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Abstract Background Patients with head and neck squamous cell carcinoma (HNSCC) enter the palliative phase when cure is no longer possible or when they refuse curative treatment. The mean survival is five months, with a range of days until years. Realistic prognostic counseling enables patients to make well-considered end-of-life choices. However, physicians tend to overestimate survival. The aim of this study was to develop a prognostic model that calculates the overall survival (OS) probability of palliative HNSCC patients. Methods Patients diagnosed with incurable HNSCC or patients who refused curative treatment for HNSCC between January 1st 2006 and June 3rd 2019 were included (n = 659). Three patients were lost to follow-up. Patients were considered to have incurable HNSCC due to tumor factors (e.g. inoperability with no other curative treatment options, distant metastasis) or patient factors (e.g. the presence of severe comorbidity and/or poor performance status).Tumor and patients factors accounted for 574 patients. An additional 82 patients refused curative treatment and were also considered palliative. The effect of 17 candidate predictors was estimated in the univariable cox proportional hazard regression model. Using backwards selection with a cut-off P-value

Alpha Particle X‐ray spectrometer (APXS) analyses of the distinct Amapari Marker Band (AMB), Gale crater, Mars reveal the highest, in situ, FeO and Zn abundances (47.51, 2.23 wt%), and elevated MnO associated with a lower rippled unit. APXS analyses also reveal a marked shift in provenance, to a generally basaltic composition, compared to the underlying Mg‐sulfate‐bearing strata, which persists into the overlying stratigraphy. The AMB also records perturbation in the MgSO4‐forming conditions present above and below. AMB chemistry could be consistent with a volcanic ash source; high metal concentrations resulting from volatile reactions within an ash cloud. Alternatively, syn‐ and/or post‐depositional precipitation processes within a primary lake setting and/or a later diagenetic event or events may have played a role. Ongoing and future work will aim to further constrain processes responsible for deposition of the AMB, the high metal concentrations and its regional and global implications. Plain Language Summary: The Amapari Marker Band (AMB) at Gale crater forms a distinct, dark‐toned, resistant horizon identified from orbit within rock layers of the Mg‐sulfate‐bearing, central mound. Curiosity recently investigated the AMB and found a lower rippled layer, consistent with a shallow lake, contrasting with windblown sediment deposition above and below it. Analysis of the AMB by the Alpha Particle X‐ray spectrometer also revealed a marked change in the chemistry of the rocks, with the highest in situ FeO and Zn abundances measured on Mars, elevated MnO, and a composition consistent with input of different sediment compared to underlying rocks. The change in bulk chemistry persists into the overlying rocks indicating that the AMB marks a significant event in the evolution of Gale crater, and possibly beyond. The AMB may record deposition of basaltic volcanic ash into a lake; the high metal concentrations resulting from gas reactions within an ash cloud. Alternatively, the high metals may be the result of water/sediment interactions: either in the lake, and/or after deposition and possibly after becoming a solid rock. Ongoing and future work will aim to further constrain processes responsible for deposition of the AMB, the high metal concentrations and its regional and global implications. Key Points: APXS analysis reveals a marked change in chemistry and provenance associated with the Amapari Marker Band, Gale craterHighest in situ iron and zinc, and elevated manganese detected by APXS within the Amapari Marker BandThe Amapari Marker Bands marks a significant event in the evolution of Gale crater, and possibly beyond [ABSTRACT FROM AUTHOR]

