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Hyalinizing clear cell carcinoma is an uncommon neoplasm arising in minor salivary glands. We present a rare case of hyalinizing clear cell carcinoma in the base of the tongue. We report a case of a 38-year-old female presented with a progressive history of hemoptysis and dysphagia over the course of 4 years. Examination revealed a mass originating from the base of the tongue with a biopsy confirmed as hyalinizing clear cell carcinoma . An Ovid MEDLINE and PubMed literature review was conducted due to the rarity of this type of tumor. The patient underwent surgical excision with immediate reconstruction with radial forearm free flap followed with adjuvant radiotherapy and was disease free at her most recent follow-up (12 months). Our review included a total of 13 new cases, including our case. The majority of the cases presented with dysphagia. Surgical excision is the mainstay of treatment, and overall these patients have a good prognosis. Our case highlights a rare presentation of hyalinizing clear cell carcinoma of the base of the tongue, successfully treated with surgical excision, free tissue reconstruction and adjuvant radiotherapy.

Abstract Background Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches. Methods This is a multicenter phase II study randomizing one hundred and forty patients with T1–2 N0–2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50–60 Gy based on risk factors). Patients will be stratified based on smoking status (

Abstract Background Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. Divided into non- and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity. Case presentation We present a case of an aggressive central giant cell granuloma (CGCG) in a six year-old female. The lesion originated in the right mandibular ramus and progressed rapidly to involve the condyle. Diagnosis was made using a combination of imaging and pathology. A timely en bloc resection of the hemi-mandible was performed with placement of a reconstructive titanium plate and condylar prosthesis. Conclusion Our case demonstrates the importance of considering CGCG in the differential diagnosis of rapidly progressive mandibular lesions in the pediatric population. Prompt diagnosis and management can greatly improve long-term outcomes.

The impact of the New Tech Network (NTN) design on several academic measures was tested on ninth graders in four schools in one state located in the Southeastern United States. Research questions explored the extent to which achievement test scores, dual credits earned, and dropout rates differed between ninth grade students in high fidelity NTN schools and similar students in traditional schools. A quasi-experimental design using student-level variables from the state's PowerSchool database was conducted in order to test hypotheses related to the research questions. Results suggest that, when implemented with fidelity to the model, there was a significant effect of NTN on achievement test scores as students in NTN schools scored higher on both the End of Course (EOC) Math and English Language Arts (ELA) tests compared to students in control schools. This effect remained after controlling for poverty, race, and preexisting achievement level. Students in NTN schools also were slightly more likely to earn dual credit compared to similar students in control schools. However, there was no effect of NTN participation on dropout rate as students in NTN schools were more likely to be retained in their current grade level and not moving to the next grade level compared to students in control schools.

Enrollment in dual credit classes has increased over the last 10 years benefiting K-20 education and high school students in providing an opportunity to obtain college credits and increasing postsecondary education enrollment. The purpose of this study was to investigate the predictors of achievement through the lens of Social Cognitive Theory by documenting cognitive and noncognitive factors of dual credit students in grades 9-12 at an east Texas university charter school. The Noncognitive Questionnaire was used to measure the noncognitive characteristics, and the Texas Success Initiative Assessment (TSI) reading and writing scores were used as the cognitive measurement. Multiple regression analysis, using weighted least squares, found TSI writing and positive self-concept to be significant predictors of achievement. The findings from this study could suggest states and districts to consider admission requirements for dual credit classes to include other cognitive and/or noncognitive artifacts for admission decisions.

BackgroundLong-term loss of arm function after ischaemic stroke is common and might be improved by vagus nerve stimulation paired with rehabilitation. We aimed to determine whether this strategy is a safe and effective treatment for improving arm function after stroke.MethodsIn this pivotal, randomised, triple-blind, sham-controlled trial, done in 19 stroke rehabilitation services in the UK and the USA, participants with moderate-to-severe arm weakness, at least 9 months after ischaemic stroke, were randomly assigned (1:1) to either rehabilitation paired with active vagus nerve stimulation (VNS group) or rehabilitation paired with sham stimulation (control group). Randomisation was done by ResearchPoint Global (Austin, TX, USA) using SAS PROC PLAN (SAS Institute Software, Cary, NC, USA), with stratification by region (USA vs UK), age (≤30 years vs >30 years), and baseline Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (20-35 vs 36-50). Participants, outcomes assessors, and treating therapists were masked to group assignment. All participants were implanted with a vagus nerve stimulation device. The VNS group received 0·8 mA, 100 μs, 30 Hz stimulation pulses, lasting 0·5 s. The control group received 0 mA pulses. Participants received 6 weeks of in-clinic therapy (three times per week; total of 18 sessions) followed by a home exercise programme. The primary outcome was the change in impairment measured by the FMA-UE score on the first day after completion of in-clinic therapy. FMA-UE response rates were also assessed at 90 days after in-clinic therapy (secondary endpoint). All analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT03131960.FindingsBetween Oct 2, 2017, and Sept 12, 2019, 108 participants were randomly assigned to treatment (53 to the VNS group and 55 to the control group). 106 completed the study (one patient for each group did not complete the study). On the first day after completion of in-clinic therapy, the mean FMA-UE score increased by 5·0 points (SD 4·4) in the VNS group and by 2·4 points (3·8) in the control group (between group difference 2·6, 95% CI 1·0-4·2, p=0·0014). 90 days after in-clinic therapy, a clinically meaningful response on the FMA-UE score was achieved in 23 (47%) of 53 patients in the VNS group versus 13 (24%) of 55 patients in the control group (between group difference 24%, 6-41; p=0·0098). There was one serious adverse event related to surgery (vocal cord paresis) in the control group.InterpretationVagus nerve stimulation paired with rehabilitation is a novel potential treatment option for people with long-term moderate-to-severe arm impairment after ischaemic stroke.FundingMicroTransponder.

