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Many teacher education programs are committed to social justice. This commentary argues that gender-expansive education—teaching that opens up, democratizes, and complicates our understandings of gender, gender identity, and gendered embodiment in our classrooms in ways that make space for all kinds of students—must be meaningfully, intersectionally included in teacher education that aims to promote equity, democracy, and freedom through schooling. We suggest ways that teacher education programs can leverage many of the critical skills and dispositions already cultivated in social justice education to integrate gender-expansive perspectives throughout their curriculum.

Objectives Elective unilateral neck irradiation in well-lateralized tonsil carcinoma for N2b disease is controversial. Metrics regarding nodal burden beyond the N-stage to define the upper limit of this de-escalation approach remain limited. We investigated the role of nodal number, level, and volume on outcomes in patients with well-lateralized tonsil carcinoma treated with this approach. Methods A total of 37 patients received radiotherapy (RT) with unilateral neck coverage for well-lateralized tonsil cancer. Of patients, 95% had p16+ disease, and 81% were staged with positron emission tomography/computed tomography. The majority of patients received definitive chemoradiation on prospective de-escalation trials. Ten patients had ipsilateral neck dissections and were treated adjuvantly. The median RT dose to the ipsilateral neck (generally II-IV) was 45 Gy. The effects of nodal number, max dimension, volume, and level on recurrence-free survival (RFS) and overall survival (OS) were to be analyzed via Cox proportional hazards (Cox-PH). Results After a median follow-up of 3.9 years, two-year RFS and two-year OS were 100% and 97%, respectively. Given the 0% contralateral recurrence rate, Cox-PH analysis was not performed. Of patients, 70% were American Joint Committee on Cancer (AJCC) 7th edition N2b, with a median number of nodes, number of nodal levels, max dimension, and volume of two, one, 3.4 cm, and 15.6 cc, respectively. There were several patients with low-lying nodes; aggregate nodal volume measured was up to 85.4 cc. Conclusion Unilateral neck irradiation in well-lateralized tonsil carcinoma resulted in no contralateral recurrence. Nodal volume, level, and number do not seem to have a significant impact on outcomes.

Noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) are follicular-patterned thyroid neoplasms defined by nuclear atypia and indolent behavior. They harbor RAS mutations, rather than BRAFV600E mutations as is observed in papillary thyroid carcinomas with extensive follicular growth. Reliably identifying NIFTPs aids in safe therapy de-escalation, but has proven to be challenging due to interobserver variability and morphologic heterogeneity. The genomic scoring system BRS (BRAF-RAS score) was developed to quantify the extent to which a tumor’s expression profile resembles a BRAFV600E or RAS-mutant neoplasm. We proposed that deep learning prediction of BRS could differentiate NIFTP from other follicular-patterned neoplasms. A deep learning model was trained on slides from a dataset of 115 thyroid neoplasms to predict tumor subtype (NIFTP, PTC-EFG, or classic PTC), and was used to generate predictions for 497 thyroid neoplasms within The Cancer Genome Atlas (TCGA). Within follicular-patterned neoplasms, tumors with positive BRS (RAS-like) were 8.5 times as likely to carry an NIFTP prediction than tumors with negative BRS (89.7% vs 10.5%, P

This study explores the disciplinary literacy perspectives of middle school students of color attending urban parochial schools and the reader subject positions they took up across content-area classrooms. Qualitative analysis of 19 student interviews and accompanying observations of subject-area classes revealed that students’ constructions of reading, circumscribed by classroom literacy activities, inhibited discipline-specific reading subject positions. In particular, this study highlights how teachers’ reading activities promoted reading as being about accomplishing a task rather than being apprenticed in ways of taking discipline-specific knowledge from text. When the boundaries between students’ home literacy experiences and school disciplinary literacy experiences were more contiguous, and when more meaningful, authentic literacy experiences were provided, students evidenced deeper disciplinary literacy engagement. Educational implications, including troubling disciplinary knowledge to open the disciplines to wider ways of knowing and learning for all learners, are discussed.

To report functional outcomes for patients with human papillomavirus-positive oropharyngeal cancer treated on a phase 2 protocol of risk- and induction chemotherapy response-adapted dose and volume de-escalated radiation therapy (RT)/chemoradiation (CRT).Patients were stratified as low risk (LR) or high risk (HR) according to T/N-stage and smoking history. Induction chemotherapy was followed by radiographic response assessment. LR patients with ≥50% response received 50 Gy RT (RT50), whereas LR patients with 30% to 50% response or HR patients with ≥50% response received 45 Gy CRT (CRT45). All other patients received 75 Gy CRT (CRT75) with RT limited to the first echelon of uninvolved nodes. Pre- and post-RT/CRT modified barium swallow studies were performed. Percutaneous endoscopic gastrostomy (PEG) tube placement, body mass index (BMI), and narcotic use were recorded. Statistical comparisons used linear or logistic regression, the Mann-Whitney U test, the χTwenty-eight LR and 34 HR patients were enrolled; 49 completed RT50/CRT45 and 11 completed CRT75. PEG-tube dependency at the end of RT/CRT and 3 months post-RT/CRT significantly differed according to risk and treatment groups (all P.05). Treatment intensity was independently associated with 3-month PEG status while adjusting for risk group (P = .002). The CRT75 group had a median -8.42% change from baseline BMI at 1 year post-RT/CRT versus -2.54% for the RT50/CRT45 group (P = .01). At the end of RT/CRT, CRT75 patients were less likely to tolerate a normal diet, more likely to have swallowing performance status scale scores ≥4, more likely to have Rosenbek's penetration-aspiration scores ≥7, more likely to have developed trismus, and more likely to require narcotics2 months (all P.05).Induction chemotherapy followed by risk- and response-adapted dose and volume de-escalated RT/CRT is associated with clinically meaningful functional outcomes including (1) improved swallowing function, (2) higher BMI, and (3) shorter narcotic use for patients receiving de-escalation.

