Search

Background and purposeThe Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results.Materials and methodsPublished or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint.ResultsFor the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans. Human papillomavirus-related/p16(+) oropharyngeal squamous cell carcinoma will now be staged separately; this change reflects the markedly better prognosis of these tumors compared with non-human papillomavirus/p16(-) oropharyngeal squamous cell carcinoma. Nodal staging has dramatically changed so that there are different tables for human papillomavirus/p16(+) oropharyngeal squamous cell carcinoma, Epstein-Barr virus-related nasopharyngeal carcinoma, and all other head and neck squamous cell carcinomas. Extranodal extension of tumor is a new clinical feature for this third staging group. In the oral cavity, the pathologically determined depth of tumor invasion is a new staging criterion, while extrinsic tongue muscle invasion is no longer part of staging. This review serves to educate radiologists on the eighth edition changes and their rationale.

Mesoproterozoic and Neoproterozoic basins in western North America record the evolving position of the Laurentian craton within two supercontinents during their growth and dismemberment: Columbia (Nuna) and Rodinia. The western-most exposures of the Columbia rift-related Belt-Purcell Supergroup are preserved in northeastern Washington, structurally overlain by the Deer Trail Group and depositionally overlying the Neoproterozoic Windermere Supergroup. It has been disputed whether the Deer Trail Group is correlative with the Belt-Purcell Supergroup, or younger. To help resolve the uncertain correlation of these units and their bearing on supercontinent evolution, we characterized the detrital zircon age populations of units from the Deer Trail Group, the Windermere Supergroup, and the Belt-Purcell Supergroup in northeastern Washington. These data show that the western part of the Columbia supercontinent (now located in Australia and eastern Antarctica) remained attached to western Laurentia and continued to supply 1600-1500 Ma detrital zircon grains to the Belt-Purcell Supergroup until after ca. 1391 Ma. The Deer Trail Group is younger than the Belt-Purcell strata, with the basal unit younger than ca. 1362 Ma and a middle unit younger than ca. 1300 Ma. The Deer Trail Group has a pre-Grenville-age provenance from the southwestern USA and possibly east Antarctica. The Buffalo Hump Formation is younger than the Deer Trail Group, with Grenville-age (ca. 1112 Ma) detrital zircon grains and a detrital zircon signature like that of the overlying Neoproterozoic Windermere Supergroup. We interpret the Deer Trail Group to have been deposited during the rift-demise of supercontinent Columbia and before the Grenville-age assembly of the supercontinent Rodinia. Key words: Precambrian, Proterozoic, supercontinent Columbia, Rodinia, Laurentia, detrital zircon U-Pb geochronology, petrochemistry, Belt-Purcell Supergroup, Deer Trail Group, Windermere Supergroup, Washington. Des bassins mesoproterozoiques et neoproterozoiques de l'Ouest de l'Amerique du Nord renferment un registre de l'evolution de la position du craton laurentien au sein de deux supercontinents, ceux de Columbia (Nuna) et Rodinia, durant leur croissance et leur demantelement. Les expositions les plus occidentales du Supergroupe de Belt-Purcell associe au rift de Columbia sont preservees dans le nord-ouest de l'Etat de Washington, le Groupe de Deer Trail se trouvant structuralement au-dessus et le Supergroupe neoproterozoique de Windermere, stratigraphiquement en dessous. La question a savoir si le Groupe de Deer Trail est correlatif ou plus jeune que le Supergroupe de Belt-Purcell a fait l'objet d'un debat. Pour aider a determiner les correlations incertaines entre ces unites et leur importance en ce qui concerne l'evaluation des supercontinents, nous avons caracterise les populations d'ages de zircons detritiques d'unites du Groupe de Deer Trail, du Supergroupe de Windermere et du Supergroupe de Belt-Purcell dans le nord-est de l'Etat de Washington. Ces donnees montrent que la partie ouest du supercontinent de Columbia (qui se trouve aujourd'hui en Australie et dans l'est de l'Antarctique) demeure attachee a la Laurentie occidentale et a continue de fournir des grains de zircons detritiques donnant des ages de 1600-1500 Ma au Supergroupe de Belt-Purcell jusqu'apres ~1391 Ma. Le Groupe de Deer Trail est plus jeune que des strates de Belt-Purcell, l'age de son unite basale etant inferieur a ~1362 Ma et l'age d'une unite intermediaire etant inferieur a ~1300 Ma. Le Groupe de Deer Trail a une region source d'age pre-grenvillien dans le sud-ouest des Etats-Unis et possiblement dans l'est de l'Antarctique. La Formation de Buffalo Hump est plus jeune que le Groupe de Deer Trail, presentant des grains de zircons detritiques d'age grenvillien (~1112 Ma) et une signature de zircons detritiques semblable a celle du Supergroupe neoproterozoique de Windermere sus-jacent. Nous interpretons le Groupe de Deer Trail comme ayant ete depose durant le demantelement par rifting du supercontinent de Columbia et avant l'assemblage d'age grenvillien du supercontinent de Rodinia. Mots-cles : Precambrien, Proterozoique, supercontinent de Columbia, Rodinia, Laurentie, geochronologie U-Pb sur zircons detritiques, petrochimie, Supergroupe de Belt-Purcell, Groupe de Deer Trail, Supergroupe de Windermere, Washington., Introduction Our understanding of how western Laurentia fit into the great Proterozoic supercontinents (Columbia (sometimes called Nuna): ca. 1.7-1.3 Ma, Zhao et al. 2004; Rodinia: 1.1-0.75 Ma, Li et al. [...]

Belinda O’Sullivan,1 Joelena Leader,2 Danielle Couch,3 James Purnell4 1Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia; 2Edwards School of Business, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 3School of Rural Health, Monash University, Bendigo, Victoria, Australia; 4Department of Academic Family Medicine Northern Medical Services, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCorrespondence: Belinda O’Sullivan Email belinda.osullivan@uq.edu.auAbstract: Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socio-economic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemic-related healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.Keywords: pandemic, rural primary healthcare, risk assessment, preparedness, rural system, outbreak, hazard; COVID-19

A first-principles study of native point defects in monoclinic, cubic, two different tetragonal, and five different orthorhombic phases of hafnia (HfO2) is presented. They include vacancy of tri-coordinated and tetra-coordinated oxygen, metal vacancy, interstitial metal, and interstitial oxygen. Defect formation energy, trap depth, and relaxation energy upon optical excitation of defects are listed. The trap depth of oxygen vacancies shows little variation among different phases compared to other defects. Results of the trap depth are compared against measurements and found to have reasonable agreement. [ABSTRACT FROM AUTHOR]