Long-term oncological outcomes of endoscopic full-thickness resection after previous incomplete resection of low-risk T1 CRC (LOCAL-study): study protocol of a national prospective cohort study

Background: T1 colorectal cancer (CRC) without histological high-risk factors for lymph node metastasis (LNM) can potentially be cured by endoscopic resection, which is associated with significantly lower morbidity, mortality and costs compared to radical surgery. An important prerequisite for endoscopic resection as definite treatment is the histological confirmation of tumour-free resection margins. Incomplete resection with involved (R1) or indeterminate (Rx) margins is considered a strong risk factor for residual disease and local recurrence. Therefore, international guidelines recommend additional surgery in case of R1/Rx resection, even in absence of high-risk factors for LNM. Endoscopic full-thickness resection (eFTR) is a relatively new technique that allows transmural resection of colorectal lesions. Local scar excision after prior R1/Rx resection of low-risk T1 CRC could offer an attractive minimal invasive strategy to achieve confirmation about radicality of the previous resection or a second attempt for radical resection of residual luminal cancer. However, oncologic safety has not been established and long-term data are lacking. Besides, surveillance varies widely and requires standardization. Methods/design: In this nationwide, multicenter, prospective cohort study we aim to assess feasibility and oncological safety of completion eFTR following incomplete resection of low-risk T1 CRC. The primary endpoint is to assess the 2 and 5 year luminal local tumor recurrence rate. Secondary study endpoints are to assess feasibility, percentage of curative eFTR-resections, presence of scar tissue and/or complete scar excision at histopathology, safety of eFTR compared to surgery, 2 and 5 year nodal and/or distant tumor recurrence rate and 5-year disease-specific and overall-survival rate. Discussion: Since the implementation of CRC screening programs, the diagnostic rate of T1 CRC is steadily increasing. A significant proportion is not recognized as cancer before endoscopic resection and is therefore resected through conventional techniques primarily reserved for benign polyps. As such, precise histological assessment is often hampered due to cauterization and fragmentation and frequently leads to treatment dilemmas. This first prospective trial will potentially demonstrate the effectiveness and oncological safety of completion eFTR for patients who have undergone a previous incomplete T1 CRC resection. Hereby, substantial surgical overtreatment may be avoided, leading to treatment optimization and organ preservation.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Tectonic model for development of the Byrd Glacier discontinuity and surrounding regions of the Transantarctic Mountains during Neoproterozoic-Early Paleozoic

The Byrd Glacier discontinuity us a major boundary crossing the Ross Orogen, with crystalline rocks to the north and primarily sedimentary rocks to the south. Most models for the tectonic development of the Ross Orogen in the central Transantarctic Mountains consits of two-dimensional transects across the belt, but do not adress the major longitudinal contrast at Byrd Glacier. This paper presents a tectonic model centering on the Byrd Glacier discontinuity. Rifting in the Neoproterozoic producede a crustal promontory in the craton margin to the north of Byrd Glacier. Oblique convergence of the terrane (Beardmore microcontinent) during the latest Neroproterozoic and Early Cambrian was accompanied by subduction along the craton margin of East Antarctica. New data presented herein in the support of this hypothesis are U-Pb dates of 545.7 ± 6.8 Ma and 531.0 ± 7.5 Ma on plutonic rocks from the Britannia Range, subduction stepped out, and Byrd Glacier. After docking of the terrane, subduction stepped out, and Byrd Group was deposited during the Atdabanian-Botomian across the inner margin of the terrane. Beginning in the upper Botomian, reactivation of the sutured boundaries of the terrane resulted in an outpouring of clastic sediment and folding and faulting of the Byrd Group

Employee and workplace well-being: a multi-level analysis of teacher personality and organizational climate in Norwegian teachers from rural, urban and city schools

Although teaching is frequently cited as a stressful profession, limited recent Norwegian data is available. This study addressed the extent to which organizational climate and individual and organizational well-being outcomes vary between schools in rural, urban, and city locations. Participants were predominantly female (68%), aged 45+ years(63.2%) and reported 20+ years of teaching experience (51%). Teachers from rural schools reported smaller student and teacher numbers, a more positive organizational climate and better organizational well-being. Multi-level analyses, with teachers grouped within school location, indicated that personality is most strongly associated with employee well-being, and organizational climate most strongly related to school morale and distress. Schools in rural locations are smaller and possess workplace climates that are conducive to positivity in the workplace, and subsequently better workplace wellbeing outcomes

eLearning Attitudes in Botswana’s Private Sector

International audienceThe study investigated eLearning attitudes in Botswana’s private sector. Selected companies in Gaborone, (Botswana) served as the unit of analysis. The study used a multi-pronged approach for data collection. The results show positive attitudes towards eLearning. However, current organizational policy did not accommodate training via eLearning. The results also suggest that eLearning counters threat of national and international private seizure of employee markets. All respondents agreed that integrating eLearning technologies in training would prepared better employees and increase access to education in a cost effective way. Respondents further alleged that eLearning created and supported new research opportunities, and that organizations required intellectual property rights policy. Most respondents reported readiness to implement eLearning, and suggested that eLearning would alleviate increasing administrative and training pressures. Finally, results show that eLearning would increase the success rate and quality of training, and that eLearning was not just a fad that would disappear shortly