Background/Context Teachers can help ensure trans and gender-creative students’ opportunity for, and equal access to, education, yet the field of educational research has just begun to explore how teachers understand trans and gender-creative students’ experiences and negotiate their responsibilities to protect these students’ rights. Purpose/Objective/Research Question/Focus of Study This article aims to address this essential gap by exploring preservice teachers (PSTs’) understandings of, and preparation for, creating supportive educational contexts for trans and gender-creative students, guided by the following research question: How do PSTs construct their responsibilities as future teachers to support trans and gender-creative students? Ultimately, this study aims to inform the development of effective teacher education curricula and related policy on trans and gender-creative identities. Participants Participants were 183 undergraduate preservice teachers enrolled in 10 sections of an educational equity course. Research Design We conducted a qualitative, inductive, thematic online discourse analysis. Using a queer, social justice teacher education framework, we qualitatively analyzed 549 online PST-authored posts. Findings/Results Three themes emerged: (1) PSTs voiced discomfort negotiating conflicting values and roles in supporting trans and gender-creative students, and PSTs suggested (2) individualized, differentiated interventions, and (3) community education approaches to promote comfort for trans and gender-creative students—strategies that may reinscribe normative, institutionalized views of gender identity. Conclusions/Recommendations Findings suggest the pressing need for innovative teacher education on gender identity and fluidity: PSTs need more opportunities to learn about supporting trans and gender-creative students, to critically consider constructs of gender and sexuality, and to explore how systemic gender oppression intersects with other forms of oppression through schooling practices.

Granular cell tumors (GCT) are rare tumors that most frequently present in the oral cavity. While some present within the gastrointestinal tract, a GCT near the trachea is an extremely rare occurence.A 42-year-old man presented to the Emergency Department after a motor vehicle accident. A computerized tomography (CT) scan revealed an incidental soft tissue 3.2 × 5.5 cm mass anterior to the esophagus and posterior to the trachea with no adjacent lymphadenopathy. The patient denied dyspnea, voice changes, or dysphagia. Due to its size and location, the patient underwent a transcervical excision of the retrotracheal tumor. Tumor cells were positive for CD68, CD163, S100, and SOX10, confirming a GCT.This is a distinctive presentation of a large (5 cm) GCT in the plane between the trachea and esophagus. GCTs are not often on the differential diagnosis of masses that present in this region.

Background: The standard of care for T4 laryngeal cancer patients (pts) includes surgical resection followed by adjuvant radiation (RT) with or without chemotherapy (CRT). Our institution has experience with organ preservation (OP) for this population. This study assessed racial differences in survival outcomes of T4 larynx cancer pts pursuing OP.Method: T4 larynx pts at our institution who received definitive CRT were identified from January 1990 to December 2019. Race was self-reported. CRT consisted of 4-6 alternating weekly cycles of paclitaxel (100mg/m2 on d1), infusion 5-fluorouracil (600mg/m2/d on d1-5), hydroxyurea (500mg PO BID), and either 2 Gy daily or 1.5 Gy twice-daily RT (TFHX). Clinicodemographic characteristics: age at diagnosis, sex, diagnosis period (10-year), nodal stage, tracheostomy or g-tube use, chemotherapy, RT dose or fractionation, and clinical trial enrollment were compared using Student’s t, X2, or Fisher’s exact tests. The Kaplan-Meier method was used to estimate 2- and 5-year distant metastasis-free survival (DMFS), overall survival (OS), and laryngectomy free-survival (LFFS), overall and by race. Multivariable Cox proportional hazards were modeled for survival outcomes between Black and White pts to report adjusted hazard ratios (aHR) and 95% confidence intervals (CI).Results: Of 104 pts, 45% were Black, 55% were White, mean age at diagnosis was 60 (SD 10) years, 66% were male, and median follow-up time was 52 (IQR: 24-99) months. The rate of Black pts decreased from 71% (1990-1999), 54% (2000-2009) to 28% (2010-2019). 64% of Black pts enrolled in a clinical trial compared to 51% of White pts. A higher rate of Black pts required tracheostomy before treatment than White pts (87% vs. 47%, p Citation Format: Jared H. Hara, Jason Q. Freeman, Sara E. Kochanny, Naomi S. Ecanow, Ari J. Rosenberg, Alexander T. Pearson, Zhen Gooi, Brandon J. Baird, Elizabeth A. Blair, Nishant Agrawal, Everett E. Vokes, Daniel J. Haraf, Aditya Juloori. Racial differences in organ preservation with definitive chemoradiotherapy among patients with T4 laryngeal squamous cell carcinoma [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A085.

This essay explores the implications of new managerialist policies entwined with right-wing ideological challenges for social justice teaching in higher education. We engage with reflexive memos of...

