text:
WCTA Breakfast Panel: Leadership and Sustainability
Posted on December 6, 2012 by Tom Ranken
Is there a difference between good business management and sustainability? Not according to the WCTA panel on December 6, 2012, which was moderated by WCTA Board Member John Gardner, Vice President and Dean of the Bainbridge Graduate Institute.
Kevin Wilhelm of Sustainable Business Consulting said sustainability is almost completely consistent with hard-nosed business thinking. It is entirely consistent with corporate objectives: maximizing returns, cutting costs, improving brand, and maximizing shareholder value. No one, according to Kevin, is implementing sustainability because 'it is the right thing to do.' It is implemented–and widely–by individual business cases.
TJ DiCaprio reported that Microsoft is motivated by achieving business objectives, corporate citizenship, and reducing energy consumption. Carbon is now priced at Microsoft and it is reflected in business unit performance measurement. Pollution and sustainability needed to be translated into business relevant terms, she said, and then they become a compelling business came for management. Information technology is the source of 2% of global emissions. Find TJ's presentation slides here and Microsoft's Becoming Carbon Neutral document here.
Jim Hannah of Starbucks emphasized that employee retention is an important benefit of the company's sustainability programs. He told us that every new store will be LEEDS certified. Sustainability is part of Starbuck's DNA, but it needed to be translated into understandable business terms within the company.
Patrick Drum of the Arbor Group UBS told us that current metrics to evaluate socially responsible investing didn't even exist six months ago. Find Patrick's presentation here.
Find YouTube video of the conference here. (It is divided into 10 minute segments.) Section 1 | Section 2 | Section 3 | Section 4 | Section 5 | Section 6 | Section 7 | Section 8
Here are short bios of the panelists:
John Gardner, Vice President and Dean, Bainbridge Graduate Institute, Moderator. John has been a key leader in the growth of BGI over the past two years. Prior, he was VP at WSU responsible for leveraging WSU's assets for economic growth and vitality of the state. He filled a similar role at Missouri as VP for Research and Economic Development. In all, he has been a student, faculty member, or administrator at five land grant universities. Gardner is a native of the Kansas City area and earned degrees in agriculture and agronomy at Kansas State and a PhD at Nebraska in plant physiology. Though most of his career has been in the US Great Plains, his graduate work in both institutions was supported by US-AID in the sorghum/millet program INTSORMIL directed at Africa and India. While at the Missouri, his international research and development efforts focused on East Asia. He spent twenty years in ND, much of it as Director of the NDSU Carrington Research Extension Center. His work on the domestication of new crops led to business interests throughout the 1990's. He was one of the founders and chief executive of AgGrow Oils, a 540 member LLC that integrated the production, processing, and marketing of both novel and designer oilseeds.
Tamara "TJ" DiCaprio, Sr. Director, Carbon and Renewable Energy Policy, Microsoft: TJ is responsible for designing and managing Microsoft's new carbon neutral policy with internal carbon fee model that drives accountability while supporting efficiency and green projects. TJ has worked for Microsoft for 15 year, and has over 25 years of experience in the technology industry. She brings an educational background of Environmental Studies and Energy from the UC Santa Barbara and graduate work from Marylhurst, as well as a history of policy leadership to the role. TJ is a certified pilot and enjoys sailing and diving. She has led several expeditions piloting aircraft across the Americas and South Africa and sailed extensively off the coast of North America, French Polynesia, Croatia, and Turkey. TJ is a member of the Explorer's Club and a Founding Member of the Santa Barbara Maritime Museum.
Jim Hanna, Director, Environmental Impact, Starbucks Coffee Company: Since joining Starbucks in 2005, Jim has collaborated with partner corporations and nongovernmental organizations to help shape the company's environmental strategy. He contributes to enterprise-wide initiatives that support green building, energy conservation, international procurement, recycling, and waste reduction efforts. Prior to Starbucks, Jim served as Director of Environmental Affairs for Xanterra Parks & Resorts at Yellowstone National Park. In the position, he oversaw many progressive environmental initiatives in operations as the primary concessionaire in the park including an ISO 14001-certified Environmental Management System. Before escaping to Yellowstone, he worked as Director of Operations for Teris Environmental in Los Angeles, managing the company's seven offices in North America. A native of Olympia, Jim earned a BS in Environmental Sciences from WSU and is a U.S. Green Building Council LEED-accredited professional. He serves on the board of directors for the National Recycling Coalition, Washington Environmental Council, and Yellowstone Park Foundation.
Kevin Wilhelm, CEO, Sustainable Business Consulting: Kevin is a highly regarded business consultant in the field of sustainability and climate change. He is the CEO of Sustainable Business Consulting, a Seattle-based consulting firm focused on practical solutions that deliver profit improvement through the use of sustainable business practices. Kevin brings over 16 years of experience working with businesses ranging from Fortune 500 multinationals to government agencies to renewable energy start-ups. Some of his clients include Nordstrom, REI, The North Face, Coinstar/Redbox, Drugstore.com, and BECU. His firm works with companies to measure their sustainability and carbon impacts, develop successful implementation goals and strategies, engage employees through sustainability training, and help them communicate their CSR efforts both internally and externally. He is the author of the acclaimed Return on Sustainability: How Business Can Increase Profitability & Address Climate Change in an Uncertain Economy. He is an adjunct professor at the Bainbridge Graduate Institute where he teaches Sustainable Business.
Patrick T. Drum CFA, CFP, Financial Advisor and Senior Portfolio Manager at the Arbor Group/UBS Financial Services Inc. provided an overview of new practices in evaluating social responsibility in companies.
Fourth & Madison Building, 925 Fourth Ave, 18th Floor Conference Room, Seattle
This event sold out.
This was the first part of a two part series exploring corporate sustainability.
Posted in FeaturedTagged clean energy, clean tech, clean technology, cleantech, cleantech conference, sustainability, Washington Clean Technology Alliance
Maximize Sales and Marketing at the World's Largest Industrial Show
Seattle Company Developing Hybrid Mega-Ships

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: how can I make a custom overlay filter? I have a viewController with a UIImageView. The imageView is to be loaded with a different random picture from a given array when the viewController is displayed. Above the UIImageView I would like to implement a filter similar to one I found in photoshop but with my own custom modification for a clear window to the image below. Basically, what I am looking to do is display a random image behind a blurred filter but I would like a part of the blur filter to have a custom shaped window to the image below it where the image can be seen clearly. The rest of the image would still be blurred out. I have read apples documentation for applying filters to images but none of them suit my needs. Pretty new to development and haven't written any code for this feature yet. I'm more looking to see if it can be done and if so, could you point me in the direction of where I can research to find the answers I'm looking for? cheers!

A: I would recommend that you take the input image, pass it through a CIGaussianBlur, then I'd draw the image applying an image mask (using CIBlendWithMask or a CGPath.)

redpajama_set_name: RedPajamaStackExchange


text:
Culture Shock… USA
Before the arrival of European colonists in the 17th Century, America was populated by Indigenous groups of people. By the 1770s, there were thirteen British colonies in America containing two and a half million people. By 1776 these colonies had declared independence and became the United States of America.
Other big moments in American history include the assassination of Abraham Lincoln, the purchase of Louisiana, the assassination of John F. Kennedy, the American Revolution, the Civil War, the Manhattan Project, the Vietnam War, September 11 and the death of Osama Bin Laden.
George Washington was apparently the largest distiller of whiskey in the new American nation during the late 1700s. In the year before his death (1798), Washington's distillery produced 11,000 gallons of whiskey.
In America, the most popular sports include American football, baseball, basketball and ice hockey. The four Major leagues in the United States are the National Basketball Association (NBA), National Football League (NFL), Major League Baseball (MLB), the National Hockey League (NHL). These Leagues receive massive media exposure and are a huge part of American culture.


text:
Евге́ний Влади́мирович Вульф () — советский , флорист и биогеограф, специалист в области исторической географии растений.

Работал в Никитском ботаническому саду близ Ялты (1914—1926), один из лучших знатоков флоры Крыма.

Жизненный и научный путь
Родился в семье Владимира Михайловича и Генриетты Михайловны Вульф. У него был брат Георгий. Окончил Симферопольскую мужскую казённую гимназию. С 1903 по 1906 год учился в Московском университете. В 1909 году учился в Венском университете. В 1913 году, будучи магистрантом Московского университета, избран в члены Таврической учёной архивной комиссии.

С 1921 по 1926 год — профессор Таврического университета.

С 1926 года — во Всесоюзном институте растениеводства.

С 1934 года — профессор Ленинградского педагогического института имени М. Н. Покровского.

Погиб в Ленинграде во время блокады в декабре 1941 года от осколка фашистского снаряда. Похоронен на Серафимовском кладбище.

