Proxy assessments in children with SpLD and their parents may be

Proxy assessments in children with SpLD and their parents may be useful for planning targeted support interventions for these families.”
“Study Design. Cyclopamine molecular weight Cross-sectional study with retrospectively assessed work determinants.

Objective. To study the association between the history of physically demanding work and sciatica, among the occupationally active, and among persons of working age who are not occupationally active.

Summary of Background Data. Few studies have examined the association of physically loading work with sciatica, and studies concerning

women are scarce.

Methods. A nationally representative sample of The Health 2000 survey comprised 4811 Finns aged 30 to 64, which we further stratified into 2 groups based on working status during the preceding 12

months. The diagnosis of sciatica was based on characteristic symptoms and a standardized clinical examination by physicians trained for the purpose. Life-long exposure to physically demanding work tasks was assessed retrospectively by interview.

Results. A total find more of 3.8% of working subjects and 7.9% of nonworking subjects had sciatica; men more often than women. In the multivariable logistic regression models, a history of physically demanding work in general was associated with sciatica among men. The risk increased with the length of exposure for the first 20 years (OR: 1.85; 95% CI: 1.17-2.91 for 1-10 years and 2.67; 1.61-4.43 for 11-20 years of exposure), but decreased thereafter. When analyzing manual handling of heavy objects, bending, and kneeling separately, odds ratios for these factors were high for both working and nonworking men. However, they remained at the borderline

of statistical significance among working men. None of the physical work exposures were associated with sciatica among working women, whereas a long history of handling heavy objects and bending were related to sciatica among nonworking women.

Conclusion. Physically demanding work in general is a risk factor for sciatica Prexasertib clinical trial among men. Sciatica may be a significant cause of premature health-related selection out of the heavy work among both genders.”
“Our primary objective was to identify cognitive and behavioural profiles that affect adjustment, in order to make relevant recommendations about support and assistance for parents of autistic children.

One hundred and sixty French parents completed a battery of questionnaires and self-report measures developed or adapted to assess (1) the child and family situations; (2) perceived stress; (3) perceived social support; (4) perceived control; (5) coping strategies; and (6) quality of life.

The psychometric properties of the instruments we used proved to be adequate. Our results support the pre-existing data and our findings may prove to be of interest to clinicians. Our primary finding was that emotion-focused coping strategies seem to be less effective.

Secondary objectives were to measure the distance from the vagina

Secondary objectives were to measure the distance from the vaginal introitus to the sacrum and distances of the sacral fixation elements to other vital structures.

Methods Fourteen fresh-frozen cadavers were used. Specialized instruments were developed to optimize visualization and facilitate performance of the procedure.

Results Five cadavers had a transperineal approach (an approach found unfeasible), and eight of the remaining nine had complete or

partial completion of the transvaginal approach. The mean distance from the introitus to the promontory BMS-345541 manufacturer was 14.6 cm (12-16.5 cm). The mean distance from the sacral fixation elements to the aorta was 5.2 cm; common iliac artery, 3.5 cm; internal iliac artery, 3.25 cm; middle sacral artery, 1.75 cm, and ureters, 3.5 cm. The position of the sacral fixation elements was consistently at the level of S1-2.

Conclusion Vaginal sacrocolpopexy is feasible in a cadaver model.”
“A total 17 fronto-mesial grade II Duvelisib and III gliomas among a total of 64 frontal grade II and III gliomas underwent surgical resection between January 2003 and June 2007. Eleven fronto-mesial gliomas originated from the anterior cingulate gyrus, while

the others originated from the genu of the corpus callosum. None of the grade II or III gliomas originated from the gyrus rectus. Anterior cingulate gliomas exhibited distinct features with regard to presenting symptoms, MRI, histopathology and prognosis. Epilepsy was the dominant presenting symptom of anterior cingulate buy GDC-0068 tumours. Five of the 11 gliomas had a sharp border on MRI. Four of the 11 were histopathologically classified as WHO grade II and seven as WHO grade III and

an oligodendrocytic component was apparent in eight of the 11 specimens. Comparison of the post-operative survival with the entire set of frontal gliomas showed a trend that anterior cingulate tumours had a more favourable prognosis.”
“Cellular exchange of carbon dioxide (CO2) is of extraordinary importance for life. Despite this significance, its molecular mechanisms are still unclear and a matter of controversy. In contrast to other living organisms, plants are physiologically limited by the availability of CO2. In most plants, net photosynthesis is directly dependent on CO2 diffusion from the atmosphere to the chloroplast. Thus, it is important to analyze CO2 transport with regards to its effect on photosynthesis.