Summary Background Primary analyses of the SWORD-1 and SWORD-2 trials at 48 weeks showed that switching to a two-drug regimen of dolutegravir plus rilpivirine was non-inferior to continuing a standard three-drug or four-drug antiretroviral regimen for maintenance of virological suppression in people with HIV-1. Here, we present efficacy and safety data from the 100-week analysis of the trials. Methods SWORD-1 and SWORD-2 are identically designed, randomised, open-label phase 3 studies at 65 centres in 13 countries and 60 centres in 11 countries, respectively. Adults aged 18 years or older who were on a standard three-drug or four-drug antiretroviral therapy (ART) and had had fewer than 50 HIV-1 RNA copies per mL of plasma for at least 6 months were randomly assigned (1:1) to 50 mg dolutegravir plus 25 mg rilpivirine orally once daily (early-switch group) or to continue their standard regimen for 52 weeks before switching to the dolutegravir plus rilpivirine combination (ie, the late-switch group). In this analysis of week 100 data, the efficacy endpoint of interest was the proportion of participants with fewer than 50 copies of HIV-1 RNA per mL of plasma (per the US Food and Drug Administration snapshot algorithm). This outcome was assessed in all randomly assigned participants who received at least one dose of the study drug. Data were analysed after the last participant completed week 100 (Sept 15, 2017) and verified through the data cutoff (Nov 21, 2017). SWORD-1 and SWORD-2 are registered with ClinicalTrials.gov, numbers NCT02429791 and NCT02422797, respectively. Findings 513 participants were randomly assigned to dolutegravir plus rilpivirine (ie, the early-switch group) and 511 to continue their standard ART regimen, 477 of whom then switched to dolutegravir plus rilpivirine at week 52 (ie, the late-switch group). At week 100, 456 (89% [95% CI 86–92]) of 513 participants in the early-switch group and 444 (93% [91–95]) of 477 in the late-switch group had fewer than 50 HIV-1 RNA copies per mL. Drug-related adverse events occurred in 103 (20%) participants in the early-switch group and 58 (12%) in the late-switch group. The most common drug-related adverse events were headache (11 participants in the early-switch group [2%] vs eight [2%] in the late-switch group) and nausea (eight [2%] vs five [1%]). Interpretation The combination of dolutegravir plus rilpivirine sustained virological suppression of HIV-1, was associated with a low frequency of virological failure, and had a favourable safety profile, which support its use as a nucleoside reverse transcriptase inhibitor-sparing and protease inhibitor-sparing alternative to three-drug regimens that reduces overall exposure to ART. Funding ViiV Healthcare and Janssen Pharmaceutica.

6075 Background: Blockade of the PD-1/PD-L1 immune checkpoint improves survival in recurrent/metastatic head and neck cancer. PD-L1 expression is a biomarker that enriches for clinical benefit with anti-PD-1 therapy alone or in combination with chemotherapy in this setting. The role of PD-L1 expression as a predictive biomarker in locoregional human papillomavirus associated (HPV+) head and neck cancer (HNC) treated with induction nivolumab-based chemoimmunotherapy is unknown. We evaluate PD-L1 expression and response to induction chemoimmunotherapy in the context of an investigator initiated trial, OPTIMA II. Methods: Patients with locoregionally advanced HPV+ HNC were enrolled to the prospective OPTIMA II study evaluating induction chemoimmunotherapy followed by response adaptive de-escalated locoregional therapy. Induction therapy consisted of nivolumab, nab-paclitaxel, and carboplatin, for three cycles. Anatomic imaging of the head and neck with either CT or MRI was obtained at baseline and following induction therapy. Expression of PD-L1 was assessed by immunohistochemistry on baseline biopsies and calculation of tumor proportion score (TPS) and combined positive score (CPS) was performed. Response is defined as percentage of tumor shrinkage per RECIST 1.1 criteria. Deep response rate is defined as the proportion of patients with > = 50% tumor shrinkage. Kruskal-Wallis and Mann-Whitney tests were used for analysis. Results: Twenty-nine patients (pts) underwent evaluation of PD-L1 expression and started treatment with induction chemoimmunotherapy. Median age 61 (range 37-81), smoker > 20 pack years in 24%, tonsil primary in 79%, and HPV16 subtype in 97%. The median response following induction was 63% (range 29% to 100%). PD-L1 TPS scores were < 1, 1-19, and > = 20 in 28%, 34%, and 38% respectively. PD-L1 CPS scores were < 20 and > = 20 in 55% and 45% respectively. Median response among PD-L1 TPS of < 1, 1-19, and > = 20 was 49%, 59%, and 66% respectively (p = 0.16). Among PD-L1 CPS of < 20 and > = 20, median response was 57% and 69% respectively (p = 0.11). The deep response rate among PD-L1 CPS < 20 and > = 20 was 69% and 77% respectively. Conclusions: Deep responses were observed following induction chemoimmunotherapy in locoregionally advanced HPV+ HNC. There was a non-significant increase in median response and deep response rate with higher expression of PD-L1. Evaluation of PD-L1 expression as a biomarker for response with induction chemoimmunotherapy is worthy of further investigation in locoregional HPV+ disease. Clinical trial information: NCT03107182.

Objectives Research has associated both school night sleep duration (SNSD) and circadian preference (CP) with middle school-aged students’ attendance and tardiness, but the interaction between these characteristics remains unexplored within this context, along with the impact of SNSD and CP on school suspension likelihood. Thus, this study investigated associations between SNSD, CP, and their interaction with middle school-aged student attendance, tardiness, and suspension, while accounting for sociodemographic characteristics. Participants About 4175 students from 12 middle schools in the Madison, Wisconsin, Metropolitan School District. Methods Students completed a computer-based, sleep-related survey during class. Students reporting SNSD between 4 and 12 hours were included in the final analytical sample (N = 3860; mean age ± standard deviation = 12.0 ± 0.86 years; range = 10-16 years). CP was characterized using the single-item self-morningness/eveningness question. Linear mixed-effects regression estimated associations of SNSD and CP with tardiness and attendance. Logistic mixed-effects regression assessed associations with school suspension. Fully adjusted multilevel models included sociodemographic covariates, nesting students within schools. Results About 3860 student responses comprised the final sample, which had a SNSD of 8.15 ± 1.37 hours and general eveningness preference. Short-and-long SNSD associated with lower attendance and increased out-of-school suspension. Greater eveningness preference was negatively associated with attendance and tardiness. No SNSD and CP interactions emerged. Associations between sociodemographic characteristics and attendance, tardiness, and suspension were observed. Conclusions Results support need for efforts to improve middle school-aged student sleep health and account for eveningness preference. Research clarifying the interactive influence of sleep, circadian, and sociodemographic characteristics on attendance and achievement is warranted.

