real-time measurements of skin dose equivalent H The cumulative skin exposure from the production process measured by ED, was 74.7 ± 32.7 µSv/GBq and 40.1 ± 14.3 µSv/GBq for the right and left hand, respectively. The exposure recorded by the ED was in the average 19.4 % ± 40.0 % (median = 21.3 %) lower compared to the results from TLD. Highest exposure was recorded during synthesis (guided hand: 24.5 ± 12.2 µSv/GBq) and measuring of product yield including preparation of probes for quality control (guided hand: 36.1 ± 12.7 µSv/GBq). The highest local exposure was measured by a TLD close to the tip of the index finger of the guiding hand (range: 773-1257 µS/GBq). The chosen methodology using ED, proved to be a good concept for identifying procedure steps with an increased exposure level and to determine the time course of skin exposure and to identify procedure steps for further optimization of handling. Furthermore, miniaturized electronic dosimeters may be used for online surveillance of local exposure rates at hands and fingers.ZIEL: Diese Studie untersucht die lokale Dosisverteilung sowie den zeitlichen Verlauf der Hautexposition der Hände und Finger bei der [ Ein kompaktes kalibriertes elektronisches Dosimeter (ED) mit einer miniaturisierten Sonde wurde für die Echtzeitmessungen der Oberflächen-Personendosis H Die aus dem Herstellungsprozess akkumulierte Hautexposition betrug 74,7 ± 32,7 µSv/GBq bzw. 40,1 ± 14,3 µSv/GBq für die rechte sowie für die linke Hand. Die mit dem ED aufgezeichnete Exposition war im Durchschnitt 19,4 % ± 40,0 % (Median = 21,3 %) niedriger als die Ergebnisse der TLDs, die neben dem ED positioniert wurden. Die höchste Exposition resultierte aus der Synthese (führende Hand: 24,5 ± 12,2 µSv/GBq) und der Messung der Produktausbeute inklusive Vorbereitung der Proben für die Qualitätssicherung (führende Hand: 36,1 ± 12,7 µSv/GBq). Die höchste lokale Exposition wurde mittels TLD an der führenden Hand nahe der Zeigefingerspitze bestimmt (Spannweite: 773–1257 µS/GBq). Die mit dem ED gewählte Methodik erwies sich als geeignet zur Identifizierung von Prozessschritten mit einem erhöhten Expositionsniveau sowie zur Erfassung des zeitlichen Verlaufs der Hautexposition, um somit Prozessschritte für die weitere Optimierung des Umgangs zu identifizieren. Außerdem bietet die Nutzung von miniaturisierten elektronischen Dosimetern die Möglichkeit zur Online-Überwachung der lokalen Expositionsraten an Händen und Fingern.

The Problem As a result of the domination of U.S.- and U.K.-centric approaches to human resource development (HRD), current academic practices often reside in ethnocentric content-related silos, which include certain theoretical frameworks, models, mindsets, and ways of conceptualizing. Given the exponential increase in globalization and the complex global issues facing the field of HRD, these teaching and research practices as well as the limited HRD global and transdisciplinary networks cannot offer the needed solutions to the problems faced by professionals around the world in their workplaces, communities, and societies. The Solution To understand this problem empirically and recommend solutions based on our findings, we reviewed journal articles published in the last year in our four Academy of Human Resource Development (AHRD)-sponsored journals and HRD programs of universities that are members of AHRD’s Program Excellence Network (PEN) and University Forum for Human Resource Development (UFHRD) to understand the state of globalization of HRD research and teaching. We offer recommendations for HRD scholars representing the new guard to globalize their teaching and research and professional associations to guide and support the globalization of HRD academic practice. The Stakeholders This article is of particular interest to HRD scholars in all stages of their careers seeking to globalize their academic practice and contribute to their own and their learners’ global mindset development and to professional associations guiding and supporting the globalization of HRD academic practice.

