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Takeshi Yokoo,1 Amish D Patel,1 Naama Lev-Cohain,1 Amit G Singal,2 Adam C Yopp,3 Ivan Pedrosa1 1Department of Radiology, 2Department of Internal Medicine, 3Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Background: Extrahepatic metastases have important implications in the clinical management of hepatocellular carcinoma (HCC). The purpose of this study was to validate tumor staging parameters and serum AFP as risk factors of HCC metastasis.Patients and methods: In this retrospective case–control study, patients with a new diagnosis of HCC (N=236), median age 57 years (range 28–89 years), and male-to-female ratio of 183/53 were divided into a “no-met” group (N=101) without extrahepatic metastasis or a “met” group with extrahepatic metastases (N=135). Metastasis risk factors based on tumor staging parameters (size, number, infiltration, and vascular invasion) and serum AFP level were calculated as odds ratio (OR). Sensitivities of the risk factors as metastasis screening tests were also calculated.Results: AFP >400 mg/mL, index tumor size >5 cm, and vascular invasion individually had strong association with metastasis, with OR (95% confidence interval) of 11.5 (5.9–22.1), 17.7 (9.0–34.8), and 18.9 (8.2–43.9), respectively, but with moderate sensitivities as metastasis screening tests, with 71.9% (65.7–77.3), 75.6% (69.6–80.7), and 58.5% (52.1–64.7), respectively. Composite multiparametric criteria, eg, a logical union of 1) tumor size outside of Milan criteria, 2) AFP threshold >35 mg/mL, and 3) vascular invasion, had excellent OR up to 55.6 (13.0–237.1) with screening sensitivity 98.5% (95.8–99.6).Conclusion: Serum AFP, tumor size, and vascular invasion are strongly associated with extrahepatic metastasis of HCC, especially when combined into a multiparametric metastasis prediction criterion. Keywords: hepatocellular carcinoma, risk factor, α-fetoprotein, stage, metastasis

Background: Operative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery. Study design: This prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events. Results: Across 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, P = .66) for patients undergoing cancer operations. Conclusion: Across three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.ClinicalTrials.gov Identifier: NCT02359994

Abstract Immune checkpoint inhibitors targeting PD-1/L1 have modest efficacy in hepatocellular carcinoma as single agents. Targeting membranous phosphatidylserine may induce pro-inflammatory and -immune stimulating effects that enhance immunotherapy activity. This hypothesis was tested in a single-arm phase 2 trial evaluating frontline bavituximab, a phosphatidylserine targeting antibody, plus pembrolizumab (anti-PD-1) in patients with unresectable hepatocellular carcinoma (NCT03519997). The primary endpoint was investigator-assessed objective response rate among evaluable patients, and secondary end points included progression-free survival, incidence of adverse events, overall survival, and duration of response. Among 28 evaluable patients, the confirmed response rate was 32.1%, which met the pre-specified endpoint, and the median progression-free survival was 6.3 months (95% CI, 1.3–11.3 months). Treatment related-adverse events of any grade occurred in 45.7% of patients, with grade 3 or greater adverse events in 14.3% of patients. Adverse events of any cause were observed in 33 patients (94.3%), with grade 3 or greater adverse events in 11 patients (31.4%). Prespecified exploratory analyses of baseline tumor specimens showed that a depletion of B cells, and the presence of fibrotic tissue and expression of immune checkpoints in stroma was associated with tumor response. These results suggest that targeting phosphatidylserine may lead to synergistic effects with PD-1 blockade without increasing toxicity rates, and future studies on this therapeutic strategy may be guided by biomarkers characterizing the pre-treatment tumor microenvironment.

This study describes student interest in the agricultural content pathways established by the National Council for Agricultural Education. Differences exist between male and female students concerning curriculum choices in agriculture, food, and natural resources. Male students were most interested in food products and processing systems, while females averaged the highest interest in animal systems. Females were significantly more interested in animal systems. Males were more interested in power, structural, and technical systems, biotechnology, food products and processing, and agribusiness systems. When considering the students' race and ethnic background, Native Americans or Alaska Natives reported the most interest in animal systems. Asian students reported the highest interest in natural resource systems. African American students averaged the highest interest in power, structural and technical systems. White Non-Hispanic students reported the highest interest in animal systems. White Hispanic students reported the highest average interest in natural resources. White Non-Hispanic students were significantly more interested in agribusiness systems, animal systems, food products, and processing systems than were African American students. Native American or Alaskan Native students were significantly more interested in animal systems than African American students. This study concluded that male and female students value agricultural curriculum content differently and that the differences were significant in most agricultural content pathways. Students of different races and ethnic backgrounds value agricultural content pathways differently, but most of these differences were insignificant.