Память
Карстовая шахта-понор Вульфа (574-1). Находится на северо-западе массива Северная Демерджи. Заложена в горных породах верхнеюрского возраста. Протяженность 90 м, глубина 45 м, площадь 55 м². Названа в честь Евгения Владимировича Вульфа, автора многотомной «Флоры Крыма», исследователя растительности Крымских яйл, профессора Таврического университета и Крымского педагогического института. Название присвоено в 2000 году Карстовой комиссией КАН в связи со 115-летием со дня рождения.

Печатные труды
 Вульф Е. В. К флоре вершин крымских гор. 1. Сююр-кая, Парагельмен, Гелин-кая, Большая и Малая Цюцюли, гора Черная. Симферополь. Тип. Тавр. Губ. Земства. 1919.
 Вульф Е. В. Ареал и возраст // Труды по прикладной ботанике, генетике и селекции. 1927. Т. 17, вып. 4. С. 515—538
 Вульф Е. В. Введение в историческую географию растений. — М.: Сельхозгиз, 1932
 Вульф Е. В. Опыт деления земного шара на растительные области на основе количественного распределения видов // Труды по прикладной ботанике, генетике и селекции. Сер. 1. 1934. Вып. 2. С. 3—67
 Вульф Е. В. Историческая география растений. — М.; Л.: Издательство АН СССР, 1936
 Вульф Е. В. Полиплоидия и географическое распространение растений // Успехи современной биологии. 1937. Т. 7, вып. 2. С. 161—197
 Вульф Е. В. Историческая география растений. История флор земного шара. — М.; Л.: Издательство АН СССР, 1944
 Wulff E.V. An Introduction to Historical Plant Geography. — Waltham, MA: Chronica Botanica Co., 1943

Примечания

Литература

Ссылки
 Биография Евгения Владимировича Вульфа на сайте Всероссийского института растениеводства им. Н. И. Вавилова
 Кафанов А. И., Кудряшов В. А., 2005. Классики биогеографии : биобиблиографический указатель.

Выпускники Симферопольской мужской казённой гимназии
Преподаватели Российского государственного педагогического университета
Преподаватели Таврического национального университета им. В. И. Вернадского
Сотрудники ВИР
Жертвы блокады Ленинграда
Члены Русского ботанического общества
Сотрудники Никитского ботанического сада
Члены Таврической учёной архивной комиссии
Похороненные на Серафимовском кладбище

redpajama_set_name: RedPajamaWikipedia


Pond CLEAN is great for new ponds and existing ponds opening for the season. Pond Clean breaks down dead organic debris with natural bacteria and brings clean water clarity back to your pond. Pond Clean is safe for all Aquatic life, fish and plants!


text:
Q: IOS 8 Scan credit card name and expiration date in html form How can i get Expiration date and card holder name after scanning credit card?
the attribute name="cardNumber", can helps to scan the card number.
Does is their any way to get expiration month and name fields?

A: I just add autocomplete="cc-exp-year" and autocomplete="cc-exp-month"
and it works on my iPhone.
https://dotnetfiddle.net/pYwbUk


Charter schools in the area enjoy higher test scores and lower suspension rates, but administrators say their schools are more than just numbers.
Charter schools have been a politically contentious issue across the country, pitting school-choice advocates against teachers unions and backers of public education.
The argument against charters is they take students, and therefore funding, away from traditional public schools. But in the Coachella Valley, charter schools are thriving, in part due to partnerships with districts.
Three charter schools in the valley, George Washington Charter and Palm Desert Charter Middle School in Palm Desert and Cielo Vista Charter School in Palm Springs, continue to outperform other schools on state tests. While socioeconomic factors and demographics might play a role, teachers and administration use the same word to describe the reason for their success: autonomy.
"I think when you have the autonomy and the responsibility, you're more committed," said Sallie Fraser, principal of Palm Desert Charter Middle School.
"I can go to my principal and say, 'This is a really good book, can I have 50 copies?'" said teacher Claudia Lopez.
These charter schools are publicly funded but operate independently of any school districts. Every five years, the charters for these schools are approved by the local school districts. Like other public schools in the Coachella Valley, state money is their main source of revenue.
But once that money arrives at charters, it can be spent more swiftly without bureaucratic delays at the district level, according to administrators and teachers. Fraser said keeping financial control at the school level not only means more power for teachers but more responsibility. She said her teachers even try to conserve electricity because they know the money saved will go back to students.
The payoff: students at these schools meet or exceed state standards in math and English language arts at rates up to four times that at other schools, depending on the grade level.
In 2018, 58 percent of students at Palm Desert Charter Middle School met or exceeded standards based on the English language arts test results for the California Assessment of Student Performance and Progress, or CAASPP, according to the public database. At Desert Sands Unified overall, 48 percent met or exceeded standards.
At Washington Charter, 75 percent met or exceeded standards. At Cielo Vista Charter, 65 percent of students met or exceeded English language arts standards, compared with about 40 percent overall at Palm Springs Unified School District.
Despite their successes, the charter schools are anything but in competition with traditional public schools in the Coachella Valley.
In fact, the three schools are referred to as "dependent" charters because they contract with school districts for various services, like transportation, payroll and special education services. Moreover, teachers at all three of these schools are members of the teachers unions in their respective districts, meaning teacher salary schedules match those at other schools.
Allan Lehmann and Fraser, principals of Washington and Palm Desert charter, said they've cultivated collaborative relationships with Desert Sands Unified School District.
At Cielo Vista, Co-Principals Jennifer Geyer and Devlinn Clinton said test scores are only one metric of success. Amazing things are happening across the Palm Springs Unified School District, they said.
"I never want our successes that make the others look bad," Geyer said. "They're working so hard and they're addressing the unique needs of their schools."
For Geyer and Clinton, the social-emotional well-being of students is just as important as test scores. All three charters enjoy lower suspension rates than other comparable schools in their districts.
At Cielo VIsta, several teachers start classes with "circle time" during which students get to share what they did over the weekend or discuss who they would invite to a dinner party.
"It's about connecting with the kids before telling them what to do," said Jessica Parent, an English language arts teacher at Cielo Vista.
Demographics vary at these charter schools. Cielo Vista's student population is most reflective of the surrounding district. Students at Palm Desert Charter Middle and Washington Charter, however, tend to be whiter and less likely to be low income.
At Washington Charter, 39 percent of students are white compared with 20 percent across the Desert Sands School District overall. About 73 percent of the district's students are Latino while Washington has about half that percentage.
Census data, however, shows that Washington Charter's demographics match those of the surrounding neighborhood in southern Palm Desert, beneath Highway 111.
"If you look at the demographics of south Palm Desert, the demographics don't mirror the demographics of the valley," said Lehmann. "These are our neighborhood children who are coming to our school."
Demographic differences are most stark when comparing Washington Charter to Abraham Lincoln Elementary, just a mile north on Portola Avenue, across Highway 111. About 85 percent of students at Lincoln Elementary are Latino and 94 percent are from low-income families, compared with 39 percent Latino and 37 percent Latino at Washington.
Fraser said nearly all students graduating from Lincoln attend neighboring Palm Desert Charter Middle School.
Ashley Orozco, a first-grade teacher at Washington who used to teach at Roosevelt Elementary School in Indio, said she noticed more parent participation after transferring to the charter.
She said the less affluent community surrounding Roosevelt may have prevented more engagement from parents.
"The big thing I noticed here was more parent involvement," Orozco said. "We wanted it at Roosevelt, but it was the other side of the valley."
This parent involvement at Washington Charter is in part due to the Shared Support Agreement required to be signed by teachers, parents and students. Lehmann encourages parent volunteers, but said it would never be a barrier for families wishing to attend Washington.
"If some families are not able to do that, it's not going to preclude a child's enrollment," he said.
But for families whose children do attend a charter school, administrators said, parents are naturally more involved because they made a choice to attend.
"I think there is buy-in because they choose to have their child to be here," said Clinton, co-principal at Cielo Vista. "I think parents start to understand that they have a voice in their child's education."
Monique Childers, who serves as co-president of the parent-teacher organization and whose daughter is a student in Orozco's class, said she moved from Cathedral City to Bermuda Dunes to attend Washington Charter. She said she would have been happy sending her daughter to Gerald Ford Elementary in Indian Wells, the default school based on her address, but Washington's test scores as well as Lehmann's charisma had her hooked.
And while Washington's demographic data don't reflect those of the district, she described it as a welcoming and diverse environment.
"There is nothing required. Not everyone can participate," she said. "Some parents work one or two jobs, and that's totally understandable."
But one expert said actively seeking out vulnerable student populations is a worthy goal for high-performing charters.
"The school should be required to take active steps to recruit and make families aware of the offerings," said Robin Lake, director of the Center on Reinventing Public Education at the University of Washington. "The equity-based funding model creates incentives to recruit students who bring more money with them."
In California, charter schools and districts with higher percentages of low-income students, English learners and foster children receive additional funding. For Lake, the achievement gap between the Coachella Valley's charter schools and the surrounding districts, however, indicates the limits of a need-based funding model.
"Funding alone is not enough to overcome the complex barriers that have been placed for decades," she said. "I think it requires the community to commit to say, 'We want our kids to have an integrated educational experience.'"
Students at the three schools are admitted through a lottery managed by a third-party consulting firm. According to Lehman, the wait list for Kindergarten at Washington Charter can be anywhere between 75 and 100 students.
At Washington, students living in the "preferred admissions area," the region below Highway 111 between Cook Street and the Cahuilla Hills community, and siblings of current Washington Charter students receive priority.
Palm Desert Charter Middle School and Cielo Vista Charter give preference to siblings of current students and children of employees.
While high test scores might appeal to parents, Lehmann said test scores reflect just one week in a student's life. He said the overall well-being of the student should be top priority.
"I tell parents, 'Please don't choose Washington Charter because of test scores,'" he said. "All schools are more than just a test score."
March 28, 2019, 8:09 a.m.
June 27, 2017, 10:22 a.m.
Jan. 12, 2018, 5:01 p.m.
Aug. 18, 2015, 2:32 p.m.
July 27, 2015, 3:17 p.m.
SkillsUSA Lip Sync Battles: Friday, November 21!
July 27, 2015, 3:16 p.m.


