Many of the greatest problems of communicating about concepts, and, therefore, practice in distance education arise from our use of crude hypothetical constructs-terms like distance, independence, and interaction, which are used in very imprecise and general ways, each having acquired a multiplicity of meanings. Most seriously, the same terms are commonly used at both generic and more specific levels. For example, the generic concept "independence" is frequently confused with its species, independence of learners from instructors in space and time and independence of learners to control their means of study. These are further confused with the many subspecies of each type of independence. The same could be said of the concept and term "distance" itself, which is commonly used in the most general sense to describe education characterized by separation between learner and instructor, but by too few users in the more technical and specific meanings as discussed, for example, by Saba (1988), Keegan (1988), Shale (1988), or Moore (1984). Interaction is another important term that carries so many meanings as to be almost useless unless specific submeanings can be defined and generally agreed upon. Progress in this direction Learner-Content InteractionThe first type of interaction is interaction between the learner and the content or subject of study. This is a defining characteristic of education. Without it there cannot be education, since it is the process of intellectually interacting with content that results in changes in the learner's understanding, the learner's perspective, or the cognitive structures of the learner's mind. It is this type of interaction that I believe is at least partly involved in what Holmberg (1986) calls the "internal didactic conversation" when learners "talk to themselves" about the information and ideas they encounter in a text, television program, lecture, or elsewhere.The oldest form of distance teaching that aimed to facilitate interaction with content was the didactic text. In medieval times nearly all texts were aimed at instructing, not merely informing, and certainly not at entertaining. In the nineteenth century the use of print for teaching was advanced by the invention of home study guides that accompanied a text, providing explanations of it and directions for its study. In more recent times learners have interacted with content broadcast on radio and television programs, and with electronic recordings on audiotape, videotape, and computer software. Interactive videodisc is the most advanced form of didactic interaction invented so far. Some learning programs are solely content-interactive in nature. They are one-way communications with a subject expert (sometimes assisted by an instructional designer), intended to help distant learners in their study of the subject. No other professional teaching expertise is provided, and learning is largely self-directed. According to the findings of adult education research, the majority of the adult population undertakes selfdirected s...

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PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Importance: The rapidly expanding 2019 novel coronavirus pandemic (COVID-19, caused by the SARS-CoV-2 virus) has challenged the medical community to an unprecedented degree. Physicians and healthcare workers are at added risk of exposure and infection during the course of the patient care. Due to the rapid spread of this disease through respiratory droplets, healthcare providers such as otolaryngologists-head & neck surgeons who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures are particularly at risk. Here we present a set of safety recommendations based on our review of literature and communications with physicians with first-hand knowledge of safety procedures during the 2019 COVID-19 pandemic.Observations: A high number of healthcare providers were infected during the first phase of the pandemic in Wuhan province. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for healthcare providers without jeopardizing the care of patients. We reviewed the most common procedures related to the examination and treatment of upper aerodigestive tract diseases. Each category was reviewed based on the potential risk imposed to healthcare workers. Specific recommendations were made, based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in COVID-19 patients. Conclusions and Relevance: Preserving highly skilled healthcare work force is a top priority for any community and healthcare system. Based on the experience of healthcare systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of healthcare providers could be significantly reduced, while providing high levels of care. The provided recommendations could be used as broad guidance for all healthcare workers who are involved with the care of COVID-19 patients.