Solar water splitting directly converts solar energy into H2 fuel that is suitable for storage and transport. To achieve a high solar-to-hydrogen (STH) conversion efficiency, elaborate strategies yielding a high photocurrent in a tandem configuration along with sufficient photovoltage should be developed. We demonstrated highly efficient solar water splitting devices based on emerging low-cost Sb2Se3 photocathodes coupled with semitransparent perovskite photovoltaics. A state-of-the-art Sb2Se3 photocathode exhibiting efficient long-wavelength photon harvesting enabled by judicious selection of junction layers was employed as a bottom absorber component. The top semitransparent photovoltaic cells, i.e., parallelized nanopillar perovskites using an anodized aluminum oxide scaffold, allowed the transmittance, photocurrent, and photovoltage to be precisely adjusted by changing the filling level of the perovskite layer in the scaffold. The optimum tandem device, in which similar current values were allocated to the top and bottom cells, achieved an STH conversion efficiency exceeding 10% by efficiently utilizing a broad range of photons at wavelength over 1000 nm.

Advances in the molecular biology of tumor metastasis have paralleled the evolution in the management of metastatic disease from colorectal cancer. In this review, we summarize the current understanding of the mechanism of colorectal cancer metastases, in particular that of peritoneal metastases, as well as clinical data on the treatment of this disease. A review of relevant English literature using MEDLINE/PubMed on the biology of colorectal cancer metastases, determinants of oligometastasis, and use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of metastatic colorectal cancer is presented. Recognition of oligometastasis in the evolution of colorectal peritoneal metastases provides the theoretical framework for which cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy is considered. Clearly, a subset of patients benefit from peritoneal metastasectomy. Advances in cancer biology and clinical imaging promise to expand the role of cytoreductive surgery with or without intraperitoneal chemotherapy in the management of peritoneal metastases from colorectal cancer.

Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS. Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p

Surgeons encounter neutropenic patients through elective or emergency consultation with increasing regularity. As medical management continues to extend the lives of patients with benign hematologic diseases, hematologic malignancies, solid malignancies, or iatrogenic neutropenia, more patients are presenting with infectious complications caused and/or complicated by their neutropenia. This leaves surgeons in the difficult position of managing medically fragile patients with unusual presentations of common disease processes. These patients often fall outside of classical guidelines and treatment pathways. Many studies addressing these issues are retrospective and non-randomized. Here, we review common emergency gastrointestinal surgery scenarios and their management in the setting of a neutropenic patient. While biliary disease, appendicitis, anorectal disease, and perforations will be covered in detail, an extensive appreciation of a patient’s medical or oncologic disease course and appropriate utilization of consultants such as interventional radiology, gastroenterology, and hematology is often necessary.

Most patients with rare diseases do not receive a molecular diagnosis and the aetiological variants and causative genes for more than half such disorders remain to be discovered1. Here we used whole-genome sequencing (WGS) in a national health system to streamline diagnosis and to discover unknown aetiological variants in the coding and non-coding regions of the genome. We generated WGS data for 13,037 participants, of whom 9,802 had a rare disease, and provided a genetic diagnosis to 1,138 of the 7,065 extensively phenotyped participants. We identified 95 Mendelian associations between genes and rare diseases, of which 11 have been discovered since 2015 and at least 79 are confirmed to be aetiological. By generating WGS data of UK Biobank participants2, we found that rare alleles can explain the presence of some individuals in the tails of a quantitative trait for red blood cells. Finally, we identified four novel non-coding variants that cause disease through the disruption of transcription of ARPC1B, GATA1, LRBA and MPL. Our study demonstrates a synergy by using WGS for diagnosis and aetiological discovery in routine healthcare.