Results: The results indicate that 0 5 % w/v trehalose was the mo

Results: The results indicate that 0.5 % w/v trehalose was the most effective lyoprotectant and it essentially maintained the particle size of lyophilised BSA-loaded CS/DS nanoparticles which changed slightly from 188 +/- 11 nm to 174 +/- 14 nm during lyophilisation. Mannitol was also as effective Dehydrogenase inhibitor as trehalose at 0.1 and 1.0 % w/v in stabilising the nanoparticles. The particle size of lyophilized nanoparticles increased moderately from 188 +/- 11 nm to 234 +/- 12 nm and 287 +/- 18 nm at 0.1 and 1.0 % w/v, respectively. In contrast, the other lyoprotectants (inulin and histidine) did not show stabilizing effects. Moreover, trehalose also

reduced the degree of particle aggregation from 329 +/- 16 to 836 +/-

21 nm upon storage for 24 h as compared to CS/DS nanoparticles without trehalose; from 438 +/- 14 to 1298 +/- 18 (p < 0.05). The rate of BSA leakage from the nanoparticles containing trehalose was reduced from 92 to 42 % over a 11-day storage period compared GSK1838705A supplier with 99 to 0 % for CS/DS nanoparticles without trehalose.

Conclusion: Trehalose (0.5 % w/v) is a promising lyoprotectant for storage stabilisation of BSA-loaded CS/DS nanoparticles.”
“Contents Actin microfilaments and mitochondria distribution are considered useful markers of cytoplasmic maturation, but no information is available regarding their distribution in cat oocytes and embryos. Thus, the purpose of this study was to (i) assess cytoplasmic characteristics of the oocyte by mitochondria and actin staining in immature and in vitro/in vivo matured cat oocytes and (ii) characterize mitochondria and actin distribution in in vitro produced blastocysts by confocal laser scanning microscopy. Additionally, in vivo matured oocytes were collected to

assess mitochondria and actin. Transzonal cumulus cell projections were more abundant in immature oocytes than in matured oocytes. A relocation Combretastatin A4 solubility dmso of mitochondria throughout meiosis was not clearly observed. However, most in vitro produced blastocysts were of good quality, according to their actin cytoskeleton integrity and mitochondria distribution. The functional significance of mitochondria distribution in cat oocytes in relation to their developmental competence requires further research. This study represents the original description of actin and mitochondrial patterns in cat oocytes and embryos.”
“Background The prevalence of severe obesity is rising in the United States. Although mild to moderately elevated body mass index (BMI) is associated with reduced mortality after acute ischemic stroke, less is known about severe obesity.

Methods and Results Patients with acute ischemic stroke (n=1791) 45 years were identified from the biethnic population-based Brain Attack Surveillance in Corpus Christi (BASIC) study from June 1, 2005, to December 31, 2010. Median follow-up was 660 days. BMI was abstracted from the medical record.

Results Over the follow-up of 90 days, the mean NPS in group A de

Results Over the follow-up of 90 days, the mean NPS in group A decreased from 6 +/- 2 to 3 +/- 2 and in group B from 5 +/- 1 to 2 +/- 2. From the mean NPS scores, it can be interpreted that both the modalities were effective clinically in treating GPN. However, NPS scores were statistically similar by the end of 90 days. Improvement from baseline in BPI measurement of QOL (mood, interpersonal relationship, and emotion) was earlier in group B (1, 2, and 1 months, respectively) compared with group A (2, 3, and 2 months, respectively). However, there were no significant hemodynamic adverse outcomes after administration of

the block. Conclusion This study found that patients in both the groups had significantly lower pain intensities, improved pain relief, and reduced pain interference with QOL, which was especially evident on fourth visit (2 months) after the initiation of treatment regimen. Both were safe and well tolerated. The study advocates rational this website polypharmacy approach (oral and block) in difficult to treat painful conditions. Further controlled trials are warranted to further define the impact of such a combination therapy.”
“The objectives of this matched case-control study