Background and Aim Retrospective analysis of the utility of adjuvant radiation (RT) or chemoradiation (CRT) and identify prognostic features for patients with high‐risk head and neck salivary gland cancers. Methods From 1/1997 to 12/2017, 108 patients underwent surgery, and RT (n = 50) or CRT (n = 58) for positive lymph node(s), extracapsular extension, perineural invasion, lymphovascular space invasion, positive/close margin, and/or grade 3 disease. Outcomes were estimated with the Kaplan‐Meier method. Significant predictors identified through regression analyses were incorporated into multivariable regression (MVA). Toxicities were compared using chi‐square. Results The median follow‐up was 52 months (range: 3‐226). The number of risk factors (RFs) between RT and CRT groups were: 0 to 1 (44% vs 7%), 2 to 3 (48% vs 41%), or 4 to 6 (8% vs 52%), respectively (P

One in 30 American children experience homelessness, and yet educators are often unaware of the challenges these students face. Drawing on a qualitative study of 21 pre-service teachers (PSTs) interviewed at the completion of their early childhood/ESL teacher education program, the overall purpose of this study was to ascertain PSTs’ reported attitudes, beliefs, knowledge, and self-identified skills for working with young homeless children in schools with the goal of identifying opportunities for teacher education programs to better prepare PSTs for work with children experiencing homelessness. Findings suggest that PSTs enter teacher preparation with many misconceptions about children and families experiencing homelessness. Incorporating specific information about homelessness into coursework and supervision, nurturing PSTs’ capacity for critical self-reflection, and creating opportunities for PSTs to develop positive teacher–student relationships with children experiencing homelessness were identified as essential in fostering PST self-efficacy, and, by extension, the resilience of homeless children. By illuminating the processes through which PSTs make sense of children’s experiences of homelessness and its impacts on schooling, these findings have important implications for the education of young children and the design of professional development opportunities and structured learning for preservice teachers.

Aneurysmal bone cysts (ABCs) are benign lesions which most frequently occur in the long bones of pediatric patients. Long thought to be reactive, recent molecular advances have demonstrated that the majority of primary ABCs harbor rearrangements of the USP6 gene, confirming their neoplastic nature. Secondary ABCs arising from other lesions do not demonstrate this recurrent genetic anomaly. ABCs rarely occur in the craniofacial bones, and sinonasal ABCs are exceedingly rare. We report a case of a primary ABC arising the maxillary sinus of a 14-year-old female, which was found to harbor USP6 rearrangement. We describe the clinical, radiologic, and pathologic features of this case, and review the current literature on craniofacial ABCs. Careful histologic evaluation and genetic studies are warranted in order to confirm the rare occurrence of a primary sinonasal ABC.

Objectives Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. Materials and Methods Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. Results 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. Conclusion Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.

Background Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (OPC) led to investigation of response-adaptive de-escalation, yet long-term outcomes are unknown. We present expanded experience and follow-up of risk/response adaptive treatment de-intensification in HPV+ OPC. Methods A phase 2 trial (OPTIMA) and subsequent cohort of sequential off-protocol patients treated from September 2014 to November 2018 at the University of Chicago were reviewed. Eligible patients had T3-T4 or N2-3 (AJCC 7th edition) HPV+ OPC. Patients were stratified by risk: High-risk (HR) (T4, ≥N2c, or >10PYH), all others low-risk (LR). Induction chemotherapy (IC) included 3 cycles of carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (off-protocol). LR with ≥50% response received low-dose radiotherapy (RT) alone to 50 Gy (RT50). LR with 30–50% response and HR with ≥50% response received intermediate-dose chemoradiotherapy (CRT) to 45 Gy (CRT45). All others received full-dose CRT to 75 Gy (CRT75). Results 91 patients consented and 90 patients were treated, of which 31% had >10PYH, 34% had T3/4 disease, and 94% had N2b/N2c/N3 disease. 49% were LR and 51% were HR. Overall response rate to induction was 88%. De-escalated treatment was administered to 83%. Median follow-up was 4.2 years. Five-year OS, PFS, LRC, and DC were 90% (95% CI 81,95), 90% (95% CI 80,95), 96% (95% CI 90,99), and 96% (88,99) respectively. G-tube placement rates in RT50, CRT45, and CRT75 were 3%, 33%, and 80% respectively (p Conclusion Risk/response adaptive de-escalated treatment for an inclusive cohort of HPV+ OPC demonstrates excellent survival with reduced toxicity with long-term follow-up.

