This article begins with a consideration of curricular reform proposals influenced by cultural studies and interdisciplinary approaches to the study of modern languages. Addressing the lack of ...critical perspectives on language in such approaches, we call for a pedagogy designed to foster students' critical understanding of the role of language and language ideologies in the production of knowledge, culture, and identities. Whereas earlier pedagogies based on critical language awareness (CLA) were limited to a few select courses, we argue that ideologies on language and the material conditions surrounding language use should be examined throughout the Spanish curriculum. So too should students be given opportunities to examine the construction of the discipline itself. We demonstrate the feasibility of incorporating CLA into the study of literary texts, which remain at the core of most major programs in the U.S., by providing detailed examples of activities to accompany Guaman Poma de Ayala's "Nueva corónica y buen gobierno".
Published data suggests that wedge resection for stage I non-small cell lung cancer (NSCLC) is associated with improved overall survival compared to stereotactic body radiation therapy. We report ...CyberKnife outcomes for high-risk surgical patients with biopsy-proven stage I NSCLC. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs) were contoured using lung windows; the margins were expanded by 5 mm to establish the planning treatment volume (PTV). Treatment plans were designed using a mean of 156 pencil beams. Doses delivered to the PTV ranged from 42 to 60 Gy in three fractions. The 30 Gy isodose contour extended at least 1 cm from the GTV to eradicate microscopic disease. Treatments were delivered using the CyberKnife system with tumor tracking. Examination and PET/CT imaging occurred at 3 month follow-up intervals. Forty patients (median age 76) with a median maximum tumor diameter of 2.6 cm (range, 1.4-5.0 cm) and a mean post-bronchodilator percent predicted forced expiratory volume in 1 s (FEV1) of 57% (range, 21-111%) were treated. A median dose of 48 Gy was delivered to the PTV over 3-13 days (median, 7 days). The 30 Gy isodose contour extended a mean 1.9 cm from the GTV. At a median 44 months (range, 12-72 months) follow-up, the 3 year Kaplan-Meier locoregional control and overall survival estimates compare favorably with contemporary wedge resection outcomes at 91 and 75%, respectively. CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1-2 cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.
Background
Reduction in immunosuppression is considered the therapy of proven benefit for BKV infection in renal transplantation, but the use of leflunomide has also been reported. It was observed at ...this center that the patterns of viral load response while on leflunomide appear to fall into two distinct types.
Methods
Medical records of 22 kidney and kidney‐pancreas recipients at a single center who received leflunomide therapy for BKV DNAemia were reviewed. Information was collected on demographics, BKV viral loads, other antiviral therapy, immunosuppressive drug levels and doses, adverse effects, and graft and patient outcomes.
Results
Eighteen of 22 cleared BKV viremia, and 12 of 22 had preserved allograft function; only two graft losses occurred in the screening era among leflunomide‐treated patients. Two patterns of viral load reduction were observed, termed the “smooth” and the “zigzag” pattern, which differed in mean time to clear of BKV DNA (2.9 vs. 19.5 months, p = 0.0073). Graft preservation was correlated with lower serum creatinine (SCr) at the start of leflunomide therapy.
Conclusions
Long courses and “zigzag” fluctuations in viral load can occur in patients who eventually clear BKV on leflunomide with preserved allograft function. Intermittent increases in viral load do not necessarily portend therapeutic failure. Although the utility of leflunomide is still debated in the transplant community, this information may be useful to clinicians who choose to use it in selected patients.
This article describes a critical service-learning initiative in which college students of Spanish taught in an after-school Spanish class for young heritage language (HL) speakers at a local ...elementary school. We contextualize the program within broad curricular revisions made to the undergraduate Spanish program in recent years, explaining how critical pedagogy and our students' experiences motivated the design of the program. After describing the program, we analyze reflections from participants that show how the experience helped them take their critical language agency beyond the classroom walls and integrate university, school and community knowledges, as both the college students and the children they taught came to view their cultural and linguistic heritages to be of educational and public importance.
Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research ...evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.
