Globally, head & neck sarcoma care pathways remain unclear. In 2018, the London Sarcoma Service (LSS) set up a dedicated head and neck sarcoma (HNS) multidisciplinary team (MDT) with a clear ...objective to provide formal access to super-specialist expertise in diagnosis, treatment planning and management of HNS. The aim of the study is to provide first results of a dedicated HNS MDT.
All patients discussed between 2018 and 2022, in HNS MDT, with a new histologically confirmed HNS diagnosis were included in the study. Demographics, anatomic site, morphology, MDT recommendation, treatment details and outcomes were obtained from electronic patient records.
A total of 337 patients were discussed in the HNS MDT of which 178 patients were included in the study, with a median age of 53 years(range 2–94); 67 % were soft tissue sarcomas(STS) and 33 % were bone sarcomas(BS), of which 43 % and 71 % were high grade, respectively. 55 % BS and 39 % STS underwent surgery. 9 % of BS and 7 % of STS received adjuvant Proton Beam therapy. With a median follow-up of 2.16 years, recurrence was observed in 12 %, distant metastasis in 6 % of patients and overall survival was 72 %.
The HNS MDT provides expertise on diagnosis and multi-modality management of HNS. STS are more likely to be misdiagnosed. Atypical imaging characteristics should trigger a specialist referral. Adequate surgery at first presentation remains the mainstay of treatment and the strongest prognosticator of overall survival. Formation of an expert working group specific to HNS must work towards streamlining sarcoma care.
•Transformative Impact: Specialized MDT enhances Head and Neck Sarcoma Care•Optimizing Outcomes: Insights into Delays, Diagnostics, and Treatment Strategies•Integrated Approach: A Diagnostic Algorithm for Improved Patient Survival
Sustainable livelihood development is an ongoing challenge worldwide, and has regained importance due to threats of water shortages and climate change. To cope with changing climatic, demographic and ...market conditions in Vietnam's Mekong Delta (VMD) an agricultural transformation process has been suggested in the recent Mekong Delta Plan. This agricultural transformation process requires the implementation of alternative livelihood models. The majority of current agricultural livelihood models in the VMD have been introduced by the government in a top-down manner. In this study, we applied a bottom-up approach to understand the motivations and abilities of local farmers to adopt alternative livelihood models. It is based on the MOTA methodological framework, which is further tested with the use of multivariate analyses. The study was conducted in Ben Tre coastal province. Results showed that farmers' motivations and abilities to apply alternative models vary substantially among different groups, driven by their perceptions on triggers and opportunities. Acknowledging this diversity is essential to the development of agricultural transformation plans. Furthermore, based on the analysis, a projection of the precise support that communities need to supplement their knowledge, skills and financial capacities, as well as interventions to reduce the risks of new livelihood models, is given.
The purpose of this study was to, first, examine the potential of lesson plans (LPs) of preservice science teachers (PSTs, N = 631) as a source for gathering rich data on their pedagogical content ...knowledge (PCK) and, second, qualitatively describe PSTs’ reasons for the level of data richness in their LPs on PCK. PSTs’ handwritten LPs were analyzed through an analytic rubric, and semi-structured interviews were conducted with 79 randomly selected PSTs. Results revealed a range of the level of data richness of the PSTs’ LPs on PCK and five descriptive categories about the PSTs’ reasons for the richness of LP data on PCK. The study implies that researchers should consider the inclusion of the LP as a valid tool in their triangulation design; however, they should weigh the factors that influence the collection of rich data in their PCK studies to triangulate findings better to portray a holistic picture of PCK.
Introduction According to Control-Mastery Theory (CMT)-a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy-patients come to therapy with an unconscious ...plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship. Objectives: The present study aimed to replicate and expand the results of previous studies suggesting that therapists' responses that disconfirmed patient's pathogenic beliefs were predictive of patients' within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance. Methods: Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient's plan was formulated and tests identified, the accuracy of the therapist's responses to these tests was rated, and the impact of the therapist's interventions on the patient's subsequent communications and their relationship with the therapeutic alliance was measured. Results: The results supported the central hypothesis of the CMT that when the therapist's interventions passed the patient's tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient's tests correlated with the therapeutic alliance. Conclusions: The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians' optimal responsiveness.
This research article contributes to the challenge of global warming by presenting the approach of the use of green hydrogen to reduce greenhouse gases. It shows that CO2 emissions can be ...significantly reduced in thermal power plants by replacing natural gas with green hydrogen as a fuel. This work presents the techno-economic study of the energy transition of a 12 MW thermal power plant based on green hydrogen. The presented study is based on the energy consumption of Nigeria, 73% of which is covered by natural gas thermal power plants. The obtained results show that the cost of this transition is ca. 17 million dollars (USD) for a reduction of 114 tCO2 per plant with a return on investment between 4-5 years. In addition, through modeling and numerical simulation, this article shows that estimated return on investment can be shortened by using the thermal power resulting from the turbine, through industrial use.