Histologically benign airway strictures are frequently misdiagnosed as asthma or COPD and may present with severe symptoms including respiratory failure. A clear understanding of pathophysiology and existing classification systems is needed to determine the appropriate treatment options and predict clinical course. Clinically significant airway strictures can involve the upper and central airways extending from the subglottis to the lobar airways. Optimal evaluation includes a proper history and physical examination, neck and chest computed tomography, pulmonary function testing, endoscopy and serology. Available treatments include medical therapy, endoscopic procedures and open surgery which are based on the stricture's extent, location, etiology, morphology, severity of airway narrowing and patient's functional status. The acuity of the process, patient's co-morbidities and operability at the time of evaluation determine the need for open surgical or endoscopic interventions. The optimal management of patients with benign airway strictures requires the availability, expertise and collaboration of otolaryngologists, thoracic surgeons and interventional pulmonologists. Multidisciplinary airway teams can facilitate accurate diagnosis, guide management and avoid unnecessary procedures that could potentially worsen the extent of the disease or clinical course. Implementation of a complex airway program including multidisciplinary clinics and conferences ensures that such collaboration leads to timely, patient-centered and evidence-based interventions. In this article we outline algorithms of care and illustrate therapeutic techniques based on published evidence.

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.

Background. Salivary gland secretory carcinoma is usually a low-grade neoplasm. However, high-grade transformation can occur and has important implications for clinical outcome. Methods. A patient presented with an enlarging buccal mass. Magnetic resonance imaging (MRI) showed a tumor with a biphasic appearance along the right parotid duct. Local excision and histopathologic examination confirmed the diagnosis of secretory carcinoma with high-grade transformation. ETV6-NTRK3 translocation and loss of CDKN2A/B were identified. Results. The patient subsequently presented with cough and dyspnea and was found to have pleural metastases. Carboplatin and paclitaxel exacerbated the symptoms. Crizotinib resulted in initial symptomatic and radiographic improvement; however, the patient soon succumbed to progressive intrathoracic disease. Conclusions. High-grade salivary gland secretory carcinoma can have a biphasic appearance on MRI. Diagnosis is confirmed by the histologic appearance and associated ETV6-NTRK3 fusion. Additional molecular genetic events leading to transformation are unknown; however, loss of CDKN2A/B may have contributed. Treatment with multimodal chemotherapy was of limited benefit.

Introduction Sleep and circadian factors play an important role in school attendance, academic performance, and daytime behaviors among adolescents. This investigation assessed school night sleep duration (SNSD) and circadian preference (CP) association with first period tardies (FPT) using a middle-aged sample from the Madison (Wisconsin) Metropolitan School District (MMSD), prior to implementation of a planned district-wide delay in middle school start times. Methods 4,175 middle-school aged students from 12 MMSD schools completed a sleep survey, which included SNSD and a validated 4-level measure of CP. Self-reported SNSD between 4-and-12 hours served as final sample inclusion criterion. Mixed effects modeling was employed with students nested within school. Linear regression determined SNSD and CP effect on student tardiness. Individual, year-long FPT served as outcome variable. Inclusion of SNSD quadratic term was not statistically indicated. Full model covariates included age, sex, race, parent educational level, homelessness, free and reduced lunch, and special education status. Results Final sample included 3,860 students. Univariate regression determined a significant CP association with FPT [β=1.20, 95% CI (0.54, 1.86), F(1,10.41)=13.7, p=0.004), but not SNSD [β=-0.31, 95% CI (-0.70, -0.09), F(1,10.21)=2.5, p=0.14]. SNSD and CP interaction was not significant. CP significance was maintained in the full model [β=1.24, 95% CI (-0.70, -0.09), F(1,11.21)=13.7, p=0.004]. Evening preference associated with 3.72 more FPT, relative to morning preference. Conclusion Results suggest evening preference is associated with increased risk of tardiness among middle school students. Future research that examines the relationships between delayed school start times, circadian preference, and impact on school tardiness is indicated. Support This research was generously supported by a grant from the Madison Education Partnership (MEP).

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy, but categorization is complicated by variability in grading systems and uncertain prognostic significance of MAML2 rearrangement. The aims of this study were to determine the prognostic significance of MEC grading systems and MAML2 rearrangement status. Fifty-three carcinomas originally diagnosed as MEC (45 primary; 8 recurrent) of major and minor salivary glands were graded according to modified Healey, Brandwein, AFIP, and Katabi systems. Fluorescence in-situ hybridization for MAML2 rearrangement was performed. Clinical features and outcomes were recorded. Twenty-five (47%) carcinomas scored the same in all grading systems. The most common histologic feature leading to a diagnosis of intermediate grade was isolated solid growth. Brandwein assigned the highest percentage of high grade (29%) and AFIP the highest percentage of low grade (80%). MAML2 was rearranged in 37/46 (80%) cases. Forty-three (81%) were morphologically compatible with MEC, and these were more likely to be low-intermediate grade and MAML2-rearranged. Of primary carcinomas, 6 (13%) recurred. Statistically significant univariate risk factors for recurrence included non-MEC morphology, stage T4, and high Brandwein grade. Margin status, MAML2 rearrangement, and isolated solid growth were not predictive of recurrence. A binary grading system (Brandwein high versus low-plus-intermediate) could be considered to better reflect biologic behavior in MEC. Our study confirms that MAML2 wildtype tumors more likely represent high grade non-MECs, and prior studies demonstrating worse prognosis in MAML2-non-rearranged MECs may be diluted by high grade non-MECs.

