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Retrospective studies and meta-analyses suggest that upfront primary tumour resection (UPTR) confers a survival benefit in patients with asymptomatic unresectable metastatic colorectal cancer (mCRC) undergoing chemotherapy, however a consensus of its role in routine clinical practice in the current era of targeted therapies is lacking. This retrospective study aimed to analyse the survival benefit of UPTR in terms of tumour location and mutational status, in patients with synchronous mCRC receiving chemotherapy and targeted therapy.Survival was analysed in a pooled cohort of synchronous mCRC patients treated with a first-line anti-VEGF or anti-EGFR inhibitor in seven trials of the Spanish TTD group, according to UPTR, tumour-sidedness and mutational profiling.Of 1334 eligible patients, 642 (48%) had undergone UPTR. UPTR was associated with significantly longer overall survival (OS; 25.0 vs 20.3 months; HR 1.30, 95%CI 1.15-1.48; p 0.0001). UPTR was associated with significant OS benefit in both left-sided (HR 1.38, 95%CI 1.13-1.69; p = 0.002) and right-sided (HR 1.39, 95%CI 1.00-1.94; p = 0.049) tumours, RASwt (HR 1.29, 95%CI 1.05-1.60; p = 0.016) and BRAFwt (HR 1.49, 95%CI 1.21-1.84; p = 0.0002) tumours, and treatment with anti-EGFRs (HR 1.47, 95%CI 1.13-1.92; p = 0.004) and anti-VEGFs (HR 1.25, 95%CI 1.08-1.44; p = 0.003). Multivariate analysis identified number of metastatic sites, RAS status, primary tumour location and UPTR as independent prognostic factors for OS.Considering the selection bias inherent to this study, our results support UPTR before first-line anti-EGFR or anti-VEGF targeted therapy in right and left-sided asymptomatic unresectable synchronous mCRC patients. RAS/BRAF mutational status may also influence UPTR function.

Purpose: The article researches the compatibility between the cooperative group and the current commercial environment in Vietnam to propose for improvement to the laws and for promotion of development of the cooperative group. Theoretical framework: Recent literature points out that the cooperative group model is quite suitable for the production and business psychology of citizens in Vietnam. In the current stage of development, however, from the influence and impact of international integration and the increasingly fierce competitive pressure of various types of enterprises, the cooperative group have encountered many difficulties to survive. On the other hand, in the context of judicial reform in Vietnam, the issue of complete law system and expanding the freedom to business has always been paid special attention by the Party and Vietnam State. Design/methodology/approach: The authors have combined traditional research methods of legal science such as legal analysis method, legal efficiency assessment method and legal comparison method. Findings: According to research, the cooperative group is well adapted to Vietnam's commercial environment because it is compatible with investor psychology and meets the conditions and circumstances of nature, economy and society. However, since Vietnam's deep integration with the rest of the world, the cooperative group model has faced numerous difficulties and challenges, and if suitable solutions are not found, it is very likely that this collective economy will become increasingly difficult. As a result, the article suggests some important solutions, such as offering cooperative group legal status and requiring more preferential lending policies with long loan terms, simple and quick loan procedures, and easy team cooperation. Research, Practical & Social implications: This research may support many develop future research in Vietnam. Originality/value: The study of the freedom to business become more and more urgent and very important in Vietnam.

Radiation therapy plays an important role in the multidisciplinary management of breast cancer. Recent years have seen improvements in breast cancer survival and a greater appreciation of potential long-term morbidity associated with the dose and volume of irradiated organs. Proton therapy reduces the dose to nontarget structures while optimizing target coverage. However, there remain additional financial costs associated with proton therapy, despite reductions over time, and studies have yet to demonstrate that protons improve upon the treatment outcomes achieved with photon radiation therapy. There remains considerable heterogeneity in proton patient selection and techniques, and the rapid technological advances in the field have the potential to affect evidence evaluation, given the long latency period for breast cancer radiation therapy recurrence and late effects. In this consensus statement, we assess the data available to the radiation oncology community of proton therapy for breast cancer, provide expert consensus recommendations on indications and technique, and highlight ongoing trials' cost-effectiveness analyses and key areas for future research. (c) 2021 Elsevier Inc. All rights reserved.

Background Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. Objectives To enable data to be collected worldwide on FFA using common criteria and assessment methods. Methods A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. Results Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. Conclusions These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.