Abstract
Background
Reduction in immunosuppression is considered the therapy of proven benefit for
BKV
infection in renal transplantation, but the use of leflunomide has also been reported. It was ...observed at this center that the patterns of viral load response while on leflunomide appear to fall into two distinct types.
Methods
Medical records of 22 kidney and kidney‐pancreas recipients at a single center who received leflunomide therapy for
BKV DNA
emia were reviewed. Information was collected on demographics,
BKV
viral loads, other antiviral therapy, immunosuppressive drug levels and doses, adverse effects, and graft and patient outcomes.
Results
Eighteen of 22 cleared
BKV
viremia, and 12 of 22 had preserved allograft function; only two graft losses occurred in the screening era among leflunomide‐treated patients. Two patterns of viral load reduction were observed, termed the “smooth” and the “zigzag” pattern, which differed in mean time to clear of
BKV DNA
(2.9 vs. 19.5 months, p = 0.0073). Graft preservation was correlated with lower serum creatinine (SCr) at the start of leflunomide therapy.
Conclusions
Long courses and “zigzag” fluctuations in viral load can occur in patients who eventually clear
BKV
on leflunomide with preserved allograft function. Intermittent increases in viral load do not necessarily portend therapeutic failure. Although the utility of leflunomide is still debated in the transplant community, this information may be useful to clinicians who choose to use it in selected patients.
Standard treatment for operable patients with single peripheral lung metastases is metastasectomy. We report mature CyberKnife outcomes for high-risk surgical patients with biopsy proven single ...peripheral lung metastases. Twenty-four patients (median age 73 years) with a mean maximum tumor diameter of 2.5 cm (range, 0.8-4.5 cm) were treated over a 6-year period extending from September 2004 to September 2010 and followed for a minimum of 1 year or until death. A mean dose of 52 Gy (range, 45-60 Gy) was delivered to the prescription isodose line in three fractions over a 3-11 day period (mean, 7 days). At a median follow-up of 20 months, the 2-year Kaplan-Meier local control and overall survival rates were 87 and 50%, respectively. CyberKnife with fiducial tracking is an effective treatment for high-risk surgical patients with single small peripheral lung metastases. Trials comparing CyberKnife with metastasectomy for operable patients are necessary to confirm equivalence.
This retrospective analysis examines the local control and toxicity of five-fraction fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for single vertebral body (VB) metastases. All ...patients had favorable performance status (ECOG 0-1), oligometastatic disease, and no prior spine irradiation. A prescribed dose of 30-35 Gy was delivered in five fractions to the planning target volume (PTV) using the CyberKnife with X-sight spine tracking. Suggested maximum spinal cord and esophagus point doses were 30 and 40 Gy, respectively. A median 30 Gy (IQR, 30-35 Gy) dose was delivered to a median prescription isodose line of 70% (IQR, 65-77%) to 20 patients. At 34 months median follow-up (IQR, 25-40 months) for surviving patients, the 1- and 2-year Kaplan-Meier local control estimates were 80 and 73%, respectively. Two of the five local failures were infield in patients who had received irradiation to the gross tumor volume and three were paravertebral failures just outside the PTV in patients with prior corpectomy. No local failures occurred in patients who completed VB radiation alone. The 1- and 2-year Kaplan-Meier overall survival estimates were 80 and 57%, respectively. Most deaths were attributed to metastatic disease; one death was attributed to local recurrence. The mean maximum point doses were 26.4 Gy (SD, 5.1 Gy) to the spinal cord and 29.1 Gy (SD, 8.9 Gy) to the esophagus. Patients receiving maximum esophagus point doses greater than 35 Gy experienced acute dysphagia (Grade I/II). No spinal cord toxicity was documented. Five-fraction fiducial-free CyberKnife SBRT is an acceptable treatment option for newly diagnosed VB metastases with promising local control rates and minimal toxicity despite the close proximity of such tumors to the spinal cord and esophagus. A prospective study aimed at further enhancing local control by targeting the intact VB and escalating the total dose is planned.
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