Incidence and predictive factors of retropharyngeal lymph node metastases in patients with oropharyngeal cancer undergoing multimodality treatment planning imaging.

BACKGROUND: We investigated the incidence and predictive factors of retropharyngeal lymph node (RPLN) metastases in patients with oropharyngeal cancer (OPC) undergoing multimodality treatment planning imaging before radiotherapy. METHODS: Consecutive patients with OPC treated with curative-intent radiotherapy from 2017 to 2019 were retrospectively analyzed. Treatment planning comprised contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) unless contraindicated. RESULTS: Of 300 patients, 66 (22%) had radiological evidence of RPLN involvement on planning images, compared to 17 (6%) on diagnostic CT alone. On multivariate analysis, RPLN involvement was statistically (p < 0.05) associated with tonsil, soft palate, and posterior pharyngeal wall primaries, and with disease extension to the soft palate or vallecula. CONCLUSIONS: Multimodality treatment planning imaging reveals a high rate of RPLN metastases from OPC compared to diagnostic CT alone. Patients with tonsil, soft palate, or posterior pharyngeal wall primaries or disease extending to the soft palate or vallecula appear at higher risk.

Paradoxical Tensions Related to AI-Powered Evaluation Systems in Competitive Sports.

Judging in competitive sports is prone to errors arising from the inherent limitations to humans' cognitive and sensorial capabilities and from various potential sources of bias that influence judges. Artistic gymnastics offers a case in point: given the complexity of scoring and the ever-increasing speed of athletes' performance, systems powered by artificial intelligence (AI) seem to promise benefits for the judging process and its outcomes. To characterize today's human judging process for artistic gymnastics and examine contrasts against an AI-powered system currently being introduced in this context, an in-depth case study analyzed interview data from various stakeholder groups (judges, gymnasts, coaches, federations, technology providers, and fans). This exploratory study unearthed several paradoxical tensions accompanying AI-based evaluations in this setting. The paper identifies and illustrates tensions of this nature related to AI-powered systems' accuracy, objectivity, explainability, relationship with artistry, interaction with humans, and consistency.

Survey of Australian general paediatricians regarding insulin initiation practices in children with new onset of type 1 diabetes.

AIM: Australian and New Zealand (NZ) paediatric endocrinologists' and NZ general paediatricians' insulin initiation strategies for children with type 1 diabetes (T1D) was recently described. The aim of this study was to document the insulin initiation practices of Australian general paediatricians in newly diagnosed children with T1D. METHODS: An online survey was sent to Australian general paediatricians identified through the Australian Paediatric Society diabetes database. RESULTS: Twenty four general paediatricians participated on behalf of their Australian regional and metropolitan diabetes units managing 2059 patients. The diabetes units averaged 86 patients and all practices were multidisciplinary models of care. Intensive insulin therapy regimens were initiated at diagnosis for children age 2-10 years by 93% respondents compared with 73% Australian endocrinologists, 17% NZ endocrinologists and 36% NZ general paediatricians. Carbohydrate counting as part of flexible bolus dosing was usual practice for 83% of respondents, which was substantially more than Australian endocrinologists (63%), NZ endocrinologists (64%) and NZ general paediatricians (33%). CONCLUSION: Almost all Australian general paediatricians who completed the survey initiate intensive insulin therapy regimes with carbohydrate counting in newly diagnosed children with T1D, consistent with the 2018 evidence-based recommendations of the International Society of Pediatric and Adolescent Diabetes. A substantial proportion of children with T1D within Australia are managed by general paediatricians who tend to align with international peak body guidelines.

Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial.

BACKGROUND: Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS: One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION: This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.

Efficient coupling of a quantum cascade laser to a few-mode chalcogenide fiber: erratum.

The authors wish to acknowledge an additional funding source which was absent from our manuscript.

Efficient coupling of a quantum cascade laser to a few-mode chalcogenide fiber.

We report efficient coupling of a quantum cascade laser (QCL) into step-index chalcogenide fibers (As 2S 3). Mechanically robust and low-loss chalcogenide fibers were fabricated using a hybrid, multi-material thermal drawing process. With suitable free-space optics, more than 160 mW of optical power was coupled into the fiber with predominantly single-mode excitation. Antireflection coatings on the fiber facets enabled 88.9% transmission with strong core confinement. By accurately tailoring the core diameter and antireflection-coating thickness, these fibers offer a versatile platform for high-power and low-loss transmission across the infrared spectrum. This work introduces an attractive alternative to the use of hollow-core fibers or multimode solid-core fibers for diffraction-limited infrared beam delivery.

Phase I/II trial of Durvalumab plus Tremelimumab and stereotactic body radiotherapy for metastatic head and neck carcinoma.