Radiotherapy (RT) technology and utilization has considerably evolved over the last 50 years in the management of pediatric Hodgkin lymphoma (HL). In response to significant late effects from RT in HL survivors, clinical trials in the United States and Europe have evaluated ways to maintain high cure rates while reducing late toxicities from treatment. While numerous differences exist with respect to the RT guidelines embedded within therapeutic protocols across the cooperative groups, greater agreement is observed in the indications for RT, doses, volumes, and the incorporation of modern treatment modalities. This report provides an overview of RT delivery in pediatric HL protocols in the United States and Europe and examines areas of consensus on the utilization and delivery of RT in pediatric HL.

Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For this study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014-2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945 respectively, and $301 693 and $49 824 RF respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < 0.05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < 0.001 GP, P = 0.008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential “industry bias” that could influence the integrity of their conclusions. This article is protected by copyright. All rights reserved.

This research aimed to analyze the influence of Cooperative Development on Economic Performance and Public Welfare in Padang Municipality and analyze the indirect and direct effect of Economic Performance as a mediator construct related to Cooperative Development on Public Welfare in Padang Municipality. Cooperative Performance data used in this research as panel data consists of 17 sub-sectors of Cooperative groups in Padang Municipality within 2012–2019 (8 years). Data analysis using quantitative statistical analysis approached by structural equation modeling-partial least square (SEM-PLS) method. This research found that Cooperative Development positively and significantly influenced Economic Performance and Public Welfare in Padang Municipality. Economic performance has a positive and significant influence on Public Welfare in Padang Municipality. Cooperative Development on Public Welfare through Economic Performance has a considerable contribution compared to direct influenced Cooperative Development on Public Welfare in Padang Municipality. Finally, Economic Performance has effective and complete mediation to improve Public Welfare by Cooperative Development in Padang Municipality within 2012–2019.

Purpose/Objective(s) Monte Carlo (MC) dose calculation has appeared in primary commercial treatment-planning systems and various in-house platforms. Dual-energy computed tomography (DECT) and metal artifact reduction (MAR) techniques complement MC capabilities. However, no publications have yet reported how proton therapy centers implement these new technologies, and a national survey is required to determine the feasibility of including MC and companion techniques in cooperative group clinical trials. Materials/Methods A 9-question survey was designed to query key clinical parameters: scope of MC utilization, validation methods for heterogeneities, clinical site-specific imaging guidance, proton range uncertainties, and how implants are handled. A national survey was distributed to all 29 operational US proton therapy centers on 13 May 2019. Results We received responses from 25 centers (86% participation). Commercial MC was most commonly used for primary plan optimization (16 centers) or primary dose evaluation (18 centers), while in-house MC was used more frequently for secondary dose evaluation (7 centers). Based on the survey, MC was used infrequently for gastrointestinal, genitourinary, gynecology and extremity compared with other more heterogeneous disease sites (P < .007). Although many centers had published DECT research, only 3/25 centers had implemented DECT clinically, either in the treatment-planning system or to override implant materials. Most centers (64%) treated patients with metal implants on a case-by-case basis, with a variety of methods reported. Twenty-four centers (96%) used MAR images and overrode the surrounding tissue artifacts; however, there was no consensus on how to determine metal dimension, materials density, or stopping powers. Conclusion The use of MC for primary dose calculation and optimization was prevalent and, therefore, likely feasible for clinical trials. There was consensus to use MAR and override tissues surrounding metals but no consensus about how to use DECT and MAR for human tissues and implants. Development and standardization of these advanced technologies are strongly encouraged for vendors and clinical physicists.

ARST1321, a trial of patients with advanced soft tissue sarcoma, was the first National Clinical Trials Network study codeveloped by pediatric and adult consortia with two treatment cohorts. We report on the findings of a survey to identify barriers to enrolling adolescent and young adult patients (15-39 years) onto the nonchemotherapy arm. The survey response rate was 31% with a 70% completion rate. Common identified reasons for low accrual in order of decreasing frequency included insufficient funding, lack of study awareness or interest, competing trials, toxicity concerns, philosophical differences in the therapy backbone, and regulatory and infrastructure barriers. Clinical Trials.gov ID: NCT02180867.

