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Research exploring the influences of cultural experiences, future imaginations and aspirations on the formation of pedagogy among immigrant Early Childhood (EC) educators remains scarce. This collaborative autoethnography (CAE) is about the first author's pedagogical journey. Educated and trained in India as an EC educator, the stories shared in this paper offer insights into how the first author navigated and negotiated her understandings of pedagogies from padhana, a more traditional Indian focused pedagogy to 'Western' play-based pedagogy. Using photo-elicitation techniques from visual images as data and Appadurai's theoretical framework on cultural global flows, the changes and continuities of conceptions of pedagogy influenced by cultural experiences, future imaginations and aspirations are explored. The iterative process supported by CAE helped redefine understandings about pedagogies, teacher identity and EC education.

Purpose Precision oncology is hindered by the lack of decision support for determining the functional and therapeutic significance of genomic alterations in tumors and relevant clinically available options. To bridge this knowledge gap, we established a Precision Oncology Decision Support team that provides annotations at the alteration level and subsequently determined whether clinical decision making was influenced. Methods Genomic alterations were annotated to determine actionability on the basis of a variant's known or potential functional and/or therapeutic significance. The medical records of a subset of patients annotated in 2015 were manually reviewed to assess trial enrollment. A Web-based survey was implemented to capture the reasons genotype-matched therapies were not pursued. Results The Precision Oncology Decision Support team processed 1,669 requests for annotation of 4,084 alterations (2,254 unique) across 49 tumor types for 1,197 patients. A total of 2,444 annotations for 669 patients included an actionable variant call: 32.5% actionable, 9.4% potentially actionable, 29.7% unknown, and 28.4% nonactionable. Sixty-six percent of patients had at least one actionable/potentially actionable alteration, and 20.6% of patients (110 of 535) annotated enrolled in a genotype-matched trial. Trial enrollment was significantly higher for patients with actionable/potentially actionable alterations (92 of 333; 27.6%) than for those with unknown (16 of 136; 11.8%) and nonactionable (2 of 66; 3%) alterations (P < .001). Actionable alterations in PTEN, PIK3CA, and ERBB2 most frequently led to enrollment in genotype matched trials. Clinicians cited a variety of reasons that patients with actionable alterations did not enroll in trials. Conclusion Over half of alterations annotated were of unknown significance or nonactionable. Physicians were more likely to enroll a patient in a genotype-matched trial when an annotation supported actionability. Future studies are needed to demonstrate the impact of decision support on trial enrollment and oncologic outcomes. [ABSTRACT FROM AUTHOR]