in a veterinary teaching hospital were to investigate selleck screening library the influence of signalment and historical data on the odds of occurrence of canine parvovirus (CPV) enteritis and the potential usefulness of the clinical signs and clinicopathologic abnormalities recorded on admission as prognostic indicators of mean duration of hospitalization (DOH) and outcome of the disease. Ninety-four puppies with natural CPV enteritis and 188 age-matched controls were studied. The odds to develop CPV enteritis were higher in purebreds compared to mixed-breed puppies. Vomiting and depression at the time of admission were associated with a prolongation Copanlisib inhibitor of DOH by 2 and 1.75 days, respectively. The lymphopenic and hypoalbuminemic dogs were hospitalized for 1.9 and 2.5 more days,

respectively, compared to those without these abnormalities. The odds of non-survival were higher in those puppies with evidence of systemic inflammatory response syndrome (SIRS) at the time of admission. (C) 2010 Elsevier Ltd. All rights reserved.”
“Objectives The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. Methods A 4-week prospective study of 387 outpatients suffering from chronic rheumatic diseases was carried out. Pain level was evaluated using a 0100 mm visual analog scale. An anchoring method based on patient’s opinion was used. The PAccSS was defined as the 75th percentile of the score for patients who considered their state satisfactory. Pearson’s chi-square and binary logistic regression were used to analyze the data.

Most surgeries were related to treating conditions associated wit

Most surgeries were related to treating conditions associated with hereditary hemorrhagic telangiectasia, with the majority

being procedures to the nasal mucosa for recurrent epistaxis (47.2 %). A sizeable proportion of procedures to the nasal mucosa required transfusion of blood (12/77). One case of epistaxis required 11 units of blood until it was successfully controlled. Another notable complication included migration of a coil to pulmonary arteriovenous malformations into the cerebral circulation.

Surgical patients with hereditary hemorrhagic telangiectasia often present with multiorgan involvement. click here The anesthesia provider needs to be aware of the high prevalence of pulmonary arteriovenous malformations, which may be asymptomatic but can lead to embolic complications.

Hemorrhage from epistaxis can be severe, and relatively focal procedures to the nasal mucosa can require blood transfusions.”
“The urothelium is a multifunctional tissue that not only acts as a barrier between the vesical contents of the lower urinary tract and the underlying tissues TH-302 concentration but also acts as a sensory organ by transducing physical and chemical stresses to the attendant afferent nervous system and underlying smooth muscle. This review will consider the nature of the stresses that the urothelium can transduce; the transmitters that mediate the transduction process; and how lower urinary pathologies, including overactive bladder syndrome, painful bladder syndrome and bacterial infections, are associated with alterations to this GSK3235025 inhibitor sensory system. In particular, the role of muscarinic receptors and the TRPV channels system will be discussed in this context. The urothelium also influences

the contractile state of detrusor smooth muscle, both through modifying its contractility and the extent of spontaneous activity; potential pathways are discussed. The potential role that the urothelium may play in bladder underactivity is introduced, as well as potential biomarkers for the condition that may cross the urothelium to the urine. Finally, consideration is given to vesical administration of therapeutic agents that influence urinary tract function and how the properties of the urothelium may determine the effectiveness of this mode of delivery. Neurourol. Urodynam. 31:293299, 2012. (C) 2012 Wiley Periodicals, Inc.”
“The cells of Rhodococcus opacus 412 and R. rhodnii 135 were adapted to phenanthrene and anthracene on a solid mineral medium. Preliminary adaptation of the strains accelerated the metabolism of polyaromatic hydrocarbons and provided for the ability of microorganisms to grow on pheanthrene as a sole carbon and energy source in a liquid mineral medium.