This study describes the internal values that motivate non-traditional urban agriculture students to stay in the field and the external factors influencing the motivation of non-traditional urban agriculture students to remain in the field of agriculture. A phenomenological approach was employed to gather information on student motivation, engagement, background, knowledge, lived experiences, and post-graduation plans. The findings suggest that urban students of color have a favorable opinion of agriculture when provided with a systematic course of instruction in the agricultural sciences, particularly when the learning experiences align closely with their academic and career interests. However, it was concluded that while instruction in the agricultural sciences and positive agricultural youth organization experiences contribute to a positive perception of the agriculture industry, they do not necessarily lead to a career preference for agriculture among urban students of color. Urban students of color viewed local agricultural youth organization experiences favorably. However, they perceived that the FFA Organization above the school level is not inclusive of urban students of color. Finally, agriculture teachers, mentors, and role models support positive academic performance and career development choices in urban students of color.

Because of discrepancies among U.S. states regarding how they assess school-based agricultural education (SBAE) teacher performance and program quality, little knowledge has existed regarding how these differences might influence critical decisions regarding hiring, pay, promotion, and dismissal. In response, the purpose of our study was to examine commonalities and differences in state-level program quality standards of teacher and program performance expectations for SBAE in the U.S. To accomplish this, we analyzed documents containing teacher and program standards used by state SBAE leaders. Using cognitive sensemaking as our lens, we found states that measured SBAE teacher and program standards using a variety of formats and methods, emphasizing teacher engagement in professional development, organization of course syllabi and lesson plans, program safety, and health protocol adherence. We also found little mention of instructional practice as a prominent metric for success and no delineation regarding standards for teachers' years of experience. We discuss the merits of these documents and encourage practitioners to critically examine their intent and use them moving forward.

Little progress has been made to understand the (in)abilities of school-based agricultural education (SBAE) teachers to balance their work and life responsibilities. Nevertheless, advancing this conversation is critical, especially in light of ongoing teacher shortage trends. In response, this study's purpose was two-fold: (1) examine how early career teachers in Louisiana co-constructed their conceptualizations of work-life balance as SBAE teachers, and (2) illuminate the contextual factors that shaped how the early career teachers negotiated meaning regarding their reified views of work-life balance. When interpreting findings through the lens of landscapes of practice, five themes emerged: (1) The Success Trap, (2) The Work Eclipse, (3) Aspired Boundaries, (4) Grin and Bear It -- Silence, and (5) Undercurrents of Change. The findings speak against the dominant narrative perpetuated by various actors and forces in the discipline that have championed the notion that work-life balance should be the ultimate goal. Instead, our findings problematize this notion by illuminating how early career teachers in Louisiana visualized success and work-life balance in diverse and complex ways. As a result, researchers offer implications and recommendations to help reimagine how early career teachers can better traverse issues of work and life in the SBAE landscape.

In this collective case study, we described three agricultural education programs that challenge stereotypes of agricultural education in urban settings. We observed and interviewed teachers in different environments and, in many cases, while working with students. Observations were made in classrooms and laboratories at secondary schools, in livestock barns, greenhouses, and vineyards on school farms. We explored the reciprocal relationship between personal, behavioral, and environmental determinants of social cognitive theory within and among components of the total agricultural education program model. In each program, all three components of the total agricultural education program model were being implemented using a combination of activities and curriculum that would often be considered traditional content. According to teachers, agriculture was a novel, captivating topic for students. Students' lack of familiarity with production agriculture provided opportunities for students to experience something new.

Social and Emotional Learning (SEL) has often been an umbrella term for a wide range of competencies, including emotional processes, social and interpersonal skills, and cognitive regulation (Jones, Bouffard, & Weissbourd, 2013). We used the Borich (1980) needs assessment model to assess the professional development needs of Texas agricultural education teachers in core SEL skill areas. Data were collected with three forms of a paper questionnaire to determine teachers' self-perceived levels of competence in core SEL skill areas. Twenty SEL indicators were assessed in four ways (Importance, Ability to Perform, Knowledge, and Ability to Teach), and then used to create three latent variables (Performance Competence, Knowledge Competence, and Consequence Competence), which served as dimensions of professional development needs. Agriculture teachers perceived the importance of all core SEL skill areas as having average or greater importance, their ability to model core SEL skill areas as average or greater, their knowledge of core SEL areas as average or greater, and possessing average or greater ability to teach core SEL skill areas. The findings of this study support the Collaborative for Academic, Social, and Emotional Learning (CASEL, 2003) report and emphasize the importance of SEL in agricultural education.