WHIM syndrome (warts, hypogammaglobulinemia, infections, and myelokathexis), a primary immunodeficiency disorder involving panleukopenia, is caused by autosomal dominant gain-of-function mutations in CXC chemokine receptor 4 (CXCR4). Myelokathexis is neutropenia caused by neutrophil retention in bone marrow. Patients with WHIM syndrome are often treated with granulocyte colony-stimulating factor (G-CSF), which can increase neutrophil counts but does not affect cytopenias other than neutropenia. In this investigator-initiated, open-label study, three severely affected patients with WHIM syndrome who could not receive G-CSF were treated with low-dose plerixafor, a CXCR4 antagonist, for 19 to 52 months. Myelofibrosis, panleukopenia, anemia, and thrombocytopenia were ameliorated, the wart burden and frequency of infection declined, human papillomavirus-associated oropharyngeal squamous-cell carcinoma stabilized, and quality of life improved markedly. Adverse events were mainly infections attributable to the underlying immunodeficiency. One patient died from complications of elective reconstructive surgery. (Funded by the National Institutes of Health.).

6011 Background: Despite the success of anti-PD-1 in recurrent/metastatic head and neck cancer, incorporation in the curative setting with induction therapy has yet to be investigated. Favorable prognosis of human papillomavirus associated (HPV+) oropharyngeal cancer (OPC) has led to interest in treatment de-escalation. OPTIMA 2 evaluated nivolumab (nivo) with nab-paclitaxel and carboplatin followed by risk/response adaptive de-intensified treatment for locoregionally advanced HPV+ OPC. We report the primary analysis and outcomes. Methods: OPTIMA 2 enrolled locoregionally advanced HPV+ OPC. Nivo, nab-paclitaxel, and carboplatin were administered for 3 cycles. High-risk (HR) included any of the following: T4, N2c-N3 (AJCC 7th edition), > 20 pack year smoking history, non-HPV16 subtype; All others were low-risk (LR). Arm A included LR with ≥50% post-induction shrinkage by RECIST received single-modality de-escalation with low-dose radiation (RT) alone (50 Gy) or transoral robotic surgery (TORS). Arm B included HR with ≥50% shrinkage or LR with

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for the management of nasopharyngeal cancer are reviewed here in a systematic fashion. These guidelines outline the workup, treatment and surveillance of patients with nasopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck 39: 201-205, 2017.

The role of cetuximab in the treatment of locoregionally advanced head and neck squamous cell cancer (LA-HNSCC) remains poorly defined. In this phase 2 randomized study, we investigated the addition of cetuximab to both induction chemotherapy (IC) and hyperfractionated or accelerated chemoradiation.Patients with LA-HNSCC were randomized to receive 2 cycles of weekly IC (cetuximab, paclitaxel, carboplatin) and either Cetux-FHX (concurrent cetuximab, 5-fluorouracil, hydroxyurea, and 1.5 Gy twice-daily radiation therapy every other week to 75 Gy) or Cetux-PX (cetuximab, cisplatin, and accelerated radiation therapy with delayed concomitant boost to 72 Gy in 42 fractions). The primary endpoint was progression-free survival (PFS), with superiority compared with historical control achieved if either arm had 2-year PFS ≥70%.110 patients were randomly assigned to either Cetux-FHX (n=57) or Cetux-PX (n=53). The overall response rate to IC was 91%. Severe toxicity on IC was limited to rash (23% grade ≥3) and myelosuppression (38% grade ≥3 neutropenia). The 2-year rates of PFS for both Cetux-FHX (82.5%) and Cetux-PX (84.9%) were significantly higher than for historical control (P.001). The 2-year overall survival (OS) was 91.2% for Cetux-FHX and 94.3% for Cetux-PX. With a median follow-up time of 72 months, there were no significant differences in PFS (P=.35) or OS (P=.15) between the treatment arms. The late outcomes for the entire cohort included 5-year PFS, OS, locoregional failure, and distant metastasis rates of 74.1%, 80.3%, 15.7%, and 7.4%, respectively. The 5-year PFS and OS were 84.4% and 91.3%, respectively, among human papillomavirus (HPV)-positive patients and 65.9% and 72.5%, respectively, among HPV-negative patients.The addition of cetuximab to IC and chemoradiation was tolerable and produced long-term control of LA-HNSCC, particularly among poor-prognosis HPV-negative patients. Further investigation of cetuximab may be warranted in the neoadjuvant setting and with non-platinum-based chemoradiation.

Past research suggests that undergraduate women have faced educational cultures in which their college experience is defined through romantic experiences. This study expands this literature by investigating how heightened achievement expectations for undergraduate women inform their broader conceptions of intimate relationships, by asking the following research question: how do high-achieving undergraduate women conceptualise intimate relationships? Through qualitative analysis of 76 semi-structured interviews, I find that study participants reject gendered narratives of romance and instead preserve their achievement by constructing two ideal relationship logics: independent and companionate logics. I suggest that participants’ conceptions of relationships have undergone a notable inversion: students’ constructions of positive intimate relationships centre on the maintenance of academic achievement and autonomy, and show the long reach of neoliberal, ‘post-feminist’ ideologies into women’s everyda...