text:
Philosophical Glossary
Denigrating Masculinity
This video insinuates that masculinity is some sort of social construct that has nothing to do with biological inclination:
What's really worrying is that, having watched it all, you may be asking yourself whether it's a men's rights or a feminist vid, that is, if you've listened to enough rhetoric from both movements, and aren't biased in one direction or another. By checking the 'about' section of the channel that the vid is uploaded to you will only see a few subscriptions, but one to none other than Feminist Frequency, the known feminist liar that is agitating in the gaming community with made up accusations of sexism. So this confirms a feminist bias, though in truth the whole video smacks of gender ideology masked as compassion - as usual from these manipulative predators.
The parallels that can be drawn in this vid to the average MRM (Men's Rights Movement) content these days shows that, with all the bravado of AVfM and MGTOW, they've literally turned the MRM into something that denigrates strong masculinity just as much as feminism. Basically, unless you're crying in the corner, like some sort of hysterical woman, then you're just acting out social constructs preventing you from being more like a woman, or you're a class victim, and need to be liberated from your false consciousness. In the case of MGTOW and leftist MRAs this involves loyalty to the group that mimics a gang, tribe, or cult.
Heaven forbid that you're a male that thrives in a competitive sport environment like the NFL, where injuries are likely, or loves activities that require spatial skills or logic. How dare anyone even suggest that testosterone and oestrogen generates sex specific traits such as female empathising and male systemising, making sex a predominantly binary condition, not some sort of fluid concept that tries to integrate homosexuality, and introduces made up concepts such as gender.
The question I have is what happens to civilisation when everyone cries and moans at every hurdle, and isn't prepared to stand up to bullies, tyrants and despots trying to mould people around them so they kowtow to their demands? Isn't it time we just accepted that the male warrior is what keeps authority in check, and that it's always been this way? There is no realistic scenario where interspecies predators simply go away, and while violence should always be a last resort, you can bet your bottom dollar that the toughest males will be victorious during times of adversity. You only need to look at history to see that. Shouldn't we be teaching men to use that power for good, instead of being easily exploited by the superficial charm of psychopaths and megalomaniacs?
As leftists of one type or another try to destroy the masculine spirit to protect and compete, which literally carved out modern civilisation, perhaps we should all take a moment to ask ourselves what happens if it all goes away? Do people honestly think that tyrants will disappear along with it? Or will we be left with a world where no one is prepared (or capable) of fighting for their freedom, leaving nothing but slavery in its wake? Perhaps people should ask whether this is actually what many predators want, as they pull the strings of human emotion, to make you believe that being a warrior is automatically wrong.
Tags: Feminism, Men's Rights, Science
My grandfather used to bust up communist meetings with his fists in the 40's and 50's.
He was extremely well read, and right wing according to the definition you subscribe. He knew the danger they represented from working with the cultures that were coming to this country escaping the horror of what communism was causing in Europe at the time.
I admire his conviction.
Maybe he understood Bezmenov's advice on how to get them to see the truth.
RockingMrE 27 December 2013 at 12:47
Communists have used "tolerance" as a weasel tactic to foster negative human qualities like envy, greed, and (ironically) intolerance, by suggesting that it's 'intolerant' to stand against their hateful ideology. Meanwhile they are wrecking virtues like stoicism and heroism, turning people into emotional zombies that will kowtow to leftist groupthink, becoming slaves to authority in the process. If only there were more men left that would fight against these zealots, before we all end up in the labour and re-education camps.
We don't live in a utopia where everyone is 100% safe. When something goes wrong, (a fire, a boat is sinking, someone is breaking into the house,) who does society expect to take charge? Men. Because we're generally more physically able. The truth is that many women will panic if men are not tough in even not so dangerous situation
Precisely. Nature made men the ones that take charge and fight against adversity. What these egalitarian dreamers don't understand is that without this tyrants will run amuck.
Competitiveness, the capacity for violence, and a certain sense of honor is the only thing that allows even the smallest group of humans to protect themselves from outside dangers. The only reason this film can exist is because we live in a (FALSE)peaceful time. When death comes to your family or your nation's front door, no one will look for your empathy. They will demand you commit violence with the face of a stoic.
Good point. All cultures end up destroying themselves through decadence and narcissism, which just breeds nihilism. Narcissists love to spread superficial charm and compassion to manipulate others, and it's clear as day that the people behind that video are a combination of all of these things.
Mr. Bickerstaff 28 December 2013 at 00:18
I think they do understand it, that's why they're pushing it. They want to be the tyrants- the 'elite' - controlling everyone else.
That's one of the explanations, and it's a pattern that can be confirmed with history. A lot of these people that think they'll be in charge however, will be lined up and shot when all's said and done.
They (the elites) have to destroy the fighting spirit so there is no uprising. Masculinity will lead the people to fight back, and they can't have that. It seems to be working....
It won't last forever though. I see signs that we are reaching that boiling point, when the 20% say enough is enough, as we've seen time and again in history.
Down With Foucault 31 December 2013 at 16:19
"I see signs that we are reaching that boiling point, when the 20% say enough is enough, as we've seen time and again in history."
I'm probably more of a pessimist than you: it amazes me that decent people are prepared to put up with what's going on. Perhaps we're anaesthetised by our wealth: Western society is rich (for the moment). Either way, Atlas doesn't look about to shrug anytime soon, as far as I can tell. Hope you're right, though...
Face it, MGTOW is a Cult
There is nothing of greater importance in a just world than holding oneself to the same standards as one expects from others. In the case of...
Countering Alinsky's 12 'Rules for Radicals'
Saul Alinsky's "Rules for Radicals" has become the bedrock of the modern left. It's a morally bankrupt doctrine that aims to demoralise anyo...
Stakeholder Capitalism: The World Economic Forum's Vision for Our Future
Delving into 'stakeholder capitalism', the economic model of The World Economic Forum.
New Mutation of COVID-19 Discovered
This video delves into the so-called discovery of a new mutation of COVID-19, and how this ultimately plays into the 'script' for ne...
Did Trump Throw Capitol Hill Protesters Under the Bus?
An examination of the events surrounding the Capitol Hill protest, particularly focusing on whether Donald Trump betrayed his supporters.
Archive January 2021 (4) December 2020 (6) November 2020 (9) October 2020 (8) September 2020 (7) August 2020 (7) July 2020 (6) June 2020 (5) May 2020 (8) April 2020 (7) March 2020 (8) February 2020 (9) January 2020 (8) December 2019 (6) November 2019 (8) October 2019 (7) September 2019 (9) August 2019 (9) July 2019 (5) June 2019 (8) May 2019 (8) April 2019 (6) March 2019 (8) February 2019 (6) January 2019 (9) December 2018 (4) November 2018 (4) October 2018 (6) September 2018 (4) August 2018 (3) July 2018 (9) June 2018 (8) May 2018 (8) April 2018 (7) March 2018 (9) February 2018 (8) January 2018 (8) December 2017 (7) November 2017 (9) October 2017 (9) September 2017 (8) August 2017 (6) July 2017 (8) June 2017 (9) May 2017 (9) April 2017 (4) March 2017 (9) February 2017 (8) January 2017 (8) December 2016 (6) November 2016 (8) October 2016 (8) September 2016 (6) August 2016 (4) July 2016 (6) June 2016 (5) May 2016 (5) April 2016 (2) March 2016 (4) February 2016 (6) January 2016 (3) December 2015 (3) November 2015 (6) October 2015 (4) September 2015 (4) August 2015 (3) July 2015 (4) June 2015 (5) May 2015 (5) April 2015 (3) March 2015 (5) February 2015 (3) January 2015 (4) December 2014 (3) November 2014 (4) October 2014 (3) September 2014 (5) August 2014 (3) July 2014 (3) June 2014 (5) May 2014 (3) April 2014 (3) March 2014 (5) February 2014 (5) January 2014 (5) December 2013 (9) November 2013 (3) October 2013 (2) September 2013 (2) August 2013 (1) July 2013 (1) June 2013 (3) May 2013 (1) April 2013 (1) March 2013 (1) February 2013 (1) January 2013 (1) December 2012 (1) November 2012 (1) October 2012 (1) September 2012 (2) August 2012 (1) July 2012 (2) June 2012 (2) May 2012 (3) April 2012 (1) March 2012 (1) January 2012 (2) December 2011 (1) November 2011 (4) October 2011 (3) September 2011 (4) August 2011 (1) July 2011 (1) June 2011 (1) May 2011 (1)
Tag Glossary
Party Politics (103) Communism (94) Theism & Atheism (93) Political Correctness (90) Internationalism (88) History (70) Feminism (69) Current Events (68) Democracy (63) Psychology (63) Nationalism (61) Socialism (61) The Occult (59) Popular Culture (55) Queer Ideology (53) Science (53) Depopulation Agenda (52) Collectivism (51) Men's Rights (44) Economics (43) Fascism (43) Racial Supremacy (39) Relationships (39) Nihilism (34) Censorship (30) Libertarianism (28) Individualism (26) Medicine (26) Conservatism (25) Environmentalism (22) Rationalism (16) Fake News (15) Liberalism (15) Theology (15) Natural Law (14) Corporatism (11) Postmodernism (11) Technology (10) Christian Morality (7) Realism (7) Secret Societies (4)
RockingMrE
Tweets by RockingMrE
Follow Posts by Email
Other Subscription Links