Today, sports has become an important issue in society and its role in women's society is undeniable. The emphasis of sociologists, psychologists, doctors, etc. is on women to do sports because women ...are the main pillar of society and family, and a healthy family is one whose mother is healthy. In different societies, creating suitable grounds for women's sports is considered an important and national issue, and the presence or absence of women in sports activities is considered a global indicator of the social status of women in society. One of the most important aspects of women's sports is championship sports, and promoting this aspect of sports can lead to the development and promotion of society. In fact, the importance of the development of championship sports in the general sense and the development of women's sports in a specific sense due to the high capacity of earning medals and creating social vitality in women reveals the necessity of conducting such a study. In addition, it seems very necessary to set goals to examine the status of women in North Khorasan province in championship sports and provide strategies and solutions to overcome the obstacles and challenges ahead. North Khorasan province has a high capacity to introduce champion female athletes to the country due to the diverse cultural and climatic conditions on the one hand and the youngness of the administrative structure of the province on the other hand. Therefore, considering the importance of strategic planning in the development of championship sports, the need to pay attention to this importance in the development of women's championship sports in North Khorasan province seems more necessary than ever. A suitable solution is to prepare a strategic plan for women's championship sports in the province, which will reach its proper position with the realization of this and the development of championship sports.The current research is descriptive-survey in terms of research method, applied in terms of purpose and in terms of data collection, it is mixed (quantitative and qualitative). The statistical population includes managers, deputies and experts (sport and youth general directorates of North Khorasan province, sport and youth office in Bojnord county, sports committees and clubs in North Khorasan province), the university professors in the field of sports science, coaches and female champion athletes of North Khorasan province. The statistical sample in the qualitative section included 14 people from the statistical community. The sampling method in this section was purposeful and based on expertise, experience, and knowledge of women's championship sports in North Khorasan province. The statistical sample in the quantitative section included 23 people who were selected purposefully. The data collection tool in the qualitative phase was a semi-guided exploratory interview as well as a SWAT analysis session with a group of members of the statistical sample of the research to identify variables and complete the questions and questions resulting from library studies. In the current research, descriptive methods were used to examine demographic variables and a framework called comprehensive framework for developing a model strategy (SWOT) was used to obtain strengths, weaknesses, opportunities and threats. Finally, the ANP method and Super Decisions software were used to prioritize strategies.The findings of the research in the development of women's championship sports showed 9 strengths, 16 weaknesses, 11 opportunities and 13 threats. According to the total score of strategies formulated in this section, it can be stated that the competitive strategic position is the dominant strategy in this section. The most important strategies obtained in the research include the compilation of guidance and support programs in the path of growth of female athletes from beginner to advanced, Strengthening and investing in active and medal-winning sports for women in the province, and Special attention paid to holding appropriate and regular training camps throughout the year, sending women to national competitions, holding joint camps with champions from other provinces, and providing proper supplies and support to the teams. It is appropriate for the officials and guardians of sports in the province to pay special attention to the strategies obtained from this research for the development of women's championship sports in the province.
Organizers, which comprise groups of cells with the ability to instruct adjacent cells into specific states, represent a key principle in developmental biology. The concept was first introduced by ...Spemann and Mangold, who showed that there is a cellular population in the newt embryo that elicits the development of a secondary axis from adjacent cells. Similar experiments in chicken and rabbit embryos subsequently revealed groups of cells with similar instructive potential. In birds and mammals, organizer activity is often associated with a structure known as the node, which has thus been considered a functional homologue of Spemann's organizer. Here, we take an in-depth look at the structure and function of organizers across species and note that, whereas the amphibian organizer is a contingent collection of elements, each performing a specific function, the elements of organizers in other species are dispersed in time and space. This observation urges us to reconsider the universality and meaning of the organizer concept.
The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction ...treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment.
The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 ...study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)—96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13—were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.
A fast, convenient, and easy to perform method for preparing plan‐view transmission electron microscopy (TEM) specimens of brittle materials is proposed. The method is ideal for thin films/coatings ...and based on obtaining wedge‐shape geometries of the samples via conventional cutting and cleaving followed by gentle focused ion beam (FIB) milling to electron transparency. It enables multiple parallel windows for depth sectioning of the samples and facilitates FIB lift‐out procedure. The method has been successfully applied for preparing high‐quality plan‐view TEM samples for a range of films deposited on Si, SiC, and Al2O3 which significantly enhances throughput and reduces time at the FIB. The method further offers high success rate even for the novice, stable handling and reproducibility, which greatly widens the application of advanced plan‐view TEM studies in material science.
Easy to perform method for preparing plan‐view transmission electron microscopy specimens of brittle materials is proposed. The method is based on obtaining wedge‐shape geometries of the samples via cleaving followed by gentle focused ion beam milling to electron transparency.
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