6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a favorable prognosis, but standard multimodality treatment is associated with substantial treatment related toxicity. A de-escalation treatment paradigm that optimizes oncologic outcomes while reducing toxicity is needed. We sought to further expound on our published OPTIMA data with long-term follow-up and additional pts subsequently treated using the OPTIMA treatment paradigm. Methods: Long-term follow-up of our institutional de-escalation OPTIMA trial (NCT02258659) and retrospective review of additional patients treated subsequently per OPTIMA outline was performed. Pts were classified as low-risk (LR) (≤T3, ≤N2B, ≤10PYH) or high-risk (HR) (T4, ≥N2c, > 10PYH). Pts received induction chemotherapy (IC) of 3 cycles of dose dense carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (subsequently treated). LR with ≥50% response received low-dose radiotherapy (RT) to 50 Gy. LR with 30-50% response or HR with ≥50% response received intermediate-dose chemoradiotherapy (CRT) to 45Gy. All others received full-dose CRT to 75Gy. Results: 108 pts consented and 107 were treated (61 on study; 46 subsequently) from October 2014 through November 2019. 1 pt transferred care post-enrollment. Median follow-up was 36 months (interquartile range 17-45). Median age was 63 years (range 33-84) and 95% were male. 47% were LR and 53% were HR. ≥50% tumor shrinkage occurred in 78/107 (73%) of pts overall, and 37/51 (73%) among LR; 41/56 (73%) among HR. 82% of pts received de-escalated (C)RT. Overall, 94% of pts were alive at last follow-up (98% LR; 89% HR). 3 pts (2 HR and 1 LR) developed disease recurrence (2.7%), with 2 local recurrences and 1 distant recurrence. Likelihood of G-tube placement was 3% in low-dose RT, 35% in intermediate-dose CRT, and 84% in full-dose CRT. Conclusions: IC followed by risk-adapted dose and volume de-escalated treatment for HPV+ oropharyngeal cancer demonstrates excellent oncologic and functional outcomes with long-term follow-up. Supported by Celgene, Alinea benefit supported by Grant Achatz/Nick Kokonas, and National Cancer Institute of the National Institutes of Health (NIH) through Grant Number P30 CA14599. Clinical trial information: NCT02258659 .

Introduction Sleep plays an important role in adolescent education and development. Sleep impacts student school attendance, academic performance, and daytime behaviors. There has been limited investigation into the impact on sleep duration (SD) on school suspension risk. Given the growing public health and policy focus on altering school start times to increase SD, this study assessed SD association with school suspension risk using a middle-school aged sample from the Madison (Wisconsin) Metropolitan School District (MMSD), prior to implementation of a planned district-wide delay in middle school start times. Methods 4,175 middle-school aged students from 12 MMSD schools completed a sleep survey, which included school-night SD (SNSD). Self-reported SNSD between 4-and-12 hours served as criterion for inclusion in final sample. Mixed effects modeling was employed with students nested within school. Logistic regression determined SNSD association with in-school (ISS) and out-of-school (OSS) suspensions. ISS and OSS were dichotomized (No ISS/OSS = 0; nonzero ISS/OSS = 1) to serve as outcome variables. Full model covariates included age, sex, race, circadian preference, parent educational level, homelessness, free and reduced lunch, and special education status. Results Final sample included 3,860 students. Shorter SNSD associated with greater likelihood of OSS [OR = 0.83, 95% CI (-0.28, -0.09), X2 = 16.1, p < 0.0001], but not ISS [OR = 0.97, 95% CI (-0.14, -0.070), X2 = 0.44, p = 0.51]. Significance between SNSD and OSS was maintained in the full model [OR = 0.84, 95% CI (-0.27, -0.08), X2 = 13.2, p = 0.0003]. Each additional hour of sleep associated with 16% lower risk of OSS. Conclusion These results suggest that students with shorter SD are at increased risk for OSS, which further highlights the potential deleterious impact of short SD on adolescent educational experience. Support This research was generously supported by a grant from the Madison Education Partnership (MEP).

There are many types of cutaneous malignant neoplasms and associated conditions that can involve the head and neck regions. This chapter reviews the characteristic clinicopathological and imaging findings of basal cell carcinoma, squamous cell carcinoma, melanoma, cutaneous lymphomas, dermatofibrosarcoma protuberans, Kaposi sarcoma, Merkel cell carcinoma, microcystic adnexal carcinoma, sebaceous carcinoma, adenoid cystic carcinoma, angiosarcoma, and metastases.

Background Patients with HPV+ oropharyngeal squamous cell carcinoma were assigned to dose and volume de-escalated radiotherapy (RT) or chemoradiotherapy (CRT) based on response to induction chemotherapy in an effort to limit treatment-related toxicity while preserving efficacy. Patients and methods Patients were classified as low-risk (≤T3, ≤N2B, ≤10 pack-year history) or high-risk (T4 or ≥N2C or >10 PYH). After three cycles of carboplatin/nab-paclitaxel, response was assessed using Response Evaluation Criteria in Solid Tumors 1.1. Low-risk patients with ≥50% response received 50 Gray (Gy) RT (RT50) while low-risk patients with 30%–50% response or high-risk patients with ≥50% response received 45 Gy CRT (CRT45). Patients with lesser response received standard-of-care 75 Gy CRT (CRT75). RT/CRT was limited to the first echelon of uninvolved nodes. The primary end point was 2-year progression-free survival compared with a historic control of 85%. Secondary end points included overall survival and toxicity. Results Sixty-two patients (28 low risk/34 high risk) were enrolled. Of low-risk patients, 71% received RT50 while 21% received CRT45. Of high-risk patients, 71% received CRT45. With a median follow-up of 29 months, 2-year PFS and OS were 95% and 100% for low-risk patients and 94% and 97% for high-risk patients, respectively. The overall 2-year PFS was 94.5% and within the 11% noninferiority margin for the historic control. Grade 3+ mucositis occurred in 30%, 63%, and 91% of the RT50, CRT45, and CRT75 groups, respectively (P = 0.004). Rates of any PEG-tube use were 0%, 31%, and 82% for RT50, CRT45, and CRT75 groups, respectively (P Conclusions Induction chemotherapy with response and risk-stratified dose and volume de-escalated RT/CRT for HPV+ OPSCC is associated with favorable oncologic outcomes and reduced acute and chronic toxicity. Further evaluation of induction-based de-escalation in large multicenter studies is justified. Clinical trial registration Clinical trials.gov identifier: NCT02258659.