Chemical data acquired by Curiosity's Alpha Particle X‐ray Spectrometer during examination of the contact between the upper Mount Sharp group and overlying Stimson formation sandstones at the Greenheugh pediment reveal compositional similarities to rocks encountered earlier in the mission. Mount Sharp group strata encountered below the Basal Siccar Point group unconformity at the base and top of the section, separated by >300 m in elevation, have distinct and related compositions. This indicates enhanced post‐depositional fluid flow and alteration focused along this contact. Sandstone targets exposed immediately above the unconformity have basaltic compositions consistent with previously encountered eolian Stimson formation sandstones, except at the contact, where they show the addition of S. Resistant sandstone outcrops above the contact have higher K, Mn, and Na and lower Ni concentrations that primarily reflect changes in provenance. They are compositionally related to cap rock float blocks encountered as Curiosity climbed through the Mount Sharp group, and Bradbury group sandstone outcrops. The higher K, pediment sandstones are interpreted to have a similar provenance to some Bradbury group sandstones, further evidence for widespread, alkaline source rock within and/or in the vicinity of Gale crater. The Bradbury and Siccar Point groups may both be younger than the Mount Sharp group. Alternatively, an alkaline source area in and around Gale crater has been eroded by both water and wind at different times (both before and after deposition of the Mount Sharp group), during the evolution of the crater and its infill. Plain Language Summary: Chemical data acquired by Curiosity's Alpha Particle X‐ray Spectrometer during examination of an important regional contact between two rock units in Gale crater, Mars, reveal relationships with other rocks encountered much earlier in the mission. These relationships provide evidence for erosion by wind and water of various composition source rocks. These include more typical Martian basaltic and more alkaline composition rocks (e.g., higher potassium and sodium). Distinct chemistry within rocks immediately underlying the contact, separated by more than 300 m in elevation, indicate enhanced fluid flow and alteration along the contact. These relationships provide important insights into regional and crater‐scale processes and evidence for the long‐lived role of water and aqueous alteration and hence, habitable environments at Gale. Key Points: Enhanced post‐depositional fluid flow and alteration of the Mount Sharp group was focused at the Basal Siccar Point group unconformityAlkaline source rocks at Gale provided detritus to fluvial and eolian sandstonesBradbury and Siccar Point group sandstones may be contemporaneous, and younger than the Mount Sharp group [ABSTRACT FROM AUTHOR]

In August 2015, the Curiosity Mars rover discovered tridymite, a high‐temperature silica polymorph, in Gale crater. The existing model for its occurrence suggests erosion and detrital sedimentation from silicic volcanic rocks in the crater rim or central peak. The chemistry and mineralogy of the tridymite‐bearing rocks, however, are not consistent with silicic volcanic material. Using data from Curiosity, including chemical composition from the Alpha Particle X‐ray Spectrometer, mineralogy from the CheMin instrument, and evolved gas and isotopic analyses from the Sample Analysis at Mars instrument, we show that the tridymite‐bearing rocks exhibit similar chemical patterns with silica‐rich alteration halos which crosscut the stratigraphy. We infer that the tridymite formed in‐place through hydrothermal processes and show additional chemical and mineralogical results from Gale crater consistent with hydrothermal activity occurring after sediment deposition and lithification. Plain Language Summary: In August 2015, the Curiosity Mars rover discovered tridymite, an unexpected mineral phase, in Gale crater. The existing model for its occurrence suggests erosion and deposition from silicon‐rich volcanic rocks in the crater rim or central peak. The chemistry and mineralogy of the tridymite‐bearing rocks, however, are not consistent with silicon‐rich volcanic material. Using data from Curiosity's instrument suite, we show that the tridymite‐bearing rocks exhibit similar chemical patterns with silicon‐rich alteration zones which crosscut the layered sediments. We infer that the tridymite formed in‐place through hydrothermal processes and show additional chemical and mineralogical results from Gale crater consistent with hydrothermal activity occurring after sediment deposition and lithification. Key Points: Chemical and mineralogical data from the Curiosity Mars rover suggest a history of hydrothermal alteration within Gale craterSilica‐rich alteration halos and tridymite‐bearing deposits exhibit similar chemical signatures, suggesting related formation processesWe propose the in situ formation of tridymite through hydrothermal processes as an alternative to a detrital origin [ABSTRACT FROM AUTHOR]