Background: The Consultation and Relational Empathy (CARE) Measure, a validated questionnaire designed to assess patients' perceptions of their physician's communication skills and empathy, has been used to assess empathy in medical specialties but has seldom been applied to surgery. We assessed empathy and communication skills among a group of surgeons within a single academic institution. Methods: All surgeons within our department of surgery were invited to participate. Patients seen in clinics of participating surgeons were recruited prospectively from July 2018 to February 2019. At the end of each clinical encounter, they were asked to complete a CARE survey. Surveys were analyzed according to previously validated inclusion and exclusion criteria. We calculated mean scores for each surgeon and surgical division. About 6 months after study completion, surgeons were provided with their individual score and de-identified division scores, and were asked to complete a follow-up survey assessing their attitudes toward the CARE Measure. Results: Of the 82 surgeons invited, 51 (62%) agreed to participate; 7 had fewer than 25 completed surveys and were excluded from analysis. A total of 1801 surveys for 44 surgeons (33 male and 11 female) were included in the final analysis. The average CARE score across the department was 46.9 (95% confidence interval [CI] 46.6-47.1). Female surgeons received significantly higher scores than male surgeons (mean 47.6 [95% CI 47.1-48.0] v. 46.7 [95% CI 46.4-48.0]). Of the 35 surgeons who responded to the follow-up survey, 31 (89%) felt that the questions in the CARE Measure applied to their practice, and half of these reported that they intended to make changes in response to the feedback. Conclusion: We found high communication and empathy scores among surgeons in the outpatient setting, with enough variability to encourage continued improvement. The CARE Measure appears to have face validity among surgeons, and the vast majority found it relevant to their practice. Further study is needed to formally assess the relevance, performance, reliability and construct validity of this measure. Contexte : L'échelle Consultation and Relational Empathy (CARE), un questionnaire validé mesurant la perception des patients de l'empathie et des compétences en communication des médecins, est utilisée dans les spécialités médicales, mais rarement en chirurgie. Nous avons évalué l'empathie et les compétences en communication d'un groupe de chirurgiens au sein d'un établissement universitaire. Méthodes : Tous les chirurgiens de notre département ont été invités à participer. Les patients des participants ont été recrutés de façon prospective entre juillet 2018 et février 2019, puis ont été invités à répondre à un questionnaire CARE après chaque consultation clinique. Nous avons analysé les questionnaires selon des critères d'inclusion et d'exclusion validés, puis avons calculé le score moyen pour chaque chirurgien et division du département. Six mois après la fn de l'étude, les chirurgiens ont obtenu leur score individuel et le score anonymisé de leur division et ont été invités à remplir un sondage de suivi sur leurs attitudes à l'égard de l'échelle CARE. Résultats : Des 82 chirurgiens invités, 51 (62%) ont accepté de participer; 7 ont été exclus de l'analyse parce qu'ils avaient moins de 25 questionnaires. L'analyse finale comprend 1801 questionnaires évaluant 44 chirurgiens, dont 33 hommes et 11 femmes. Le score CARE moyen du département s'élevait à 46,9 (intervalle de confiance [IC] à 95% 46,6-47,1). Les scores moyens des chirurgiennes étaient significativement plus élevés que ceux de leurs collègues masculins (47,6 [IC à 95% 47,1-48] c. 46,7 [IC à 95% 46,4-48]). Des 35 chirurgiens ayant répondu au sondage de suivi, 31 (89%) estimaient que les questions de l'échelle CARE s'appliquaient à leur pratique, et la moitié comptaient en outre réagir à la rétroaction par des changements. Conclusion : Nous avons obtenu des scores de communication et d'empathie élevés chez les chirurgiens en ambulatoire, avec assez de variabilité par ailleurs pour favoriser l'amélioration continue. L'échelle CARE semble avoir une validité apparente chez les chirurgiens, qui étaient une majorité à la juger pertinente pour leur pratique. Des études ultérieures seront nécessaires pour évaluer de façon plus formelle la pertinence, les performances, la fiabilité et la validité des construits de l'échelle., The interaction between clinician and patient remains the cornerstone of medical care. In recent years, there has been increased emphasis on patient-centred care and attention paid to the patient's perspective [...]