Antimony selenide (Sb 2Se 3) possesses great potential in the field of photovoltaics (PV) due to its suitable properties for use as a solar absorber and good prospects for scalability. Previous studies have reported the growth of a native antimony oxide (Sb 2O 3) layer at the surface of Sb 2Se 3 thin films during deposition and exposure to air, which can affect the contact between Sb 2Se 3 and subsequent layers. In this study, photoemission techniques were utilized on both Sb 2Se 3 bulk crystals and thin films to investigate the band alignment between Sb 2Se 3 and the Sb 2O 3 layer. By subtracting the valence band spectrum of an in situ cleaved Sb 2Se 3 bulk crystal from that of the atmospherically contaminated bulk crystal, a valence band offset (VBO) of − 1.72 eV is measured between Sb 2Se 3 and Sb 2O 3. This result is supported by a − 1.90 eV VBO measured between Sb 2O 3 and Sb 2Se 3 thin films via the Kraut method. Both results indicate a straddling alignment that would oppose carrier extraction through the back contact of superstrate PV devices. This work yields greater insight into the band alignment of Sb 2O 3 at the surface of Sb 2Se 3 films, which is crucial for improving the performance of these PV devices.

Achieving both high onset potential and photocurrent in photoelectrodes is a key challenge while performing unassisted overall water splitting using tandem devices. We propose a simple interface modification strategy to maximize the performance of polycrystalline Sb2Se3 photocathodes for photoelectrochemical (PEC) water splitting. The para-aminobenzoic acid (PABA) modification at Sb2Se3/TiO2 interface enhanced both the onset potential and photocurrent of the Sb2Se3 photocathodes. The surface defects in the polycrystalline Sb2Se3 limited the photovoltage production, lowering the onset potential of the photocathode. Surface restoration using the conjugated PABA molecules efficiently passivated the surface defects on the Sb2Se3 and enabled the rapid photoelectron transport from the Sb2Se3 to the TiO2 layer. The PABA treated Sb2Se3 photocathode exhibited substantially improved PEC performance; the onset potential increased from 0.35 to 0.50 V compared to the reversible hydrogen electrode (VRHE), and the photocurrent density increased from 24 to 35 mA cm−2 at 0 VRHE.

Passive acoustic monitoring (PAM) is a useful technique for monitoring marine mammals. However, the quantity of data collected through PAM systems makes automated algorithms for detecting and classifying sounds essential. Deep learning algorithms have shown great promise in recent years, but their performance is limited by the lack of sufficient amounts of annotated data for training the algorithms. This work investigates the benefit of augmenting training datasets with synthetically generated samples when training a deep neural network for the classification of North Atlantic right whale (Eubalaena glacialis) upcalls. We apply two recently proposed augmentation techniques, SpecAugment and Mixup, and show that they improve the performance of our model considerably. The precision is increased from 86% to 90%, while the recall is increased from 88% to 93%. Finally, we demonstrate that these two methods yield a significant improvement in performance in a scenario of data scarcity, where few training samples are available. This demonstrates that data augmentation can reduce the annotation effort required to achieve a desirable performance threshold.

Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90 Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99m Tc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90 Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90 Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations., info:eu-repo/semantics/published

Programmed death-ligand 1 (PD-L1) expression has been described in patients with malignant peritoneal mesothelioma (MPM), but treatment strategies utilising immune checkpoint inhibition are yet to be defined. Here, we examine levels of PD-L1 expression in MPM patients treated with systemic and/or intraperitoneal chemotherapy using tissue from patient tumour biopsies or resections at multiple time points. We found the mean PD-L1 expression was higher in those with a germline mutation and/or those with a higher somatic mutation burden. Moreover, PD-L1 expression was lower in patients who had received prior chemotherapy as compared to the treatment-naive cohort. Twenty patients who received chemotherapy, either systemic and/or peritoneal, between PD-L1 measurements showed marked heterogeneity. Six (30%) patients demonstrated upregulation of PD-L1, while eight (40%) demonstrated downregulation. Heterogeneity in PD-L1 expression in MPM before and after cytotoxic therapies may present an additional consideration when initiating immune checkpoint inhibition in this rare and challenging disease.