Purpose When treating cancer, both quantity and quality of life are valuable, though oncology trials have long placed greater emphasis on the former. The goal of this work was to evaluate how patient-reported outcomes (PROs) have been incorporated into radiation therapy trials within the National Clinical Trials Network over the last 2 decades to measure quality of life and to assess how PRO data have been disseminated in publications upon trial conclusion. Methods and Materials This cross-sectional study analyzed the frequency of use of PROs in National Clinical Trials Network cooperative group radiation therapy phase 2 and 3 clinical trials over the past 2 decades. A literature review was performed to determine the publication outcomes of PRO data, including only trials that used PROs in their design and were mature enough to have published results. Results Fifty-seven (56.4%) of the 101 trials included in this study included PROs in their design. Brain and head and neck trials demonstrated the largest proportional incorporation of PROs (81.8% and 76.9%, respectively), and thoracic and breast trials used the fewest (18.8% and 37.5%, respectively). The EQ-5D family of questionnaires was the most commonly used PROs, used in 22.8% of trials included. The literature review demonstrated a pattern of increased publication of PRO data alongside survival endpoints in manuscripts derived from these trials over time. Conclusions Though there is room for improvement, the field of radiation oncology has embraced the incorporation of PROs into multicenter, high-impact clinical trials over the past 2 decades and has increased its publication of this data alongside survival data from these trials.

Cooperative group activities in classrooms provide an opportunity for children to learn and demonstrate relationship skills, particularly when clear expectations and explicit instruction are provided. Relationship skills are one of the five competency areas of social and emotional learning. This article provides directions and illustrations for using cooperative group activities to improve the relationship skills of students with or at risk for emotional and behavioral disorders.

Enraizando la integración y la agrupación cooperativa en el principio de intercooperación, se analiza la legislación vasca en la materia, desde los acuerdos entre cooperativas a los Grupos cooperativos, pasando por las Cooperativas de segundo y ulterior grado y las Corporaciones cooperativas, con referencias comparadas a la legislación estatal. Por último, se abordan las Cooperativas mixtas por estar englobadas dentro del mismo Capítulo de la Ley vasca. Recibido: 22 noviembre 2016Aceptado: 20 diciembre 2016

Significant progress has been made in the treatment and outcome of breast cancer. Some of the most dramatic strides have been in the surgical management of breast cancer. Breast-conserving therapy (BCT), including wide local excision of the tumor followed by irradiation, has become a standard treatment option for women with early-stage invasive breast cancer. Large cooperative group trials have contributed to the paradigm shift from mastectomy to BCT. This review reports the landmark BCT trials that provided the data for current surgical practices. The review also describes the body of literature contributing to the increasing use of oncoplastic techniques for patients undergoing BCT.

From an analysis of a cooperative and a cooperative group in the region of Lauragais in France, this paper aims to explore the consequences of globalization and capital concentration for agricultural cooperatives.We focus on cooperatives' internal organization, the links with their stakeholders and their strategies to adapt to change.We observe that both cases are crossed by the tension between achieving efficiency as collectively operated companies and the promotion of participation, democracy, and solidarity, showing a higher appreciation of the first objective with some slight differences. A partir del análisis de una cooperativa y un grupo cooperativo en la región de Lauragais, Francia, se pretende explorar las consecuencias que el actual contexto de globalización y concentración posee para las cooperativas agrícolas, en términos de su organización interna, los vínculos que establecen con sus asociados, y las estrategias que llevan adelante a fin de adaptarse al cambio. Se reconoce en el análisis que ambas experiencias son atravesadas por la tensión entre el logro de la eficiencia en tanto empresas operadas colectivamente, y el fomento de la participación, democracia y solidaridad en tanto cooperativas, mostrando –con ciertos matices- una mayor valoración del primer objetivo.

Research cooperative groups aim to facilitate collaborative and rigorous palliative care research. The purpose of this article is to (1) demonstrate how cooperative groups are taking formal and sustainable steps with commitment to pediatric palliative care research programs and (2) provide an example of how one cooperative group is implementing these innovative efforts to partner with programs to integrate pediatrics on an expanding scale. Details are described for how pediatric studies can benefit from cooperative group infrastructure and expertise. In turn, we describe how cooperative groups can benefit from collaborating on pediatric studies through broadening of data dictionaries, data repositories, and reach in palliative care research communities.

This study aimed to investigate the beliefs and practices of group work assessment of secondary school teachers. For this reason, 213 teachers were selected randomly for a questionnaire survey. In addition, two teachers and five students were selected for interviews and focus group discussions at each site, respectively. A one-sample t-test was applied to analyze the data acquired through the questionnaire while the Pearson product-moment correlation was used to examine the relationship between the beliefs and practices of group work assessment. The data obtained through interviews and focus group discussion (FGD), were analyzed through thematic verbal descriptions. The findings showed favorable teachers’ beliefs towards group work assessment. On the contrary, teachers’ assessment practices were partial with focus on group product, with diminutive or no assessment of group process and individual contribution. Hence, Ethiopian Bureaus should conduct on- job training for teachers on the assessment of group work.