Welcome Home to this fantastic 2 story home. This a quality constructed home by award winning Eagle Creek Homes LLC,. This home features 4 bedrooms with a main floor study/office. The home features a grand staircase leading to the second level.The master suite will not disappoint as it features a large walk in closet and amazing tile shower. The other 3 bedrooms are all generously sized with spacious closets. Don't miss your chance to own this great home. Call or text for your private showing today!


plaid sofa and furniture couch beautiful design throw covers country sofas s loveseat loveseats beaut.
pull out couch large size of sofas sectionals twin mattress for plaid sofa and loveseat sale sleeper latest.
plaid sofa and tapestry living room furniture 3 cushion leather country loveseat for sale.
plaid sofa and medium size of love seat piece arrangement set covers loveseat red country style sofas.
black plaid sofa and loveseat for sale white sofas windowpane country s furniture village corner.
country style sofas and furniture bill plaid sofa loveseat.
country plaid sofa cottage furniture collection blue in design throw and loveseat for sale.
throw queen pillows throws looking good target green covers sleeper sofa and sets decor plaid loveseat for sale.
plaid sofa and new lazy boy country green love loveseat red windowpane.
country plaid sofas sectional unique green furniture sets beautiful sofa and loveseat for sale.
plaid sofas large size of replacement cushions sofa classic recliners and sectional on couch loveseat slipcovers e.
country sofas and plaid sofa couches loveseat loveseats style sty.
country plaid sofas sofa and loveseat couch covers.
overstock sofas leather chair blue plaid sofa sage green turquoise soft and loveseat for sale.
plaid red and white rocker country sofas s sofa loveseat loveseats.
plaid sofa and original mid century modern slipcovers set loveseat red country sofas net.
country plaid sofas anyone have couches edited with a picture of the living area sofa couch and loveseat for sale.
jacquard sofa cover canape protector elastic cloth printed plaid covers and loveseat for sale.
download by tablet desktop original size living room couch info red plaid sofa and loveseat for sale awesome chair home.
plaid couch sofa and loveseat blue.
plaid sofa and loveseat for sale.
plaid sofa and sets loveseat for sale sure fire couches living room furniture magnificent couch country pl.
country style sofas and red plaid couch one cushion sofa furniture for sale loveseat loveseats f.
awesome fresh plaid sofa slipcovers for couch cotton and loveseat 2.
plaid couch couches living room furniture stunning improbable with interior design sofa and loveseat red cou.
plaid sofa cotton cover pastoral covers fabric slipcover couch and set loveseat.
pillows amusing plaid green set target queen sofa country throw and decor blue red sets loveseat sofas loveseats.
country style sofas and plaid cottage red sofa s loveseat slipcovers.
country couches french sofa new chair the armchair plaid sofas and loveseat for sale.
sofa and in black tartan from home plaid loveseat country sofas loveseats.
plaid sofa cover elastic zebra covers for living room furniture slipcovers armchairs and loveseat.
colonial style sofa in plaid cover arts and crafts perfectly country sofas elegant design french velvet fabric tufted loveseat for sale pl.
sold slipcover sure fit division cannon inc green plaid sofa and loveseat.
plaid sofa and appealing sofas s sales in loveseat matching green ivory red.
plaid sofa and inspirational amazon sure fit buffalo deluxe pet cover slipcover loveseat red.
deep sofa plaid new antique furniture shop and loveseat red.
red plaid sofa check fabric dollhouse furniture doll and couch loveseat antique french country bedroom.
plaid sofa and couches living room furniture magnificent couch images of home design ideas decorating loveseat red navy blue couche.