Histoplasmosis is the second most common fungal infection reported among domestic felines in the United States. Dissemination of the organism after inoculation is common and affected organ systems include the respiratory tract, gastrointestinal tract, reticuloendothelial organs, skeletal system, integument, and ocular system. However, histoplasmosis presenting as a discrete granulomatous mass identified on echocardiogram has never been reported in the veterinary literature. Here, we describe the first case of feline histoplasmosis presenting as a granuloma with cardiac involvement. The patient, a 6-year-old male neutered domestic longhair feline, was referred for tachypnea and dyspnea. A mass in the cranial mediastinum abutting the heart was diagnosed via two-dimensional echocardiography. Cytology of fine needle aspirates from the mass revealed round yeast structures consistent with Histoplasma spp. The patient was treated with oral fluconazole therapy, and subsequent rechecks have shown marked improvement in clinical parameters, lesion size, and antigen concentrations. [ABSTRACT FROM AUTHOR]

The resistant ~50 m thick Vera Rubin ridge (VRR) situated near the base of Mount Sharp, Gale crater, Mars, has been deemed a high priority science target for the Mars Science Laboratory mission. This is because of (1) its position at the base of the 5 km layered strata of Mount Sharp and (2) the detection of hematite from orbit, indicating that it could be the site of enhanced oxidation. The compositional data acquired by the Alpha Particle X‐ray Spectrometer (APXS) during Curiosity's exploration of VRR help to elucidate questions pertaining to the formation of the ridge. APXS analyses indicate that VRR falls within the compositional range of underlying lacustrine mudstones, consistent with a continuation of that depositional environment and derivation from a similar provenance. Lower Fe concentrations for VRR compared to the underlying strata discounts the addition of large amounts of hematite to the strata, either as cement or as detrital input. Compositional trends are associated with VRR cross‐cut stratigraphy, indicating postdepositional processes. Higher Si and Al and lower Ti, Fe, and Mn than the underlying mudstone, particularly within distinct patches of gray/blue bedrock, are consistent with the addition of Si and Al. Lateral and vertical compositional variations suggest enhanced element mobility and fluid flow (possibly via multiple events) through VRR, increasing toward the top of the ridge, consistent with the action of warm (~50–100°C), locally acidic saline fluids as inferred from the mineralogy of drilled samples. Plain Language Summary: Curiosity has explored the resistant Vera Rubin ridge (VRR) at the base of Mount Sharp, Gale crater, Mars, owing to (1) its position within the 5 km layered rocks of Mount Sharp, which record changes in Mars environment through time, and (2) the detection of hematite from orbit. The Alpha Particle X‐ray Spectrometer (APXS) measures the elemental composition of rocks. APXS analyses indicate that VRR has a similar composition to underlying mudstones, consistent with continued deposition in a lake. Lower iron discounts the addition of large amounts of hematite, holding together mineral grains either as cement or as detrital grains. Other elemental trends cut across layering, indicating postdepositional processes. Lateral and vertical compositional variations suggest enhanced element mobility and fluid flow (possibly via multiple events) through VRR, particularly at the top of the ridge and within gray/blue patches of bedrock, consistent with the action of warm (~50–100°C), acidic saline fluids inferred from the mineralogy of drilled samples. Key Points: Vera Rubin ridge is compositionally a continuation of the Murray formationCompositional trends cut across stratigraphy, are postdepositional, diagenetic, and/or products of later alterationAPXS data indicate enhanced fluid flow and Si, Al, and Mn mobilization within VRR [ABSTRACT FROM AUTHOR]

There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage. [ABSTRACT FROM AUTHOR]

We are conducting a long-term randomized controlled trial to find out whether intervention with a low-fat, high-carbohydrate diet reduces breast cancer risk. Subjects with extensive mammographic densities, a risk factor for breast cancer, were randomly assigned to an intervention group and given intensive individual counseling aimed at reducing total dietary fat to 15% of energy or to a control group that received general advice about diet but were not counseled to change their fat intake. Mammograms from 817 subjects taken at baseline and compared with those taken 2 y later by using a quantitative image analysis system and without knowledge of the dietary group of the subjects or of the sequence in which pairs of images had been taken. After 2 y the total area of the breast was reduced by an average of 246.2 [mm.sup.2] (2.5%) in the intervention group compared with an average of 9.2 [mm.sup.2] ([is less than] 0.1%) in controls (P = 0.01). The area of the density was reduced by 376.6 [mm.sup.2] (6%) in the intervention group compared with an average of 153.1 [mm.sup.2] (2.5%) in the control group (P = 0.02). The effect of the intervention on breast area was no longer statistically significant after weight change, menopausal status and age at trial entry were taken into account (P = 0.10). The effect of the intervention on area of density remained statistically significant after controlling for weight loss, age at entry and menopausal status (P = 0.05).

