Collaborative action research: Making it happen

Session - Head and Neck CancerBackground: Treatment of NPC is mainly guided by TNM stage. This study aims to evaluate if the active tumor volume delineated as BTV on PET scan is a predictor of local disease control. Methods: This is a retrospective review of all patients who had baseline PET scan performed before treatment in our center from Aug., 2010 to Mar., 2013. Patients with distant metastases at diagnosis were excluded. Total 77 patients were included. The BTV were automatically delineated by a signal to background ratio method we reported before. All patients completed radiotherapy (RT) with intensity modulated radiotherapy to at least 70Gy to primary tumor. 7 patients had RT alone and 70 patients had chemotherapy (cisplatin or carboplatin) concurrent with RT with either additional induction or adjuvant chemotherapy. Local control was assessed by endoscopy and biopsy at 10 weeks after completion of RT. Local failure include patients with persistent disease in NP after RT and those who had local relapse after initial disease remission. Results: T stage distributions of the group were 20 T1, 7 T2, 35 T3 and 15 T4. The BTV ranged from 2.68 to 147.5cc with a median of 14.4cc. BTV in general increase with T stage with mean BTV of 12.9, 13.6, 26.3 and 40.7cc respectively for T1, 2, 3 and 4 respectively. Median follow up of the group were 32.8 months. There were 2 patients with persistent loco-regional disease after RT and another 2 patients with NP relapse. Mean BTV for patients with local control were 22.4cc compared with 61.5cc among patients with local failure (t-test, p: 0.002). 4 years local control rates (LCR) according to T stage were 100% for T1 and T2, 91.3% for T3 and 50% for T4. Patients with BTV 15cc are at risk of local failure and should be considered for radiation dose escalation

Mapping preictal and ictal haemodynamic networks using video-electroencephalography and functional imaging

Ictal patterns on scalp-electroencephalography are often visible only after propagation, therefore rendering localization of the seizure onset zone challenging. We hypothesized that mapping haemodynamic changes before and during seizures using simultaneous video-electroencephalography and functional imaging will improve the localization of the seizure onset zone. Fifty-five patients with ≥2 refractory focal seizures/day, and who had undergone long-term video-electroencephalography monitoring were included in the study. ‘Preictal' (30 s immediately preceding the electrographic seizure onset) and ictal phases, ‘ictal-onset'; ‘ictalestablished' and ‘late ictal', were defined based on the evolution of the electrographic pattern and clinical semiology. The functional imaging data were analysed using statistical parametric mapping to map ictal phase-related haemodynamic changes consistent across seizures. The resulting haemodynamic maps were overlaid on co-registered anatomical scans, and the spatial concordance with the presumed and invasively defined seizure onset zone was determined. Twenty patients had typical seizures during functional imaging. Seizures were identified on video-electroencephalography in 15 of 20, on electroencephalography alone in two and on video alone in three patients. All patients showed significant ictal-related haemodynamic changes. In the six cases that underwent invasive evaluation, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone for all patients. The most statistically significant haemodynamic cluster within the presumed seizure onset zone was between 1.1 and 3.5 cm from the invasively defined seizure onset zone, which was resected in two of three patients undergoing surgery (Class I post-surgical outcome) and was not resected in one patient (Class III post-surgical outcome). In the remaining 14 cases, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone in six of eight patients with structural-lesions and five of six non-lesional patients. The most statistically significant haemodynamic cluster was localizable at sub-lobar level within the presumed seizure onset zone in six patients. The degree of concordance of haemodynamic maps was significantly better (P < 0.05) for the ictal-onset phase [entirely concordant/concordant plus (13/20; 65%) + some concordance (4/20; 20%) = 17/20; 85%] than ictal-established [entirely concordant/concordant plus (5/13; 38%) + some concordance (4/13; 31%) = 9/13; 69%] and late ictal [concordant plus (1/9; 11%) + some concordance (4/9; 44%) = 5/9; 55%] phases. Ictal propagation-related haemodynamic changes were also seen in symptomatogenic areas (9/20; 45%) and the default mode network (13/20; 65%). A common pattern of preictal changes was seen in 15 patients, starting between 98 and 14 s before electrographic seizure onset, and the maps had a degree of concordance with the presumed seizure onset zone in 10 patients. In conclusion, preictal and ictal haemodynamic changes in refractory focal seizures can non-invasively localize seizure onset at sub-lobar/gyral level when ictal scalp-electroencephalography is not helpfu

Transforming Learning and the Transmission of Knowledge: Preparing a learning society for the future - Report of the PMSEIC Expert Working Group

Australia is at an exciting point in its history as it develops a knowledge-based learning society. Breakthroughs in our understanding of the fundamental science of learning, encompassing the scientific understanding of how our brains function, our motivations and the practice of teaching, are at a stage at which linking research and practice has the potential to transform how each one of us acquires and retains knowledge throughout our lives. The outcome of embracing this opportunity at this potent time will be a resilient and adaptive nation, prepared to meet the challenges and opportunities of the future. Example breakthroughs include understanding the influence of the brain's attention and memory forming processes on learning effectiveness. These can be influenced by personal strategies and instructional design, yielding potential for improving learning capacity. Motivational states which can be adapted also affect learning effectiveness. One such example is the motivational impact of the community and cultural value of learning. By encouraging a culture that supports the value of learning, Australia would increase individual motivation for learning, enhancing each person's capacity for attaining and retaining knowledge. Australia faces numerous challenges and opportunities that can be met through the development and support of a highly effective and inclusive learning society