These interfacial carriers have been observed with various HTL ma

These interfacial carriers have been observed with various HTL materials and several anode compositions at voltages such that the HTL is reverse-biased. The cation density at an ITO vertical bar CF(x)vertical bar NPB interface is estimated to be approximately 1 x 10(13)/cm(2), or approximately 10% of a molecular layer. [NPB is 4,4'-bis[N-(1-naphthyl)-N-phenylamino]biphenyl. CF(x) is a fluorocarbon polymer.] The cations represent MGCD0103 the integer charge-transfer states whose presence has been

inferred from ultraviolet photoelectron spectroscopy studies of various conductor vertical bar organic interfaces. Anions of an organic hole-injecting material, 1,4,5,8,9,11-hexaazatriphenylene hexacarbonitrile (HAT-CN) were also observed. Conditions near the injecting contacts often determine the electric field

profile and drive voltage of an OLED. Elucidation of these conditions is important to a complete understanding PF00299804 and detailed modeling of OLED operation. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3525592]“
“Purpose: To determine utility of multiparametric imaging performed at 3 T for detection of prostate cancer by using T2-weighted magnetic resonance (MR) imaging, MR spectroscopy, and dynamic contrast material-enhanced MR imaging, with whole-mount pathologic findings as reference standard.

Materials and Methods: This prospectively designed, HIPAA-compliant, single-institution study was approved by the local institutional review selleck chemicals llc board. Seventy consecutive patients (mean age, 60.4 years; mean prostate-specific antigen level, 5.47 ng/mL [5.47 m g/L]; range, 1-19.9 ng/mL [1-19.9 m g/L]) were included; informed consent was obtained

from each patient. All patients had biopsy-proved prostate cancer, with a median Gleason score of 7 (range, 6-9). Images were obtained by using a combination of six-channel cardiac and endorectal coils. MR imaging and pathologic findings were evaluated independently and blinded and then correlated with histopathologic findings by using side-by-side comparison. Analyses were conducted with a raw stringent approach and an alternative neighboring method, which accounted for surgical deformation, shrinkage, and nonuniform slicing factors in pathologic specimens. Generalized estimating equations (GEEs) were used to estimate the predictive value of region-specific, pathologically determined cancer for all three modalities. This approach accounts for the correlation among multiple regions in the same individual.

Results: For T2-weighted MR imaging, sensitivity and specificity values obtained with stringent approach were 0.42 (95% confidence interval [CI]: 0.36, 0.47) and 0.83 (95% CI: 0.81, 0.86), and for the alternative neighboring approach, sensitivity and specificity values were 0.73 (95% CI: 0.67, 0.78) and 0.


“The 0 5Bi(0 8)La(0 2)FeO(3)-0 5PbTiO(3) (BLF-PT) solid so


“The 0.5Bi(0.8)La(0.2)FeO(3)-0.5PbTiO(3) (BLF-PT) solid solution nanoparticles of different particle sizes

are prepared using sol-gel method and characterized in terms of the size-dependent crystal structure, Raman scattering, dielectric susceptibility, and magnetism. Upon decreasing particle size, the crystal structure evolves from Autophagy inhibitor molecular weight tetragonal symmetry to rhombohedral one, and a substantial enhancement of magnetization is observed. These size-dependent effects are reasonably explained by a simple thermodynamic scenario and first-principles calculation based on the BLF-PT multilayer model. (C) 2010 American Institute of Physics. [doi:10.1063/1.3525120]“
“In 1996, a combined vaccine against both hepatitis A and B was licensed and commercialized and has been recommended for healthcare personnel in Belgium. This study compares the immunogenicity against hepatitis B virus (HBV) and safety of two vaccination schedules (0-1-12 months and 0-1-6 months) NU7441 molecular weight with this vaccine. This is a randomized, stratified and controlled study in healthy

adult workers, who are not occupationally exposed to HBV. Seroconversion (>= 1 IU/L) and seroprotection (>= 10 IU/L) rates were compared using Fisher’s exact test; geometric mean concentrations (GMCs) of anti-HBs were compared using one-way ANOVA. All statistical analyses were carried out with SPSS 11 on Apple Macintosh. A total of 399 subjects were enrolled in the study, and 356 were analysed according to the protocol. The rate of >= 10 IU/L at 6 months was 70.6% in the group 0-1-12 and 79.9% in the group 0-1-6; this rate decreased to 55.9% at 12 months in the first group. Seroconversion and seroprotective rates against HBV measured at month 13 in group 0-1-12 (98.9% and 95.6%) and measured

at month 7 in group 0-1-6 (99.4% and 97.1%) were not DZNeP chemical structure statistically significantly different. GMC of anti-HBs after the 0-1-12 schedule was more than two fold higher than after 0-1-6 schedule (P < 0.001). Reported side effects were comparable in both groups with a slight tendency to fewer side effects in the 0-1-12 group after the third dose. The results from our study show that the completed schedule 0-1-12 offers at least equal protective immunogenicity against HBV as the completed 0-1-6 schedule. People not receiving their third dose at 6 months can be given this dose up to 12 months after the first dose. The drawback of this flexibility, however, is the longer time period before the protection becomes effective.”
“Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide.