Alpha Particle X‐ray Spectrometer (APXS) results for Phase 2 of the Bagnold Dunes campaign, focusing on the linear dunes, complement those from Phase 1 (barchan dunes) and add to our understanding of active Martian dune systems. This work highlights both compositional similarities and differences across the dune field. The concentration of elements associated with mafic minerals in coarser grains and along active ripple crests, previously identified in the barchan dunes, highlights differences in Martian and terrestrial weathering, transport, and sorting processes. Concentration of a Cr‐Ti mineral phase within the linear sands is identified. The inactive ripple fields are geochemically similar to soil, while active ripple fields are similar to sands. Inferred dust content (S + Cl + Zn concentrations), derived from APXS analyses, provide geochemical confirmation of current and seasonal activity variations, within the barchan and linear dunes, as well as revealing a continuum between inactive soils and active sands. Plain Language Summary: During 2015–2017, the Mars Science Laboratory rover, Curiosity, in Gale Crater, Mars, crossed the active Bagnold Dunes, which comprise both barchan (crescent shaped) and linear dunes. This has enabled the first in situ appraisal of an active dune system on another planet, including the geochemical analysis (major elements, plus Ni, Zn, and Br) of sand samples via the Alpha Particle X‐ray Spectrometer. We find a concentration of elements (MgO and Ni) associated with mafic minerals (particularly olivine) along the crests of active ripples and in coarse‐grained samples. Elements such as SiO2, Al2O3, and K2O, associated with more felsic minerals such as plagioclase, are concentrated in off‐crest sand and finer‐grained portions. We find evidence for a Cr2O3‐TiO2 mineral phase, concentrated in the linear dunes. Dust content (indicated by SO3, Cl, and Zn levels) indicates that activity levels are higher in the linear dunes than in the barchan dunes. Key Points: Alpha Particle X‐ray Spectrometer results reveal compositional similarity between basaltic Bagnold barchan and linear sands (Gale Crater)Evidence of mineral segregation, and mafic element concentration in coarser fractions, along active ripple crests is observedLinear sands show evidence for the concentration of a Cr‐Ti mineral phase, previously undetected in the barchan dunes [ABSTRACT FROM AUTHOR]

The importance of Southeast Asia's tropical peat swamp forests for biodiversity is becoming increasingly recognised. Information on species presence within peatland areas is scant, however, limiting our ability to develop species conservation strategies and monitor responses to human activities. We compile species presence records for the Sebangau forest in Indonesian Borneo since 1993 and present the most complete Bornean PSF biodiversity inventory yet published. Including morpho-species that are likely to represent true species, this list comprises 215 tree, 92 non-tree flora, 73 ant, 66 butterfly, 297 spider, 41 dragon/damselfly, 55 fish, 11 amphibian, 46 reptile, 172 bird and 65 mammal taxa. Of these, 46 species are globally threatened and 59 are currently protected in Indonesia; 22 vertebrate species are Borneo endemics. Because our sampling is both biased and incomplete, the true number of species found at this site is likely to be much higher. Little is known about many of these taxa in Sebangau and peat swamp forests elsewhere. Many of these species are considered forest dependent, and the entire community is expected to be important for maintaining the resilience of the peat swamp forest ecosystem and the environmental services that it provides. This highlights the need for urgent conservation of Sebangau and its diverse biological community. [ABSTRACT FROM AUTHOR]

A seminal event occurred in the hydrogeology professian more than 20 years ago, namely, 'Love Canal.' Before Love Canal, contamination cases were dealt with on an ad hoc, site-specific basis, [...]