Impact Statement: Science of Learning Centres - Preparing a learning society for the future

To take a quantum leap towards the future of learning, Australia needs to focus on integrating multidisciplinary, scientific research with sustained practitioner involvement. The 'Transforming Learning and the Transmission of Knowledge' Report to the Prime Minister's Science, Engineering and Innovation Council focuses on fundamental questions that influence our ability to learn and highlights the potential of bringing together researchers and practitioners to address the science of learning within a structured and sustained program. The Report contains as its central recommendation the establishment of a Science of Learning Program, delivered through a number of interdisciplinary, interprofessional Science of Learning Centres (Centres). If adopted, they have the potential to transform how all Australians acquire and apply knowledge throughout their lives. ... By adopting the recommendation to establish Science of Learning Centres, and by introducing them across urban and rural Australia, we can deliver a society of effective lifelong learners and ensure that Australia continues to be at the forefront of the global education revolution

Transforming learning and the transmission of knowledge: preparing a learning society for the future

Australia is at an exciting point in its history as it develops a knowledge-based learning society. Breakthroughs in our understanding of the fundamental science of learning, encompassing the scientific understanding of how our brains function, our motivations and the practice of teaching, are at a stage at which linking research and practice has the potential to transform how each one of us acquires and retains knowledge throughout our lives. The outcome of embracing this opportunity at this potent time will be a resilient and adaptive nation, prepared to meet the challenges and opportunities of the future. Example breakthroughs include understanding the influence of the brain's attention and memory forming processes on learning effectiveness. These can be influenced by personal strategies and instructional design, yielding potential for improving learning capacity. Motivational states which can be adapted also affect learning effectiveness. One such example is the motivational impact of the community and cultural value of learning. By encouraging a culture that supports the value of learning, Australia would increase individual motivation for learning, enhancing each person's capacity for attaining and retaining knowledge. Australia faces numerous challenges and opportunities that can be met through the development and support of a highly effective and inclusive learning society

Mapping preictal and ictal haemodynamic networks using video-electroencephalography and functional imaging

Ictal patterns on scalp-electroencephalography are often visible only after propagation, therefore rendering localization of the seizure onset zone challenging. We hypothesized that mapping haemodynamic changes before and during seizures using simultaneous video-electroencephalography and functional imaging will improve the localization of the seizure onset zone. Fifty-five patients with ≥2 refractory focal seizures/day, and who had undergone long-term video-electroencephalography monitoring were included in the study. 'Preictal' (30 s immediately preceding the electrographic seizure onset) and ictal phases, 'ictal-onset'; 'ictalestablished' and 'late ictal', were defined based on the evolution of the electrographic pattern and clinical semiology. The functional imaging data were analysed using statistical parametric mapping to map ictal phase-related haemodynamic changes consistent across seizures. The resulting haemodynamic maps were overlaid on co-registered anatomical scans, and the spatial concordance with the presumed and invasively defined seizure onset zone was determined. Twenty patients had typical seizures during functional imaging. Seizures were identified on video-electroencephalography in 15 of 20, on electroencephalography alone in two and on video alone in three patients. All patients showed significant ictal-related haemodynamic changes. In the six cases that underwent invasive evaluation, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone for all patients. The most statistically significant haemodynamic cluster within the presumed seizure onset zone was between 1.1 and 3.5 cm from the invasively defined seizure onset zone, which was resected in two of three patients undergoing surgery (Class I post-surgical outcome) and was not resected in one patient (Class III post-surgical outcome). In the remaining 14 cases, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone in six of eight patients with structural-lesions and five of six non-lesional patients. The most statistically significant haemodynamic cluster was localizable at sub-lobar level within the presumed seizure onset zone in six patients. The degree of concordance of haemodynamic maps was significantly better (P < 0.05) for the ictal-onset phase [entirely concordant/concordant plus (13/20; 65%) + some concordance (4/20; 20%) = 17/20; 85%] than ictal-established [entirely concordant/concordant plus (5/13; 38%) + some concordance (4/13; 31%) = 9/13; 69%] and late ictal [concordant plus (1/9; 11%) + some concordance (4/9; 44%) = 5/9; 55%] phases. Ictal propagation-related haemodynamic changes were also seen in symptomatogenic areas (9/20; 45%) and the default mode network (13/20; 65%). A common pattern of preictal changes was seen in 15 patients, starting between 98 and 14 s before electrographic seizure onset, and the maps had a degree of concordance with the presumed seizure onset zone in 10 patients. In conclusion, preictal and ictal haemodynamic changes in refractory focal seizures can non-invasively localize seizure onset at sub-lobar/gyral level when ictal scalp-electroencephalography is not helpful