Summary

Anaesthesia is more than ‘keeping asleep’ Ana

Summary

Anaesthesia is more than ‘keeping asleep’. Anaesthesiologists have an enormous responsibility in the preoperative, peroperative, and postoperative period for patients undergoing gynaecological cytoreductive surgery.”
“Early highly active antiretroviral therapy is recommended in all vertically human immunodeficiency virus (HIV)-infected infants. We describe the long-term immunologic outcome after planned treatment interruption Oligomycin A clinical trial (PTI) in 7 children diagnosed and treated during

acute HIV infection (age < 12 weeks). Children had remained a median of 57 months off treatment, 3 of them indefinitely. The 2 patients with the lowest nadir CD4% reinitiated highly active antiretroviral therapy because of a CD4 cell decline of < 20%; 2 children resumed treatment because of clinical progression and parents’ wishes. All patients experienced

a decrease in CD4% after PTI, which particularly affected the naive subpopulation. The interferon-gamma response against HIV-p24 antigen directly correlated with nadir CD4%. Our results suggest that early treatment in HIV-infected infants increases their potential to safely control viral replication after PTI for long periods.”
“Three dimensional spin configuration in an exchange coupled Fe/NiO(100) system is investigated using a combination of photoemission electron microscopy and magnetic linear- and circular dichroism spectroscopy in the soft-x-ray range. By comparing the experimental image contrasts with a cluster model calculation including the crystal symmetry, Epigenetics inhibitor we have successfully determined the spin configuration of the bulk antiferromagnetic NiO substrate. The easy axes of the outermost ferromagnetic Fe film and the ferromagnetic interface corresponding P005091 supplier to the three kinds of spin axes of the antiferromagnetic NiO substrate have been assigned. We also observe that the magnetic field amplitude required for magnetization reversal depends on these initial easy axes directions. These findings are strongly related to

the mechanism of exchange bias phenomena. (C) 2011 American Institute of Physics. [doi:10.1063/1.3647776]“
“Enantioselective membrane was prepared using nitrocellulose as membrane material. The flux and permselective properties of membrane using water solution of D,L-tyrosine as feed solution were studied. The top surface and cross-section morphology of the resulting membrane were examined by scanning electron microscopy. The optical resolution of over 85% enantiomeric excess was achieved when the enantioselective membrane was prepared with 25 wt % nitrocellulose and 15 wt % N,N-dimethylformamide in the casting solution of methanol, 10 degrees C temperature of water bath for the gelation of the membrane, and the operating pressure and the feed concentration of the D,L-tyrosine were 6 kgf/cm2 and 0.25 mg/mL, respectively.

PLP is a coenzyme required by more than 100 cellular enzymes In

PLP is a coenzyme required by more than 100 cellular enzymes. In spite of the importance of this vitamin, the understanding

of VB6 metabolic conversion in plants is limited. In this study, learn more we developed a sensitive and reliable method to assay VB6-metabolizing enzyme activities by monitoring their products visually using high-performance liquid chromatography. With this method, the reactions catalyzed by PL/PM/PN kinase, PMP/PNP oxidase, PM-pyruvate aminotransferase, PL reductase and PLP phosphatase were all nicely detected using crude protein extracts of tobacco leaves. Under optimal in vitro conditions, specific activities of those enzymes were 0.15 +/- 0.03, 0.10 +/- 0.03, 0.08 +/- 0.02, 0.64 +/- 0.13 and 23.08 +/- 1.98 nmol product/min/mg protein, respectively. This is the first report on the conversion between PM and PL catalyzed by PM-pyruvate aminotransferase in plants. Furthermore, the PL reductase activity was found to be heat inducible. Our study sheds light on the VB6 metabolism taking place in plants. (C) 2011 Elsevier Masson SAS. All rights reserved.”
“Objective. This study was a retrospective assessment of reentry sinus augmentation compared with sinus augmentation performed for the first time.