Background Lifelong HIV antiretroviral therapy (ART) has prompted an interest in two-drug regimens to minimise cumulative drug exposure and toxicities. The safety, tolerability, and efficacy of dolutegravir and rilpivirine suggest potential compatibility and effectiveness as a two-drug regimen. We aimed to investigate this two-drug regimen in a phase 3 study. Methods We identically designed SWORD-1 and SWORD-2, which were open-label, parallel-group, multicentre, phase 3, randomised, non-inferiority studies in 12 countries evaluating efficacy and safety of once-daily dolutegravir 50 mg plus rilpivirine 25 mg versus current ART regimen (CAR). We included participants aged 18 years or older who were on first or second ART with stable plasma HIV-1 RNA (viral load

Background: Discharge anticoagulation counseling is important for ensuring patient comprehension and optimizing clinical outcomes. As pharmacy resources become increasingly limited, the impact of informational videos on the counseling process becomes more relevant. Objective: To evaluate differences in pharmacist time spent counseling and patient comprehension (measured by the Oral Anticoagulation Knowledge [OAK] test) between informational videos and traditional face-to-face (oral) counseling. Methods: This prospective, open, parallel-group study at an academic medical center randomized 40 individuals—17 warfarin-naïve (“New Start”) and 23 with prior warfarin use (“Restart”)—to receive warfarin discharge education by video or face-to-face counseling. “Teach-back” questions were used in both groups. Results: Although overall pharmacist time was reduced in the video counseling group ( P < 0.001), an interaction between prior warfarin use and counseling method ( P = 0.012) suggests the difference between counseling methods was smaller in New Start participants. Following adjustment, mean total time was reduced 8.71 (95% CI = 5.15-12.26) minutes (adjusted P < 0.001) in Restart participants and 2.31 (−2.19 to 6.81) minutes (adjusted P = 0.472) in New Start participants receiving video counseling. Postcounseling OAK test scores did not differ. Age, gender, socioeconomic status, and years of education were not predictive of total time or OAK test score. Conclusion: Use of informational videos coupled with teach-back questions significantly reduced pharmacist time spent on anticoagulation counseling without compromising short-term patient comprehension, primarily in patients with prior warfarin use. Study results demonstrate that video technology provides an efficient method of anticoagulation counseling while achieving similar comprehension.

Background Oral cavity squamous cell carcinoma (SCC) arising in nonsmokers and nondrinkers remains poorly characterized. We hypothesized that these patients had prior exposure to metallic dental hardware. Methods We utilized a questionnaire querying the lifetime oral health status of 54 patients. Demographics and extensive oral health history were collected. Results The majority of patients (74%) had prior exposure to metallic dental hardware. The younger population with almost exclusively oral tongue cancer had a high prevalence of metallic orthodontic braces (40%) within 15 years before diagnosis. In the 51+ year age group, 82% had crowns, dental implants, and/or dentures with metallic elements. Conclusion Exposure to metallic dental hardware has increased in the past few decades given the rise of orthodontic braces and older adults retaining more teeth. Although this study does not prove a causal relationship between oral cavity SCC and dental hardware, this is a step toward identifying and investigating their role.

Over the last several years, teams that collaborate across geographic, temporal and cultural boundaries are becoming common in the modern workplace. While these “distributed teams” provide organizations with numerous benefits from an operational and cost standpoint, there are still numerous challenges associated with them. One such issue that has yet to be explored is how well-known cognitive biases may impact distributed decision making. In this paper, we present an initial exploration of confirmation bias and its propagation in distributed team collaborations. Using the ELICIT task environment, we manipulated the order of information provided to teams. Our hypothesis was that serial order would influence the significance teams placed on information, such that they would overweigh incorrect information presented early in the task, thus inducing a team cognitive bias. Our results conformed to that hypothesis, i.e., when incorrect information was presented early, teams appeared to apply greater focus on that information in subsequent discussions, and they reported incorrect answers more often, suggesting the influence of a confirmation bias in their deliberations. These results highlight the need for continued research on team cognition and team cognitive biases, particularly in complex, distributed environments.

Effective communication is critical to successfully carrying out a task, especially in military operations. Real-time planning, coordination, and directives must be transmitted to operators in order to properly execute their mission. To improve our warfighter’s communication effectiveness, researchers in the Air Force Research Laboratory have developed a network-centric multi-modal communication monitoring suite. Past studies have shown an advantage of this tool compared to traditional radio and chat tools. However studies have also shown that multimodal displays do not always outperform single modality displays, especially in multi-tasking environments. This study evaluated the effectiveness of the Air Force developed multimodal communication suite compared to radio and chat only displays during a multi-tasking communication monitoring and compensatory tracking task. Results indicated that the multimodal display offers the best of both worlds, in that access to the suite provided superior performance to the radio display for communication monitoring and to the chat display for the tracking task. This evaluation aids in the testing and development of the newly developed multimodal communication management suite.

Research suggests that teachers are not meeting the needs of trans and gender creative students. Thus, we ask: How do US preservice teachers (PSTs) discursively construct the experiences of trans and gender creative students? How are these constructions informed by and reinscribe broader gender normativities in educational contexts? We analyzed 549 PST authored, online discussion posts from an educational foundations course, finding PSTs lacked familiarity with, and engaged in rhetorical distancing from, trans and gender creative student experiencessuggesting barriers to empathy that may obstruct teacher-student relationships and promotion of equity, which teacher education is called to address.