Platinum-based chemotherapeutic agents are commonly used in the treatment of several cancers. While effective, they are often discontinued due to toxicities and hypersensitivity reactions (HSRs) that occur more frequently with repeated exposure. Following discontinuation of one agent, therapy may be continued with a second platinum salt, though the cross-reactivity between agents in this class is not well understood. This is particularly true for alternative routes of administration such as hyperthermic intraperitoneal chemotherapy (HIPEC). In this case report, we describe the use of cisplatin during HIPEC in a patient who previously experienced an HSR to systemic oxaliplatin. The patient tolerated HIPEC including 200 mg cisplatin for 1 hour without any adverse effects and did not require a desensitization protocol prior to therapy. This case suggests that HIPEC with platinum-based agents can be performed in patients with prior HSRs to systemic therapy, though further studies are needed to understand safety parameters, the cross-reactivity between agents and the necessity of skin testing or desensitization protocols.

Appendiceal adenocarcinoma with signet ring cells (SCA) is associated with worse overall survival (OS), and it is unclear whether cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) should be pursued in this patient population. We assessed the prognostic implications of signet ring cells in patients with appendiceal adenocarcinoma and peritoneal carcinomatosis undergoing CRS-HIPEC.The US HIPEC Collaborative, a 12-center, multi-institutional database of patients undergoing CRS-HIPEC, was reviewed for patients with SCA. Univariate and multivariate analyses were performed.Of 514 patients undergoing CRS-HIPEC for appendiceal adenocarcinoma, 125 (24%) had SCA. The SCA and non-SCA groups had similar baseline characteristics. SCA had worse OS compared with non-SCA (32.0 vs 91.4 months, p 0.001). In univariate analysis for only SCA cases, there was worse OS in patients with poorly differentiated tumors, positive lymph nodes, LVI, PCI 20, or incomplete cytoreduction (CC-2/3). However, multivariate analysis showed only positive lymph nodes (HR 1.14 [95% CI 1.00-1.31], p = 0.04), poor differentiation (5.60 [1.29-24.39], p = 0.02), and incomplete cytoreduction (4.90 [1.11-12.70], p = 0.03) were independently associated with decreased OS for SCA.While signet cells are a negative prognostic feature, they should not be a contraindication to CRS-HIPEC in patients with well-moderately differentiated tumors with negative lymph nodes, where complete cytoreduction can be achieved.

Background: Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient. Methods: A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one. Results: Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%. Conclusions: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.

Replacing copper as the central conductor with carbon nanotube (CNT) yarn has potential for greatly reducing the weight of data and power cables for any number of aerospace and automotive applicati...

CCBY Antimony selenide (Sb$_2$Se$_3$) is an emerging chalcogenide photovoltaic absorber material that has been the subject of increasing interest in recent years, demonstrating rapid efficiency increases with a material that is simple, abundant, and stable. This paper examines the material from both a theoretical and practical standpoint. The theoretical viability of Sb$_2$Se$_3$ as a solar photovoltaic material is assessed and the maximum spectroscopically limited performance is estimated, with a 200 nm film expected to be capable of achieving a photon conversion efficiency of up to 28.2%. By adapting an existing CdTe close-spaced sublimation (CSS) process, Sb$_2$Se$_3$ material with large rhubarb-like grains is produced and solar cells are fabricated. We show that the established CdS window layer is unsuitable for use with CSS, due to intermixing during higher temperature processing. Substituting CdS with the more stable TiO$_2$, a power conversion efficiency of 5.5% and an open-circuit voltage V$_oc$ of 0.45 V are achieved; the voltage exceeding current champion devices. This paper demonstrates the potential of CSS for scalable Sb$_2$Se$_3$ deposition and highlights the promise of Sb$_2$Se$_3$ as an abundant and low-toxicity material for solar applications.