Study design. There were 38 subjects who required

sinus augmentation. The study group (17 patients, 21 sinuses) included subjects following failure of a previous sinus augmentation procedure that required reentry augmentation. The control group (21 patients, 21 sinuses) included subjects in which sinus augmentation was performed for GSK2399872A concentration the selleck products first time. Patients’ medical files were reviewed. A preformed questionnaire was used to collect data regarding demographic parameters, medical and dental health history, habits, and intra- and postoperative data.

Results. Operative challenges in the study group included adhesions of the buccal

flap to the Schneiderian membrane (62%, 13/21, P < .001), bony fenestration of the lateral wall with adhesions (71%, 15/21, P < .001), limited mobility of a clinical fibrotic Schneiderian membrane (71%, 15/21, P < .001), and increased incidence of membrane perforations (47%, 10/21, versus 9.5%, 2/21, P = .03). In the control group the Schneiderian membrane was thin and flexible.

Sinus augmentation succeeded in all cases of both groups. Implant failure was significantly higher in the study group (11% versus 0%, P < .001).

Conclusions. Clinical success of reentry sinus augmentation is predictable despite its complexity. Clinicians should be aware of anatomical changes caused by previous failure of this procedure. Patients should be informed about the lower success rate of implants when reentry sinus augmentation is required. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:287-291)”
“Intriguing electronic and magnetic properties of boron nitride (BN) layer with noble metal (Pd, Pt, Ag and Au) doping are obtained by first-principles calculations.

RESULT: Six antigens (Rv0570, Rv1996,

Rv2004c, Rv2028c, R

RESULT: Six antigens (Rv0570, Rv1996,

Rv2004c, Rv2028c, Rv2029c and Rv3133c) induced stronger T-cell responses in LTBI than in PTB, In contrast, antigen-specific antibody responses to five antigens (Rv0080, Rv1738, Rv2007c, Rv2031c and Rv2032) were found to be stronger in PTB than in LTBI cases.

CONCLUSION: Nirogacestat T-cell responses to six antigens might contribute to natural protection against dormant M. tuberculosis. These antigens are therefore considered to be potential targets of novel vaccines to control M. tuberculosis reactivation in the Japanese population.”
“High quality GaN/AlGaN multiquantum well (QW) structures were grown by ammonia molecular beam epitaxy along the

(0001) polar and (11 (2) over bar0) nonpolar directions. Each sample contains three QWs with thicknesses of 2, 3, and 4 nm as well as 10 nm Al0.30Ga0.70N barriers. The measured photoluminescence (PL) spectrum consists of three peaks originating from the radiative recombination of excitons in individual QWs. In the nonpolar sample, the energy positions buy SB203580 (E-PL) of the observed peaks are separated because of the quantum confinement effect, whereas in the polar sample an additional redshift is induced by the quantum confined Stark effect. The dependence of E-PL on QW width was used to estimate the built-in electric field magnitude in the latter sample to be about 2 MV/cm. Hydrostatic pressure studies of the PL in both samples gave qualitatively different results. In the polar sample, the pressure shift of E-PL, dE(PL)/dp decreases significantly with QW width. The important finding is derived from the observation of a QW width independent dE(PL)/dp in the nonpolar sample. It shows that for GaN/Al0.30Ga0.70N, the quantum confinement remains practically independent of the applied hydrostatic

pressure. This result reveals that in the polar sample, the variation in dE(PL)/dp with the QW width is due to the pressure-induced increase in the built-in electric field F-int. Thus, a more quantitative analysis of the latter effect becomes justified. We found that the F-int increases with pressure with a rate CCI-779 inhibitor of about 80 kV(cmGPa)(-1). (c) 2009 American Institute of Physics. [DOI: 10.1063/1.3043888]“
“Objective: Cancer and treatments for cancer affect specific aspects of sexual functioning and intimacy; however, limited qualitative work has been done in diverse cancer populations. As part of an effort to improve measurement of self-reported sexual functioning, we explored the scope and importance of sexual functioning and intimacy to patients across cancer sites and along the continuum of care.