text:
Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution
Eric J. Di Gravio1,
Pencilla Lang2,
Hugh Andrew Jinwook Kim1,
Tricia Chinnery3,
Neil Mundi1,
S. Danielle MacNeil1,2,
Adrian Mendez1,2,
John Yoo1,2,
Kevin Fung1,2,
Joe S. Mymryk1,2,4,
John W. Barrett1,
Nancy Read2,
Varagur Venkatesan2,
Sara Kuruvilla2,
Lucas C. Mendez2,
Eric Winquist1,2,
Sylvia Mitchell2,
Sarah A. Mattonen2,3,
Anthony C. Nichols1,2,5 &
David A. Palma1,2,5
Radiation Oncology volume 15, Article number: 261 (2020) Cite this article
Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.
Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria.
A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026).
Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.
Over the past few decades, there has been a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OPSCC), largely due to increasing rates of infection with human papillomavirus (HPV) [1]. HPV-associated OPSCC patients tend to be younger and healthier than traditional smoking- and alcohol-related OPSCC patients, and have a significantly improved prognosis. The 5-year survival of HPV-associated OPSCC exceeds 80%, making quality of life after treatment increasingly important since these patients may now survive for many years with significant treatment toxicities [2]. This has led to intense interest in treatment de-escalation, with the goal of reducing the toxicity of standard dose chemoradiation therapy [3]. In the United States, transoral surgery (TOS), particularly transoral robotic surgery (TORS), has largely become the preferred treatment modality for early T-stage OPSCC, as retrospective data has suggested a more favourable toxicity profile [4]. However, there is a paucity of data directly comparing the two modalities making the choice of treatment for OPSCC highly controversial [5].
The drive to adopt TOS as the standard of care revolves around the assumption that it carries a lower toxicity profile, and therefore better quality of life, than standard chemoradiation [5]. The ORATOR study, a phase II trial of 68 patients, is the only randomized clinical trial to directly compare quality of life between primary radiotherapy and primary TOS approaches, and included patients regardless of HPV status [6]. In this trial, toxicity profiles differed between the two modalities. In particular, swallowing-related quality of life as measured by the MD Anderson Dysphagia Inventory was statistically superior in the chemoradiation group as compared to the TORS group, although the difference did not represent a clinically meaningful change [6].
This discrepancy with previously published retrospective data can partially be explained by two potential sources of bias in previous studies: the inclusion of advanced stage OPSCC in chemoradiation cohorts, as well as improved toxicity profiles of modern radiation techniques [6, 7]. TORS is only FDA approved for treatment of early stage (T1-2) OPSCC. However, many retrospective studies comparing TORS to chemoradiation include chemoradiotherapy cohorts containing advanced T-stage disease even though these patients are generally not considered candidates for TORS [4, 8,9,10,11]. Furthermore, advances in radiotherapy such as intensity-modulated radiation therapy (IMRT) allow for more conformal treatment plans, reducing prevalence and severity of side effects such as dysphagia [12,13,14].
The purpose of this study is to examine the modern outcomes and toxicity in patients with early stage disease (T1-2, N1-2) treated with IMRT ± chemotherapy at a high-volume tertiary care cancer centre. We include only patients with T1-2 N1-2 disease as these patients would be considered candidates for treatment with primary transoral laser or robotic surgery.
Study participants and clinical features
Research Ethics Board approval (17222E) was obtained. A retrospective chart review was performed of all patients with early stage OPSCC treated with curative-intent radiotherapy ± chemotherapy who presented to the London Health Sciences Centre (LHSC) between 2014 and 2018. Early stage was defined as American Joint Committee on Cancer 7th Edition stage T1-T2, N0-N2. Patient, tumour and treatment-related factors collected included: gender, age at diagnosis, smoking and alcohol history, site of primary tumour (base of tongue, palatine tonsil, soft palate, vallecula, lateral or posterior pharyngeal wall, or unknown), TNM stage, HPV status, and use of concurrent chemotherapy. HPV status was determined with p16 immunohistochemical analysis with strong and diffuse staining in > 70% of tumour cells considered positive. Patients are reported with the chemotherapy protocol that they initiated treatment with regardless of whether they completed the full course or were switched to a different protocol during treatment. Alcohol abuse was defined as a history of > 20 alcoholic beverages per week. A significant smoking history was defined as a total of 10 or more pack-years.
All patients received definitive intent radiotherapy with IMRT with fixed-gantry or rotational techniques (tomotherapy or volumetric modulated arc therapy [VMAT]). Patients generally received 70 Gy in 35 fractions (5 daily fractions delivered per week) to the gross disease, and 56 Gy in 35 fractions to the elective nodal volume. Patients were generally treated with concurrent high dose cisplatin (100 mg/m2 given every three weeks), excluding patients aged ≥ 70, those with comorbidities or poor performance status or those who declined. Weekly cisplatin (40 mg/m2) could be used at the discretion of the medical oncologist. If patients were not suitable for concurrent cisplatin, alternative chemotherapy regimens could include the Calais regimen (carboplatin and 5-fluorouracil) or cetuximab. If patients did not receive concurrent systemic therapy an accelerated fractionation (6 fractions per week delivered over 5 days) was used at the discretion of the treating oncologist. Unilateral radiation was used for tonsil primaries with less than 1 cm extension into the tongue base or palate with ≤ 1 ipsilateral lymph node. All other patients received bilateral treatment.
Evaluation and follow-up
After completion of radiotherapy all patients were seen at 6 weeks for a clinical assessment of response and treatment toxicity, every 3 months for the first 2 years, and then every 4 to 6 months in the third to fifth years. A follow-up computed tomography (CT) scan was obtained at 3 months, with additional imaging, including positron emission tomography-computed tomography (PET-CT), if there was an incomplete response or if clinically indicated. Salvage surgery was reserved for patients who had persistent disease on follow-up imaging or clinically suspicious findings. All recurrences were histologically confirmed if possible.
Toxicity assessment
Treatment toxicities were graded using the CTCAE version 5.0 [15]. Toxicities or death occurring during or within 30 days of the end of treatment were included. Toxicities assessed included dysphagia, neutropenia, febrile neutropenia, ototoxicity and acute kidney injury. Any use of nasogastric, gastrostomy (G), gastrostomy-jejunostomy (GJ) tube or total parental nutrition (TPN) within this time frame was considered a grade 3 dysphagia. Any change in diet not requiring the aforementioned interventions was considered grade 2 dysphagia.
Descriptive statistics were generated for baseline patient characteristics for all patients (n = 198). Overall survival (OS) and disease-free survival (DFS) were calculated from the date of treatment to date of recurrence (DFS), date of death, or date of last follow-up, whichever occurred first. Kaplan-Meier estimates were generated for OS and DFS stratified by HPV status and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression was performed for both OS and DFS to assess the association between baseline characteristics and OS and DFS respectively. Backward step-wise analysis was used to create the final multivariate model of overall and disease-free survival (Additional files 1 and 2). All statistical analysis was performed using the R language environment for statistical computing version 3.4.0 (open source, www.r-project.org), using two-sided statistical testing at the 0.05 significance level.
Patient and treatment characteristics
A total of 198 patients (163 male and 35 female) treated with chemoradiation or radiotherapy alone were included in this analysis. Figure 1 depicts a flowchart of the screening process for inclusion. The crude median follow-up for surviving patients was 27.4 months from the completion of treatment (range: 0–63). Baseline and treatment characteristics are summarized in Table 1. Median age at diagnosis was 61 years with 114/198 patients (57.6%) having greater than a 10 pack-year smoking history and 49/198 (24.7%) consuming more than 20 alcoholic beverages per week. One hundred and forty-four of 198 (72.7%) patients had proven p16 positive disease and 140/198 (70.7%) and 125/198 (63.1%) had stage T2 and N2 disease respectively. One hundred and fifty-nine of 198 (80.3%) patients were treated with chemoradiation with the most common chemotherapy protocol being monotherapy with cisplatin. Of patients receiving cisplatin, 61.4% received high dose treatment, while 38.5% received weekly treatment (Table 1). Of patients receiving high dose cisplatin, 70/80 (87.5%) received 2 or more cycles with 54/80 (67.5%) completing all three. Of patients treated with weekly cisplatin, 45/55 (81.8%) completed 5 or more cycles with only 17/55 (30.9%) completing all 7 cycles.