BACKGROUND: Pathologic complete response (pCR) is associated with better prognosis and guides management for patients with advanced rectal cancer. Response rates vary between series for unclear reasons. We examine whether the thoroughness of pathologic assessment explains differences in pCR rates. METHODS: We retrospectively reviewed pathology reports from patients with stage II/III rectal cancer who underwent chemoradiation and resection in a prospective, multicenter trial. We utilized a novel measure for the thoroughness of pathologic assessment by dividing residual tumor size by the number of cassettes evaluated (tumor size to cassette ratio, TSCR), and evaluated whether TSCR is associated with pCR. We validated our findings using a separate cohort. RESULTS: From the trial cohort, 71 of 247 (29%) patients achieved pCR. The pCR rate ranged from 0 to 45% and mean TSCR ranged 0.29 to 0.87 across 12 institutions. Within each institution, a lower TSCR was associated with pCR, demonstrating a higher degree of thoroughness used for tumors that achieved pCR. Moreover, across all samples, low TSCR was independently associated with pCR on multivariable analysis. This finding was corroborated in a separate cohort of 201 tumors evaluated by five pathologists; each pathologist had a lower mean TSCR for pCR calls compared with non-pCR calls. However, the mean TSCR for an institution was not associated with its overall pCR rate. CONCLUSIONS: Pathologists assess rectal cancers that have responded significantly to neoadjuvant therapy more thoroughly. Thoroughness does not appear to explain differences in pCR rates between institutions. Our results suggest pCR is not a sampling artifact.

Background Scientific data on the image modality to be used in postcurative treatment surveillance of non-small cell lung cancer patients are scarce. This prospective randomized pilot trial compared the performance of integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) and contrast-enhanced computed tomography (CE-CT). Methods After termination of curative-intent treatment, patients were randomly assigned to the PET-CT or the CE-CT group. Imaging was performed every 6 months for 2 years. If suspicious radiologic findings were detected or patients became symptomatic, a diagnostic workup was initiated. Sensitivity, specificity, and positive predictive value for detecting cancer recurrence were calculated for both imaging procedures. Results The study enrolled 96 patients. In 14 of 50 patients (28%) in the PET-CT group and in 14 of 46 patients (30%) in the CE-CT group, a suspicious radiologic finding was confirmed as cancer recurrence after diagnostic workup. False-positive findings were detected in 11 patients (22%) of the PET-CT group and in 8 patients (17%) of the CE-CT group. The sensitivity, specificity, and positive predictive value for detecting cancer recurrence (95% confidence interval) were 0.88 (0.62 to 0.98), 0.62 (0.42 to 0.79), and 0.56 (0.35 to 0.76) for PET-CT and 0.93 (0.68 to 1.00), 0.72 (0.53 to 0.87), and 0.64 (0.41to 0.83) for CE-CT, respectively. Conclusions The results of our study suggest that PET-CT is not superior to CE-CT in detecting cancer recurrence during 2 years after curative-intent treatment of non-small cell lung cancer.

Background: Disasters such as the COVID-19 pandemic pose an overwhelming demand on resources that cannot always be met by official organisations. Limited resources and human response to crises can lead members of local communities to turn to one another to fulfil immediate needs. This spontaneous citizen-led response can be crucial to a community’s ability to cope in a crisis. It is thus essential to understand the scope of such initiatives so that support can be provided where it is most needed. Nevertheless, quickly developing situations and varying definitions can make the community response challenging to measure.Aim: To create an accessible interactive map of the citizen-led community response to need during the COVID-19 pandemic in Wales, UK, that combines information gathered from multiple data providers to reflect different interpretations of need and support.Approach: We gathered data from a combination of official data providers and community-generated sources to create 14 variables representative of need and support. These variables are derived by a reproducible data pipeline that enables flexible integration of new data. The interactive tool is available online (www.covidresponsemap.wales) and can map available data at two geographic resolutions. Users choose their variables of interest, and interpretation of the map is aided by a linked bee-swarm plot.Discussion: The novel approach we developed enables people at all levels of community response to explore and analyse the distribution of need and support across Wales. While there can be limitations to the accuracy of community-generated data, we demonstrate that they can be effectively used alongside traditional data sources to maximise the understanding of community action. This adds to our overall aim to measure community response and resilience, as well as to make complex population health data accessible to a range of audiences. Future developments including the integration of other factors such as well-being.