BACKGROUND: The efficacy of immunotherapy targeting the PD-1/PD-L1 pathway has previously been demonstrated in metastatic head and neck squamous cell carcinoma (HNSCC). Stereotactic Body Radiotherapy (SBRT) aims at ablating metastatic lesions and may play a synergistic role with immunotherapy. The purpose of this study is to assess the safety and efficacy of triple treatment combination (TTC) consisting of the administration of durvalumab and tremelimumab in combination with SBRT in metastatic HNSCC. METHOD: This is a phase I/II single arm study that will include 35 patients with 2-10 extracranial metastatic lesions. Patients will receive durvalumab (1500 mg IV every 4 weeks (Q4W)) and tremelimumab (75 mg IV Q4W for a total of 4 doses) until progression, unacceptable toxicity or patient withdrawal. SBRT to 2-5 metastases will be administered between cycles 2 and 3 of immunotherapy. The safety of the treatment combination will be evaluated through assessment of TTC-related toxicities, defined as grade 3-5 toxicities based on Common Terminology Criteria for Adverse Events (v 4.03), occurring within 6 weeks from SBRT start, and that are definitely, probably or possibly related to the combination of all treatments. We hypothesize that dual targeting of PD-L1 and CTLA-4 pathways combined with SBRT will lead to < 35% grade 3-5 acute toxicities related to TTC. Progression free survival (PFS) will be the primary endpoint of the phase II portion of this study and will be assessed with radiological exams every 8 weeks using the RECIST version 1.1 criteria. DISCUSSION: The combination of synergistic dual checkpoints inhibition along with ablative radiation may significantly potentiate the local and systemic disease control. This study constitutes the first clinical trial combining effects of SBRT with dual checkpoint blockade with durvalumab and tremelimumab in the treatment of metastatic HNSCC. If positive, this study would lead to a phase III trial testing this treatment combination against standard of care in metastatic HNSCC. TRIAL REGISTRATION: NCT03283605 . Registration date: September 14, 2017; version 1.

Behavioural modification framework to address wastage in household electricity consumption.

Household electricity wastage poses a sustainability issue. Ergonomic interventions that prevent wastage through technological innovations are expensive and complex, making consumers unwilling to adopt them. The study aimed to investigate the motivations and impediments in avoiding electricity wastage. Thirteen Repertory Grid interviews were conducted on household electricity users relating to the behaviour of those living with them. The key motivational themes found were altruistic and egoistic reasons while the impediments were perceived behavioural control, hedonism and self-efficacy. Based on the research findings, a behavioural modification framework was developed to encourage consumers to adopt a higher level of responsible electricity practice through the following suggested interventions - (1) reframing sustainability from 'future-for-others' to 'present-for-us', (2) clarifying responsible consumption and (3) performance feedback. The research identified the key motivations and impediments of being a responsible household electricity user and provided a framework to encourage a higher responsibility level. Practitioner Summary: Household electricity wastage poses sustainability issue: excess CO2 & high costs. We developed a mindset changing behavioural modification framework. We investigated HFE issues: motivations & impediments of avoiding the wastage, i.e. altruistic, egoistic, behavioural control, hedonism & self-efficacy. The framework provides governments insights into strategies to address the wastage.

The role of organisational interdependencies and asset orchestration in business integration: A case study of M.com.

Business integration is an important determinant of business value and firm performance which enables a firm to respond to pressing competitive forces. Given its significant role, business integration in general has been an enduring research topic over the years. However, due to its complex nature, the ways to achieve this important organisational capability in firms are still not clearly understood. Hence, the present study is an attempt to 'open this black box' and examine the relevant issues through a case study of M.com, one of the largest e-commerce firms in China. The findings of this case study emphasise that the ability to coordinate organisational interdependencies and asset orchestration according to the needs of business processes is challenging but necessary in order to achieve business integration in e-commerce firms. It is found that asset orchestration in a firm is contingent on the organisational interdependencies such that different interdependence types demand different coordination methods at the very least. It also shows the significant role of IT in asset orchestration and the coordination of organisational interdependencies during business integration. With these capabilities, firms can experience growth and improve the quality of conformance to customer needs.

Phase III Trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Trial 99-13.

PURPOSE: This multicentered phase III trial was designed to compare an emulsion containing trolamine against the usual supportive care within each participating institution for patients with head and neck cancer undergoing radiation therapy. PATIENTS AND METHODS: Patients with biopsy-proven squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx were randomly assigned to one of the following treatments: prophylactic trolamine emulsion, interventional trolamine emulsion, or declared institutional preference. The primary outcome was the reduction in grade 2 or higher skin toxicity, as per National Cancer Institute Common Toxicity Criteria version 2.0. Secondary outcomes included patient-reported quality of life (QOL). RESULTS: From October 2000 to April 2002, 547 patients from 51 institutions were entered onto the trial. The average age was 59 years. Patients were predominately male (79%) and most continued to use tobacco products (52%). The rates of grade 2 or higher radiation dermatitis were 79%, 77%, and 79% in the prophylactic, interventional, and institutional preference arms of the study, respectively. No significant differences in QOL were found. CONCLUSION: The results of this trial demonstrate no advantage for the use of trolamine in reducing the incidence of grade 2 or higher radiation dermatitis or improving patient-reported QOL. The use of 15 different local standards of care highlights the need to continue research that will result in evidence-based recommendations to reduce the burden of radiation dermatitis.