Flowchart of oropharyngeal cancer patients. CRT—chemoradiation; OPSCC—oropharyngeal squamous cell carcinoma; RT—radiotherapy
Table 1 Baseline and treatment characteristics
Treatment toxicity
Data on acute toxicity is summarized in Table 2. One hundred and thirty five of 198 (68%) of patients experienced at least one grade 2 toxicity, 95/198 (48%) a grade 3 toxicity and 8/198 (4%) a grade 4 toxicity. Of note, no patients experienced a grade 5 (fatal) toxicity during treatment. The most common toxicity was dysphagia followed by neutropenia and ototoxicity. Patients treated with radiation alone experienced fewer toxicities compared to patients treated with chemoradiation (p < 0.0001). Most notably, in total, 56/198 (28%) of patients experienced grade 3 dysphagia and 37/198 (19%) required placement of G/GJ tube. However, the rate of G/GJ tube use during treatment was significantly greater in patients treated with chemoradiation compared to patients treated with radiation alone (p = 0.0196 ). Among patients treated with radiation alone, rates of grade 3 dysphagia and G/GJ tube insertion during treatment were 4/39 (10%) and 2/39 (5.1%) respectively, compared to 52/159 (33%) and 33/159 (21%) for patients treated with chemoradiation. Two patients (1 treated with radiation alone and the other with chemoradiation) required G/GJ tube placement more than a month after completion of treatment. In total, the 1- and 2-year rates of G/GJ tube use were 2.5 and 1% respectively (5 and 2 patients respectively). Only 8 patients (4%) experienced a grade 4 toxicity (2 ototoxicity, 6 neutropenia).
Table 2 Summary of toxicities
Predictors of overall and disease-free survival
In total, 32/198 (16%) patients included in this study died. Seventeen of these 32 (53%) patients died with disease still present, either as a direct result of their disease or due to unrelated causes, while 15/32 (47%) died of unrelated causes while in remission. Furthermore, 32/198 (16%) of patients experienced disease recurrence, of which 27/32 (84%) were histopathologically proven. Nine of 32 (28%) recurrences were local, 13/32 (41%) were regional, 8/32 (25%) were distant, 1/32 (3%) was both local and regional and 1/32 (3%) was both regional and distant. Nineteen of 32 (59%) patients with recurrence required salvage surgery.
Thirty-two of 198 patients with incomplete clinical information were omitted from Cox proportional hazards regression. Univariable analysis revealed age, smoking status, alcohol use and p16- status as significant prognostic factors for OS (Additional file 1). With multivariable analysis, smoking history (HR: 3.59 95% CI: 1.02–12.7, p = 0.0472) remained a significant prognostic factor for OS (Additional file 1). Age and alcohol use were predictors of DFS in univariable and multivariable analysis (Additional file 2). p16-positive status was associated with improved OS (p = 0.0026) but not DFS (p = 0.17, Fig. 2).
Overall (a) and disease-free (b) survival for all patients with early-stage OPSCC seen at the London Health Sciences Centre by p16 status (27 patients p16 negative; 142 patients p16 positive; 26 patients with unknown status were excluded)
Patterns of treatment failure
Disease relapse stratified by p16 status is outlined in Fig. 3. Consistent with the literature, p16-negative patients were more likely to experience locoregional relapse than p16-positive patients (7/28 vs. 10/144, p < 0.01), and significantly more likely to die from that recurrence (7/7 vs. 3/10, p=0.0089) [3]. There were nine distant metastatic failures in the p16-positive cohort including lesions in the lung, liver and skeleton, while none occurred in the p16-negative group, however this was not statistically significant (9/144 vs. 0/28, p = 0.36).
Patterns of treatment failure stratified by p16 status (positive, negative or unknown). AWOD—alive without disease; DOD—dead of disease
In this study, we demonstrated that while IMRT-based (chemo)radiation can have short- and long-term toxicities, early-stage HPV-associated OPSCC patients experienced excellent survival with acceptable toxicities, low long-term gastrostomy dependency rates and negligible treatment-related mortality (0% in this study). In contrast, prior studies have reported higher toxicity rates, with treatment related deaths of up to 3% [2, 16]. Similarly, a frequently cited meta-analysis of the Radiation Therapy Oncology Group treatment intensification trials by Machtay and colleagues reported that 43% of patients treated with primary chemoradiation for OPSCC suffered a severe major late toxicity, including a 10% rate of long-term feeding tube dependency [16]. This is relevant as these studies are often cited as a reference comparison for primary transoral surgery [4, 8,9,10,11]. While TOS can be carried out for advanced stage disease, in most case series, > 85% of tumours are limited T1-T2 stage [4, 8,9,10]. In contrast, the chemoradiation studies included high rates of advanced T stage disease (> 75% in one such study by Ang and colleagues) [3], introducing bias into the comparison of historical series. Furthermore, many of these studies were carried out in the pre-IMRT era, which would likely impact function and toxicity [2, 13, 14, 16]. Patients eligible for TOS have low-volume disease that may allow for unilateral radiotherapy and improved normal tissue sparing compared to historical chemoradiation cohorts that include a wider range of patients. There is a deficiency in the literature of reported outcomes of solely early-stage patients. This study reports the outcomes and toxicities of early-stage oropharynx patients undergoing primary radiotherapy with modern techniques, and provides a historical comparison cohort for discussions around surgical outcomes. Rates of toxicity and treatment-related mortality are lower than in previously published cohorts.
Febrile neutropenia is a potentially life threatening and frequent complication of chemoradiation in many studies [17, 18]. For example, a study by Bledsoe and colleagues reported a rate of febrile neutropenia of 26% in patients treated with chemoradiation with 2/32 (6.3%) of these patients dying as a direct result [17]. In contrast, 19.7% of our early-stage patients did not require chemotherapy at all and thus were not at risk of this complication. In the chemoradiation cohort specifically, the rate of febrile neutropenia was only 8.8% and there were no fatalities (Table 2).
One of the strongest predictors of poor patient quality of life following treatment for head and neck cancer is long-term gastrostomy tube dependence [19]. Chemoradiation studies report rates of up to 10% long-term dependence while most TOS studies show lower rates [4, 20, 21]. In a previous systematic review, the majority of studies demonstrated gastrostomy rates of less than 4.5%, with many (6/13) showing rates of 0% suggesting superior swallowing function with primary surgery [4]. However, this study has 2-year gastrostomy rates of 1%. This is similar to the results of the ORATOR trial, and suggest that swallowing outcomes are similar between the two treatment strategies [6]. Given the similar survival, treatment selection for early OPSCC should be an informed decision made between clinicians and patients.
In this study, we also attempt to describe potential prognostic indicators for OS and DFS. It is well-established that HPV-associated OPSCC has a significantly better OS and DFS than HPV-negative patients [3]. In our study, OS but not DFS was found to be significantly better in HPV-associated OPSCC, possibly due to limited sample size (Fig. 1). In early stage disease, chemoradiation appeared effective regardless of HPV status, and the differences in OS may be partially related to the presumed increased incidence of comorbidities in HPV-negative patients and subsequent non-cancer related death. Likely for similar reasons, on multivariable analysis, a history of smoking was associated with a worse OS but not DFS (Additional files 1 and 2).
Concurrent chemoradiation with 3 cycles of high-dose cisplatin is currently the standard treatment for locoregionally advanced OPSCC [22]. However, due to short- and long-term toxicities, and due to the fact that HPV-associated OPSCC is more sensitive to chemotherapy and radiation than HPV-negative OPSCC, there has been much interest in treatment de-escalation [23, 24]. Some current strategies under investigation include weekly cisplatin instead of high-dose cisplatin, lower radiation dose, or decreased adjuvant radiation and/or chemotherapy after surgery [25,26,27]. Other strategies, such as using the epidermal growth factor receptor (EGFR) monoclonal antibody cetuximab, have conclusively been shown to provide inferior survival without meaningfully improving quality of life which only further highlights the importance of balancing toxicity with survival [28, 29].