Background There are 20,000 major trauma cases in England annually yet the association with concomitant upper limb injuries is unknown. Injuries of the hand and wrist can cause serious functional impairment, decreased quality of life and confer a significant economic burden to healthcare systems. The aim of this study was to determine the incidence, injury pattern and association of hand/wrist injuries with other injuries and the ISS score in multiple trauma patients in the UK. Methods A single centre retrospective cohort study was performed at a level one trauma centre. Trauma Association & Research Network (TARN) eligible patients during a 5-year period were included. Results A total of 107 patients were included in this study. Seventy patients had an ISS15. The majority were male (70.1%) and the mean age was 45 Years. Hand and wrist injuries were the second most common injury found in 26.2% of patients. There was a significant association between hand/wrist injuries and lower limb injuries (p = 0.04) and pelvic injuries (p = 0.02). The association between hand and wrist injuries with ISS score was found to be not significant (p = 0.82). Conclusion Hand and wrist injuries should be screened for in multiply injured patients with a pelvic or lower limb injury.

Low-dimensional materials have recently attracted much interest as thermoelectric materials because of their charge carrier confinement leading to thermoelectric performance enhancement. Carbon nanotubes are promising candidates because of their one-dimensionality in addition to their unique advantages such as flexibility and light weight. However, preserving the large power factor of individual carbon nanotubes in macroscopic assemblies has been challenging, primarily due to poor sample morphology and a lack of proper Fermi energy tuning. Here, we report an unprecedentedly high value of power factor (14±5 mWm-1K-2) for centimeter-long weavable fibers of aligned carbon nanotubes with ultrahigh electrical and thermal conductivity. Our theoretical simulations show that the observed giant power factor originates from the one-dimensional quantum confinement of charge carriers, appearing when the Fermi energy is near a van Hove singularity in the electronic density of states. We fabricated a textile thermoelectric generator based on these carbon nanotube fibers, which demonstrated high thermoelectric performance, weavablity, and scalability. The giant power factor we observed make these fibers strong candidates for the emerging field of thermoelectric active cooling, which requires a large thermoelectric power factor and a large thermal conductivity at the same time.

Low-dimensional materials have recently attracted much interest as thermoelectric materials because of their charge carrier confinement leading to thermoelectric performance enhancement. Carbon nanotubes are promising candidates because of their one-dimensionality in addition to their unique advantages such as flexibility and light weight. However, preserving the large power factor of individual carbon nanotubes in macroscopic assemblies has been challenging, primarily due to poor sample morphology and a lack of proper Fermi energy tuning. Here, we report an ultrahigh value of power factor (14 ± 5 mW m−1 K−2) for macroscopic weavable fibers of aligned carbon nanotubes with ultrahigh electrical and thermal conductivity. The observed giant power factor originates from the ultrahigh electrical conductivity achieved through excellent sample morphology, combined with an enhanced Seebeck coefficient through Fermi energy tuning. We fabricate a textile thermoelectric generator based on these carbon nanotube fibers, which demonstrates high thermoelectric performance, weavability, and scalability. The giant power factor we observe make these fibers strong candidates for the emerging field of thermoelectric active cooling, which requires a large thermoelectric power factor and a large thermal conductivity at the same time., Preserving the large power factor of carbon nanotubes is challenging, due to poor sample morphology and a lack of proper Fermi energy tuning. Here, the authors achieve a value of power factor of 14 ± 5 mW m−1 K−2 originating from the preserved conductivity and the ability to tune Fermi energy.