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Ensuring high quality, evidence-based radiation therapy for patients with cancer is of the upmost importance. To address this need, the Veterans Affairs (VA) Radiation Oncology Program partnered with the American Society for Radiation Oncology and established the VA Radiation Oncology Quality Surveillance program. As part of this ongoing effort to provide the highest quality of care for patients with rectal cancer, a blue-ribbon panel comprised of rectal cancer experts was formed to develop clinical quality measures.The Rectal Cancer Blue Ribbon panel developed quality, surveillance, and aspirational measures for (a) initial consultation and workup, (b) simulation, treatment planning, and treatment, and (c) follow-up. Twenty-two rectal cancer specific measures were developed (19 quality, 1 aspirational, and 2 surveillance). In addition, dose-volume histogram constraints for conventional and hypofractionated radiation therapy were created.The quality measures and dose-volume histogram for rectal cancer serves as a guideline to assess the quality of care for patients with rectal cancer receiving radiation therapy. These quality measures will be used for quality surveillance for veterans receiving care both inside and outside the VA system to improve the quality of care for these patients.

Total neoadjuvant therapy in rectal cancer may increase pathological complete response rates potentially allowing for a nonoperative approach.The objective was to identify patient and tumor characteristics that predict a complete response following total neoadjuvant therapy.This was a retrospective cohort study.This study was conducted at a university-based National Cancer Institute-designated Comprehensive Cancer Center.The patients include those with Stage 2 or 3 rectal adenocarcinoma.Total neoadjuvant therapy, total mesorectal excision, nonoperative management.Complete response was defined as patients with a clinical complete response undergoing non-operative management who remained cancer-free or patients undergoing surgery with a pathological complete response.Among 102 patients, median age was 54 years, 69% were male, median carcinoembryonic antigen level was 3.0 ng/mL, and the median distance of the tumor above the anorectal ring was 3 cm. 38 (37%) patients had a complete response which included 15 of 18 (83%) non-operative patients who remained cancer free at a median of 22 months (range 7-48 months) and 23 of 84 (27%) patients who underwent surgery and had a pathologic complete response. The incomplete response group consisted of 61 patients who underwent initial surgery and 3 non-operative patients with regrowth. There were no differences in gender, T-stage or tumor location between groups. Younger age (median 49 vs 55), normal carcinoembryonic antigen (71% vs 41%), clinical node-negative (24% vs 9%), smaller tumors (median 3.9 vs. 5.4 cm), and wild-type p53 (79% vs 47%) and SMAD4 (100% vs 81%) were more likely to have a complete response (all p0.05).This was a retrospective study and small sample size.In patients with rectal cancer treated with total neoadjuvant therapy, more than one-third will achieve a pathological complete response or sustained clinical complete response with non-operative management making oncological resection superfluous in these patients. Smaller, wild-type p53 and SMAD4, and clinically node-negative cancers are predictive features of a complete response. http://links.lww.com/DCR/B889.

Gaming, an integral part of many students’ lives outside school, can provide an engaging platform for focusing students on important disciplinary core concepts as an entry into developing students’ understanding of these concepts through science practices. This article highlights how S’cape can be used to support student learning aligned with the most recent standards documents. Through combining students’ initial engagement in a motivating gaming experience with a two-experiment scaffolded inquiry sequence enhanced with information literacy-targeted homework, this article reveals how support can be offered for asking questions, planning and carrying out investigations, analyzing and interpreting data, constructing explanations, and engaging in argument from evidence to refine understandings of core concepts. We believe that as science teachers strive to explore important concepts with students through allowing them to actually practice science, games such as S’cape strategically leveraged and se...

Radiotherapy localization is the process by which patient treatments are aligned on a daily basis. Localization has hiistorically been accomplished using 2-dimensional x-ray images, or cone-beam CT- imaging which permits excellent visualization of bony anatomy, but suboptimal soft-tissue imaging. The Department of Radiation Oncology at Washington University recently implemented the world's first MR-Image Guided Radiation Therapy program (MR-IGRT), which utilizes a O.35T MR scanner integrated with three 6"Co heads for treatment delivery. A high-resolution volumetric MR image is acquired for each patient at the time of daily treatment setup, which allows localization based on soft-tissue anatomy, and modification to the treatment plan when required while the patient is on the treatment table. Herein, we review principles of radiotherapy localization, describe implementation of the world's first MR-IGRT program, and present future directions where MR-IGRT may be applied for patient treatments.

Cultural materialism gives priority to infrastructure, that is, to productive and reproductive processes, in explaining sociocultural systems. It predicts that social structures and symbolic-ideational beliefs will be favored or eliminated depending on whether they enhance or impede these processes. The symbolic-ideational sphere of virtually every human sociocultural system contains an "individual eschatology" or theory of the fate of the human personality at death. Eschatologies are either "judgmental," in which the deceased is judged for acts in life, or "nonjudgmental," in which no such claim is made. Presumably, each is compatible with different infrastructures and structures. We hypothesized that societies with low infrastructural productivity lack judgmental eschatologies, whereas those with high productivity have them. The null hypothesis was tested using a study population of 271 sociocultural systems drawn from the Human Relations Area Files and rejected at the 0.0001 level. However, while stron...

The frequency and distribution of genetic polymorphism in the human genome is a question of major importance. We have studied this in highly conserved genes, which encode crucial functions such as DNA replication, mRNA transcription, and translation. Evolutionary comparisons suggest that these genes are under particularly strong selective pressure, and their frequency of nucleotide sequence polymorphism would be expected to represent a minimum estimate for sequence variation throughout the genome. We have analyzed the complete coding sequence and the 3′-untranslated region (3′-UTR) of 22 human genes, most of which have homologs in all cellular organisms and all of which are at least 25% amino acid identical to homologs in yeast. Comparisons with similar studies of less conserved human disease genes indicate that 1) evolutionarily conserved genes are, on average, less polymorphic than disease related genes; 2) the difference in polymorphism levels is attributable almost entirely to reduced levels of variation in protein coding sequences, whereas noncoding sequences have similar levels of polymorphism; and 3) the character of polymorphism, in terms of the spectrum and frequency of mutational changes, is similar.