There are a number of limitations with this current study. First of all, it is inherently difficult to accurately grade toxicities retrospectively, precluding the inclusion of other common but less severe toxicities such as mucositis, xerostomia or peripheral neuropathy. The follow-up period was limited and thus may have led to an underestimation of long-term toxicities. This data is limited to a single centre and thus may not accurately portray the true variability in the patient population. Lastly, a number of important potential confounders such as socioeconomic factors and compliance with treatment were not addressed.
Patients with early-stage OPSCC have excellent survival, and current assumptions about the toxicities associated with chemoradiation are likely over-stated in this population. Early-stage patients have low rates of gastrostomy tube dependence and treatment-related mortality. The lower rate of toxicity in early-stage patients compared to historical series is important to keep in mind when comparing toxicity profiles between chemoradiation and TOS. This study can provide a reference for comparison for patients treated with primary transoral laser or robotic surgery in future trials.
All data generated and analyzed during this study are included in this published article (and its supplementary information files).
CRT:
Chemoradiation
CTCAE:
Common terminology criteria for adverse events
DFS:
Disease free survival
HPV:
IMRT:
LHSC:
OPSCC:
Oropharyngeal squamous cell carcinoma
Overall survival
TORS:
Transoral robotic surgery
TOS:
Transoral surgery
VMAT:
Volumentric modulated arc therapy
Chaturvedi AK, Anderson WF, Lortet-Tieulent J, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31:4550–9.
Ringash J. Survivorship and quality of life in head and neck cancer. J Clin Oncol. 2015;33:3322–7.
Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;362:24–35.
Yeh DH, Tam S, Fung K, et al. Transoral robotic surgery vs radiotherapy for management of oropharyngeal squamaous cell carcinoma: a systematic review of the literature. Eur J Surg Oncol. 2015;41:1603–14.
Cracchiolo JR, Baxi SS, Morris LG, et al. Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base. Cancer. 2016;122:1523–32.
Nichols AC, Theurer J, Prisman E, et al. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet. 2019;20:1349–59.
de Almeida JR, Byrd JK, Wu R, et al. A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope. 2014;124:2096–102.
Weinstein GS, O'Malley BW, Magnuson JS, et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety and surgical margins. Laryngoscope. 2012;122:1701–7.
Weinstein GS, O'Malley BW, Cohen MA, et al. Transoral robotic surgery for advanced oropharyngeal carcinoma. JAMA. 2010;136:1079–85.
Moore EJ, Olsen SM, Laborde RR, et al. Long-term functional and oncological results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc. 2012;87:210–25.
Holsinger FC, Ferris RL. Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx Cancer: robotics, lasers and clinical trials. J Clin Oncol. 2015;33:3285–92.
Gupta T, Kannan S, Ghosh-Laskar S, Agarwal JP. Systematic review and meta-analyses of intensity-modulated radiation therapy versus conventional two-dimensional and/or or three-dimensional radiotherapy in curative-intent management of head and neck squamous cell carcinoma. PLoS ONE. 2018;13:e0200137.
Ursino S, Dngelo E, Mazzola R, et al. A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy: a systematic review by the Italian Head and Neck Radiotherapy Study Group. Strahlenther Onkol. 2017;193:877–89. https://doi.org/10.1007/s00066-017-1160-7.
Mazzola R, Ferrera G, Alongi F, et al. Organ sparing and clinical outcome with step-and-shoot IMRT for head and neck cancer: a mono-institutional experience. Radiol Med. 2015;120:753–8. https://doi.org/10.1007/s11547-015-0512-6.
U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Common terminology criteria for adverse events (CTCadverse event) version 5.0. 2017.
Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582–9.
Bledsoe TJ, Noble AR, Hunter GK, et al. Oropharyngeal squamous cell carcinoma with known human papillomavirus status treated with definitive chemoradiotherapy: patterns of failure and toxicity outcomes. Radiat Oncol. 2013. https://doi.org/10.1186/1748-717X-8-174.
Urban D, Corry J, Solomon B, et al. Weekly cisplatin and radiotherapy for low risk, locoregionally advanced human papillomavirus-positive oropharyngeal squamous cell carcinoma. Head Neck. 2015;38:E1117–21.
Wells M, Swartzman S, Lanh H, et al. Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey. Support Care Cancer. 2016;24:2463–72.
Chen AM, Daly ME, Luu Q, et al. Comparison of functional outcomes and quality of life between transoral surgery and definitive chemoradiotherapy for oropharyngeal cancer. Head Neck. 2014;37:382–5.
Sharma A, Patel S, Baik FM, et al. Survival and gastrostomy prevalence in patients with oropharyngeal cancer treated with transoral robotic surgery vs. chemoradiotherapy. JAMA Otolaryngol Head Neck Surg. 2016;142:691–7.
You EL, Henry M, Zeitouni AG. Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management. Curr Oncol. 2019;26:119–23.
Oosthuizen JC, Doody J. De-intensified treatment in human papillomavirus-positive oropharyngeal cancer. Lancet. 2019;393:5–7.
Price KAR, Nichols AC, Shen CJ, et al. Novel strategies to effectively de-escalate curative-intent therapy for patients with HPV-associated oropharyngeal cancer: current and future directions. Am Soc Clin Oncol Educ Book. 2020;40:1–13.
Deschuymer S, Mahanna H, Nuyts S. Toxicity reduction in the treatment of HPV positive oropharyngeal cancer: emerging combined modality approaches. Front Oncol. 2018;8:439.
Hargreaves S, Beasley M, Hurt C, et al. Deintensification of adjuvant treatment after transoral surgery in patient with human papillomavirus-positive oropharyngeal cancer: the conception of the PATHOS study and its development. Front Oncol. 2019;9:936.
Nichols AC, Lang P, Prisman E, et al. Treatment de-escalation for HPV-associated oropharyngeal squamous cell carcinoma with radiotherapy vs. trans-oral surgery (ORATOR2): study protocol for a randomized phase II trial. BMC Cancer. 2020;20:125.
Mehanna H, Robinson M, Hartley A, et al. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet. 2019;393:51–60.
Gillison ML, Trotti AM, Harris J, et al. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet. 2019;393:40–50.
This work was supported by Canadian Institutes of Health Research Grant MOP#142491 to JSM and ACN. ACN was supported by the Wolfe Surgical Research Professorship in the Biology of Head and Neck Cancers Fund.
Anthony C. Nichols and David A. Palma contributed equally to this manuscript
Department of Otolaryngology – Head and Neck Surgery, Western University, London, ON, Canada
Eric J. Di Gravio, Hugh Andrew Jinwook Kim, Neil Mundi, S. Danielle MacNeil, Adrian Mendez, John Yoo, Kevin Fung, Joe S. Mymryk, John W. Barrett, Eric Winquist, Anthony C. Nichols & David A. Palma
Department of Oncology, Western University, London, ON, Canada
Pencilla Lang, S. Danielle MacNeil, Adrian Mendez, John Yoo, Kevin Fung, Joe S. Mymryk, Nancy Read, Varagur Venkatesan, Sara Kuruvilla, Lucas C. Mendez, Eric Winquist, Sylvia Mitchell, Sarah A. Mattonen, Anthony C. Nichols & David A. Palma
Department of Medical Biophysics, Western University, London, ON, Canada
Tricia Chinnery & Sarah A. Mattonen
Department of Microbiology and Immunology, Western University, London, ON, Canada
Joe S. Mymryk
Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
Anthony C. Nichols & David A. Palma
Eric J. Di Gravio
Pencilla Lang
Hugh Andrew Jinwook Kim
Tricia Chinnery
Neil Mundi
S. Danielle MacNeil
Adrian Mendez
John Yoo
Kevin Fung
John W. Barrett
Nancy Read
Varagur Venkatesan
Sara Kuruvilla
Lucas C. Mendez
Eric Winquist
Sylvia Mitchell
Sarah A. Mattonen
Anthony C. Nichols
David A. Palma
EJD, ACN and DAP designed the study. EJD, PL, HAJK, TC, SM and ACN performed the analyses. All authors read and approved the final manuscript. EJD and ACN had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.
Correspondence to David A. Palma.
Research Ethics Board approval (17222E) was obtained.
Univariable and multivariable analysis of overall survival in all patients with early stage disease seen at the London Health Sciences Centre from 2014 to 2018 by clinical characteristics. Samples missing clinical information were excluded (30 patients were excluded, 168 remaining samples in the analysis). Backwards step-wise method was utilized to arrive at the final multivariate model that was based on patient age, alcohol abuse, and smoking status. P-values < 0.05 are bolded. HR—hazard ratio; CI—confidence interval; BoT—base of tongue; HPV—human papillomavirus.
Univariable and multivariable analysis of disease-free survival in all patients with early stage disease seen in the London Health Sciences Centre from 2014 to 2018 by clinical characteristics. Samples missing clinical information were excluded (32 patients were excluded, 166 remaining samples in the analysis). Backwards step-wise method was utilized to arrive at the final multivariate model that was based on patient age, sex, and alcohol abuse. P-values < 0.05 are bolded. HR—hazard ratio; CI—confidence interval; BoT—base of tongue; HPV—human papillomavirus.
Di Gravio, E.J., Lang, P., Kim, H.A.J. et al. Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution. Radiat Oncol 15, 261 (2020). https://doi.org/10.1186/s13014-020-01705-1


