Snowfeddersen1225

This review considers the impact of a recent update to the American Joint Committee on Cancer (AJCC) staging system, the role of SNB for patients with high-risk primary melanoma and recent advances in adjuvant systemic therapies for high-risk patients.Among-individual variation in vital rates, such as mortality and birth rates, exists in nearly all populations. Recent studies suggest that this individual heterogeneity produces substantial life-history and fitness differences among individuals, which in turn scale up to influence population dynamics. However, our ability to understand the consequences of individual heterogeneity is limited by inconsistencies across conceptual frameworks in the field. Studies of individual heterogeneity remain filled with contradicting and ambiguous terminology that introduces risks of misunderstandings, conflicting models and unreliable conclusions. Here, we synthesise the existing literature into a single and comparatively straightforward framework with explicit terminology and definitions. This work introduces a distinction between potential vital rates and realised vital rates to develop a coherent framework that maps directly onto mathematical models of individual heterogeneity. We suggest the terms "fixed condition" and "dynamic condition" be used to distinguish potential vital rates that are permanent from those that can change throughout an individual's life. To illustrate, we connect the framework to quantitative genetics models and to common classes of statistical models used to infer individual heterogeneity. We also develop a population projection matrix model that provides an example of how our definitions are translated into precise quantitative terms.

In colorectal cancer (CRC), surgery of the primary site is commonly curative. Our aim was to determine estimates of 'no surgery' for primary CRC while identifying common reasons for no surgery.

We identified all patients with a diagnosis of colorectal adenocarcinoma from the National Cancer Database between January 2004 and December 2016. Then, we identified patients who did not undergo surgery on the primary tumour and their demographic, tumour and institutional characteristics. Kaplan-Meier and logistic regression analyses were used to evaluate specific factors associated with overall survival as related to no surgery and recommendations against operative management.

A total of 1,208,878 patients with CRC were identified, 14.5% of whom had no surgery of the primary cancer. No surgery was more common in rectal cancer than in colon cancer. Cisplatinum Despite a steady incidence of CRC diagnoses, the likelihood of no surgery grew by 170% over the study period. Metastatic disease was noted in 53.7% of the no surgery cohort. Nine per cent of the no surgery patient cohort received a recommendation against surgery despite the absence of metastatic disease, 7.5% refused surgery and only 2% underwent palliative surgery. On multivariable analysis, patients who were not recommended to have surgery were more likely to be older, uninsured, comorbid and receive care at a single hospital. The no surgery patients had significantly lower overall survival.

A substantial proportion of patients with CRC do not have surgery. Interventions aimed at expanding access and promoting second opinions at other cancer hospitals might reduce the growing rate of no surgery in CRC.

A substantial proportion of patients with CRC do not have surgery. Interventions aimed at expanding access and promoting second opinions at other cancer hospitals might reduce the growing rate of no surgery in CRC.This article summarizes a virtual live-streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self-contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second panel involved a reflection on the challenges of doing nursing philosophy in a research-intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice.The safety and electrochemical performance of rechargeable lithium-metal batteries (LMBs) are primarily influenced by the additives in the organic liquid electrolytes. However, multi-functional additives are still rarely reported. Herein, we proposed heptafluorobutyric anhydride (HFA) as a qua-functional additive to optimize the composition and structure of the solid electrolyte interphase (SEI) at the electrode/electrolyte interface. The reduction/oxidation decomposition of the fluorine-rich HFA facilitate uniform inorganic-rich SEI and compact cathode electrolyte interphase (CEI) formation, which enables stable lithium plating during charge and suppresses the dissolution of transition-metal ions. Moreover, HFA optimizes the Li-ion solvation for stable Li plating/stripping and serves as the surfactant to enhance the wettability of the separator by the electrolyte to increase Li-ion flux. The symmetric Li∥Li cell with 1.0 wt % HFA electrolyte had an excellent cycling performance over 340 h at 1.0 mA cm-2 with a capacity of 0.