With many recent advancements in spasticity treatment, more patients are surviving critical illness and injury but are left with ongoing disability that needs constant treatment. Such treatment will change as the patient's condition evolves. Constant appraisal of treatment efficacy and patient progress is therefore an important component of spasticity management, and physicians need to be familiar with how to troubleshoot treatment regimens when outcomes of that regimen become suboptimal. This module considers how to optimize the use and outcomes of major treatment modalities and provides drug and device maintenance algorithms to guide the treating team.

Project/problem-based learning (PBL) can provide an effective model for school reform when implemented with fidelity. In the report, "Rising Above the Gathering Storm," it was recommended that if the U.S. is to remain competitive in the 21st-century economy, there must be a serious effort to "enlarge the pipeline of students who are prepared to enter college and graduate with a degree in STEM" (National Academy of Sciences, National Academy of Engineering, & Institute of Medicine, 2007, p. 6). The report included the recommendation that states develop statewide specialty STEM high schools (National Academy of Sciences, National Academy of Engineering, & Institute of Medicine, 2007, p. 6). In 2010, the Texas Science, Technology, Engineering, and Mathematics Academy (T-STEM) initiative was implemented to develop specialty STEM schools similar to those described in "Rising Above the Gathering Storm." The primary instructional strategy of T-STEM academies is problem- and project-based learning. In the STEM context, PBL is well suited as a primary pedagogy for STEM learning. This paper examines the following questions: What outcomes occur when PBL is implemented in a low performing school district? What is the role of PBL in school improvement? What are the challenges to implementing PBL with high fidelity?

In this study, models based on quantitative imaging biomarkers of post-stroke structural connectome disruption were used to predict six-month outcomes in various domains. Demographic information and clinical MRIs were collected from 40 ischemic stroke subjects (age: 68.1 ± 13.2 years, 17 female, NIHSS: 6.8 ± 5.6). Diffusion-weighted images were used to create lesion masks, which were uploaded to the Network Modification (NeMo) Tool. The NeMo Tool, using only clinical MRIs, allows estimation of connectome disruption at three levels: whole brain, individual gray matter regions and between pairs of gray matter regions. Partial Least Squares Regression models were constructed for each level of connectome disruption and for each of the three six-month outcomes: applied cognitive, basic mobility and daily activity. Models based on lesion volume were created for comparison. Cross-validation, bootstrapping and multiple comparisons corrections were implemented to minimize over-fitting and Type I errors. The regional disconnection model best predicted applied cognitive (R(2)  = 0.56) and basic mobility outcomes (R(2)  = 0.70), while the pairwise disconnection model best predicted the daily activity measure (R(2)  = 0.72). These results demonstrate that models based on connectome disruption metrics were more accurate than ones based on lesion volume and that increasing anatomical specificity of disconnection metrics does not always increase model accuracy, likely due to statistical adjustments for concomitant increases in data dimensionality. This work establishes that the NeMo Tool's measures of baseline connectome disruption, acquired using only routinely collected MRI scans, can predict 6-month post-stroke outcomes in various functional domains including cognition, motor function and daily activities. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc.

The aim of this work was to quantitatively model cross-sectional relationships between structural connectome disruptions caused by cerebral infarction and measures of clinical performance. Imaging biomarkers of 41 ischemic stroke patients (72.0 ± 12.0 years, 20 female) were related to their baseline performance in 18 cognitive, physical and daily life activity assessments. Individual estimates of structural connectivity disruption in gray matter regions were computed using the Change in Connectivity (ChaCo) score. ChaCo scores were utilized because they can be calculated using routinely collected clinical magnetic resonance imagings. Partial Least Squares Regression (PLSR) was used to predict various acute impairment and activity measures from ChaCo scores and patient demographics. Statistical methods of cross-validation, bootstrapping and multiple comparisons correction were implemented to minimize over-fitting and Type I errors. Multiple linear regression models based on lesion volume and lateralization information were constructed for comparison. All models based on connectivity disruption had lower Akaike Information Criterion and almost all had better goodness-of-fit values (R(2) : 0.26-0.92) than models based on lesion characteristics (R(2) : 0.06-0.50). Confidence intervals of PLSR coefficients identified brain regions important in predicting each clinical assessment. Appropriate mapping of eloquent functions, that is, language and motor, and replication of results across pathologies provided validation of this method. Models of complex functions provided new insights into brain-behavior relationships. In addition to the potential applications in prognostication and rehabilitation development, this quantitative approach provides insight into the structural networks underlying complex functions like activities of daily living and cognition. Quantitative analysis of big data will be invaluable in understanding complex brain-behavior relationships.