text:
package com.kubaspatny.nuntius.controller;

import org.springframework.context.annotation.Scope;
import org.springframework.stereotype.Component;

@Component("navigationController")
@Scope("request")
public class NavigationController {

    public String goHome(){
        return "index?faces-redirect=true";
    }

    public String goSend(){
        return "send?faces-redirect=true";
    }

    public String goContact(){
        return "contact?faces-redirect=true";
    }

    public String goAbout(){
        return "about?faces-redirect=true";
    }

}

redpajama_set_name: RedPajamaGithub


text:
Home / Reviews / TVs / LG OLED65G1 review
TVs4KLG
LG OLED65G1 review
The best OLED TV from one of the best OLED TV brands
Simon Lucas Follow @OnlySimonLucas
19 April 2021 / 11:34 BST 16 February 2022 / 17:01 GMT
Yes, there's a lot about LG's new G1 OLED TV range that's new and interesting and exciting and intriguing. Yes, LG has made changes to the OLED panel itself, to the operating system you use to interact with it, to the processing protocols that govern picture quality, even to the TV's remote control. And yet despite all this, there's one question above all others that we need an answer to.
Where exactly does LG get the nerve to charge three grand for a television that doesn't even have any feet?
Design and build: shallow, in a good way
As part of LG's 'Gallery' series (which is where the 'G' in the model name comes from), the OLED65G1 is designed to be hung on the wall. And to make this as enticing a proposition as possible, LG has managed to deliver a OLED TV that has none of the usual OLED 'incredibly slim right until the big bulky bit where all the electronics are' about it. The OLED65G1 is just 2cm deep, consistently – and the wall-bracket with which it's supplied doesn't add any depth either. So when it's on the wall, the LG is virtually flush.
(This may explain why the OLED65G1 is supplied without feet. It doesn't explain where LG acquired the neck to charge £99 for a pair of feet should you want them.)
Elsewhere, the OLED65G1 is equally minimal and discreetly decorative. The bezel surrounding the screen is vanishingly brief, to the point that there's not even room for any 'LG' branding. And to reinforce its 'gallery' credentials, the OLED65G1 will display some framed Old Masters while it's in low-power/standby mode if you so desire.
As far as build quality is concerned, well, the search for a badly made TV from a mainstream manufacturer goes on. There's just no arguing with the way the LG is constructed – even the clip-on panels that cover all cables at the rear of the chassis feel robust and built to last.
Features: punchier than previously
The first big item of news here is the 'Evo' OLED panel. Basically, LG is promising brighter, sharper images, as well as greater power efficiency, than ever before from the G1.
The construction of the panel itself is new here – there's an additional green layer, a new 'luminous' element, and narrower, better-controlled blue and red wavelengths. In theory, then, the G1 should be a brighter, more punchy, more accurate and more vibrant watch than any previous LG OLED. Which, given that LG has been responsible for some of the best OLED TVs ever made, is quite a prospect.
To run the new panel (and the show overall) there's a new processor. The Alpha 9 Generation 4 processor (these things always have the snappiest names, don't they?) is intended to optimise content to best suit the strengths of this new 'Evo' panel. It includes a big AI element to help upscale sub-4K content as convincingly as possible, as well as a feature called AI Picture Pro which can apply enhancements to specific areas of an image (whether that's augmenting sharpness, or brightness, for instance) in an effort to give the overall image as much impact as possible. While still looking natural and convincing, of course.
One of the big pluses of LG's 2020 range of TVs was its commitment to next-gen consoles, and with the OLED65G1 it's obvious the company wants to maintain a position as one of the dedicated gamer's go-to brands. All four of the G1's HDMI inputs are fully 2.1-specified – which means 40gbps, eARC, [email protected], VRR, HGiG, FreeSync and ALLM. In conjunction with a lag time of, at worst, 12ms or so, you can confidently connect your Playstation 5 or Xbox Series X to any of those four sockets and be sure you're getting the best from it.
Interface: all kinds of everything
LG embarrassed itself quite comprehensively last year by contriving to omit all of the UK's catch-up TV services from its 2020 range of screens. Happily, it's rectified that for this year – Freeview Play is back, and with it comes as complete a broadcast TV experience as is possible.
And it's part of a thorough overhaul of the user interface. The OLED65G1 (and every other 2021 LG TV) is packing webOS 6.0, and it's a pretty big change to what we've all become used to from LG. The interface now covers the entire screen, which is a double-edged sword, and as well as Freeview Play it features an extensive selection of apps including Netflix, Amazon Prime Video, Disney+ and Apple TV – all of which are compatible with Dolby Atmos and Dolby Vision. Less headline-worthy alternatives from Now, Rakuten, Google Play Movies and all the rest are here too, as well as quite a number of audio options from Spotify, Deezer, Tidal and so on.
webOS 6.0 puts a big emphasis on recommendations – but you'll need to put quite a few hours in before the OLED65G1 starts to properly understand your viewing habits. Otherwise 'recommendations' is really closer to 'some random things that are available'.
Navigating the interface and the redesigned set-up menus happens using the latest version of LG's almost entirely admirable Magic Remote. The 'point-and-click' aspect, which is so effective at both navigating the screen and antagonising cats, continues, as does the 'up/down' scroll-wheel. There's a built-in mic for voice-control and some 'direct access' buttons too, and the remote is now more palm-friendly and ergonomic. Good job, LG. There's also LG's 'Smart Remote' app, but for once where these things are concerned it's not as pleasant or helpful to use as the remote control.
Picture quality: enlightenment
There doesn't seem a lot of point in beating around the bush here, so why bother? LG's 'evo' panel basically makes good on everything it promises, which makes the OLED65G1 LG's best OLED TV so far. Which, in turn, makes it one of the best OLED TVs ever offered for sale.
The Dolby Vision-assisted Thunder Force on Netflix makes the case very strongly indeed. Every aspect of picture-making is impressive here – colours are vibrant but never overdriven, detail levels are sky-high even in dark or otherwise-demanding circumstances, contrasts are wide but not unnatural, picture noise just isn't an issue, and edge-definition is smooth and confident. Skin-tones and skin-textures are convincing, and the OLED65G1 does brilliant work with lighting – the restaurant scene featuring Melissa McCarthy's Lydia and Jason Bateman's Jerry the Crab has real visual warmth and subtlety. The three-dimensionality the LG can generate is impressive too.
There's no HDR10+ dynamic metadata here (and while we'd like every HDR standard if we're paying this sort of money, let's face it: HDR10+ is the most minor of losses), but nevertheless a 4K HDR10+ Blu-ray of Parasite looks a treat. There's real punch and dynamism from the images, but they never look overwrought or artificial.
About the only area where the LG doesn't prove downright masterful is motion control. The set-up menus offer quite a few different options, and you'll find the one that suits the content you're watching – with Thunder Force, for example, you're best off selecting 'cinematic movement'. This way the OLED65G1 can control even complex moving patterns really impressively – but you can guarantee whatever you watch next will require a different 'clarity' setting. It would be nice if there was a 'one size fits all' option that meant it was possible to switch from a Netflix stream to some broadcast TV, say, that didn't require some finessing of the screen settings before you could settle down to watch it.
The LG's an accomplished upscaler, up to a point. Certainly a 1080p Blu-ray of There Will Be Blood looks convincing, and while it's not as lavishly detailed as the native 4K equivalent it's certainly not giving much away. The colour palette continues to convince, and contrasts continue to pop. A bit of televised sport on the BBC iPlayer is equally enjoyable, with the LG managing to combine big areas of uniform colour, unpredictable and constant on-screen motion, and the required levels of detail with proper expertise. Once you've established which is the appropriate motion setting, anyway.
Inevitably, the further you set down in source quality the harder the LG has to work. So if you somehow find yourself watching daytime reruns of On The Buses on ITV3 you a) will be watching a picture that's soft, indistinct, uncertain with motion and completely without black-tone detail, and b) need to have a look at yourself.
Sound quality: kinda sorta
All in, the LG can summon a total of 60 watts of audio power. It's divided between a 'subwoofer' (20 watts) and four full-range drivers (10 watts each), arranged to be invisible and to fire downwards.
And taken on its own terms, there's not much to take issue with here. There's decent clarity, dialogue remains distinct, and with a Dolby Atmos soundtrack the OLED65G1 manages to sound quite spacious and well-defined – even if there's no actual 'Atmos' sensation of height or meaningful width.
But – and there's no polite way of saying this – the LG sounds boring. It lacks dynamism, it lacks vigour, and it lacks any kind of meaningful punch. It complements the LG's visual prowess like a lit match complements a fireworks display. And anyway, if you've £3K for a new TV, don't pretend you don't have a couple of hundred pounds, minimum, for a proper soundbar to try and bring your audio experience into line with your sonic experience.
LG OLED65G1 verdict
This is an awful lot of money to pay for a television, even one that's as slim and well-specified as this one – especially when you take its humdrum audio quality into account. But there's no denying LG has made good on its 'evo' promise by serving up pictures that exceed our OLED expectations.
And given that it's so good, we suppose LG is entitled to charge what it thinks it can get away with.
Stuff Says…
Is this LG's best-ever OLED TV? Probably. Which means it's about as good an OLED TV as we can remember seeing
Outstanding picture quality, especially from 4K HDR sources
Slim and good-looking
Great OS with a stack of apps available
Bad Stuff
Expensive, and more expensive still if you want feet to stand it on
Sounds underwhelming
Can be picky about motion settings
Best premium laptop 2023: top-end notebook options reviewed and rated
How to pick the best premium notebook for your needs
Which iPhone should you buy? Every available Apple phone compared
How to pick your perfect Apple handset
The best 4K TVs 2023 reviewed and rated
Samsung QE65QN95A review
The Mini LED with the massive performance
3 March 2021 / 12:35 GMT 25 October 2021 / 17:29 BST
Philips 48OLED+935 4K HDR OLED review
TV nirvana, in other words
27 October 2020 / 11:02 GMT 25 October 2021 / 17:30 BST
Samsung 75Q950TS 8K QLED review
A grand 8K TV, even at eight grand
27 March 2020 / 13:52 GMT 25 October 2021 / 17:31 BST
LG OLED55CX review
"Making the best a bit better (and a bit cheaper)"
19 June 2020 / 12:58 BST 25 October 2021 / 17:30 BST


hardfacing of vertical cement mill hardfacing of table liners of a vertical roller mill hi friends, I have a problem regarding the hardfacing of roll table liners and wear segments of.
Similar to Shown: Smooth vertical panels and 5/4 trim, both in Woodland Cream, about per square foot; ... Portland cement: Binds the ingredients. Made with limestone, clay, and iron. All About FiberCement Siding. IMAGE 3 OF 26. Read Full Caption The Vitals. What's it cost?
Download 661 Cement Plant Vertical Stock Photos for FREE or amazingly low rates! New users enjoy 60% OFF. 84,568,057 stock photos online.
Masonry and Cement Products Buying Guide. The first step to a good masonry project is choosing the right product. But, with such a wide selection how do you decide? Use our guide to put your project on a firm foundation. ... Portland cement, calcium and quick setting additives.
Installed Fiber Cement Select Cedarmill Vertical Siding James Hardie vertical siding delivers style and is James Hardie vertical siding delivers style and is a strong choice for contemporary designs. HardiePanel vertical siding combined with HardieTrim boards can give you a desired look and enhance your home's insulation.
HardiePanel vertical siding in Portland Oregon provides value and longlasting performance. As with all of our exterior products, HardiePanel is Engineered for Climate® and will stand up against our climate's harshest conditions.
portland cement plant project katni in mp; ... cement grinding vertical roller mill picture. cement grinding vertical roller mill picture.
Evaluation of Vertical and Overhead Adhesion for Polymer Modified Portland Cement Mortar This test procedure applies to the Polymer Modified Portland Cement Mortar Guide Bridge Special Provision.
cement vertical picturecement vertical portland; ... San Marino 600 tph vertical cement grinding mill prices. Chat Now. Vertical Roller Mill Alibaba.
Twocomponent, polymermodified, portland cement, fastsetting, nonsag mortar. It is a high performance repair mortar for vertical and overhead surfaces, and offers the additional benefit of FerroGard 901, a penetrating corrosion inhibitor.
Wall Mixes for Vertical Resurfacing Bag of vertical concrete mix from FlexCMent. Some contractors who specialize in vertical work have developed their own wall mixes based on triedandtrue formulas.
PPT – Lesson 6: Portland Cement Concrete PowerPoint presentation ... calcium hydroxide released by the hydration of portland cement to form calcium silicate hydrate.