Objective Angiosarcoma is an aggressive malignancy with endothelial differentiation and notoriously poor prognosis despite aggressive therapy. Limited data are available to guide management decisions. To address this limitation, we present a large retrospective analysis of angiosarcoma patients treated at a single institution over a 25-year period. Methods To identify factors that impact angiosarcoma outcomes, we reviewed demographic, tumor and treatment characteristics of angiosarcoma patients evaluated at the University of Wisconsin Hospital between 1987 and 2012. Results The cohort included 81 patients diagnosed at age 19–90 yo (median 67). Fifty-five (68%) patients presented with localized disease while 26 (32%) presented with metastases. The primary sites were visceral/deep soft tissue (42%), head and neck/cutaneous (37%), breast (16%) and limbs in the setting of Stewart-Treves (5%). The 5-year overall survival (OS) was 40% with a median of 16 months. By univariate analysis, significant adverse predictors of survival included metastases at presentation, visceral/deep soft tissue tumor location, tumor size > 5 cm, tumor necrosis and the absence of surgical excision. A trend toward prolonged survival was observed with radiation therapy and for chemotherapy in patients with metastases. Age, sex, and prior radiation showed no correlation with survival. Conclusions Our large single institution series confirms the poor prognosis of angiosarcoma, supports a central role for surgical excision in management and highlights the need for novel therapies particularly in patients who present with metastatic disease.

Although rapid screening of negative and inadequate cervical smears is a quality assurance requirement for all UK laboratories, there has been little attempt to standardize the method and laboratories make use of a number of different techniques and times. The aim of this study was to assess the sensitivity of these various techniques by measuring their ability to pick out known false-negative smears. Completed questionnaires from 123 laboratories across England revealed that 52% of laboratories use a "step" technique, 19% use "turret", 15% use random paths and 34% attempt to rescreen the whole slide quickly. Twenty-two percent of laboratories use a mixture of techniques. Timings are also variable, with the majority of laboratories allowing screeners to review slides at a pace decided by themselves but usually between 1 and 2 min. The study involved 120 participants who performed a total of 24 000 rapid screens. The results showed that, of the 90 abnormal slides used in the study, 62 cases (69%) were identified as abnormal or needing review by more than 50% of participants. Overall rapid screening picked out 58% of high-grade squamous abnormalities, 59% of low-grade abnormalities and 72% of glandular lesions. Step screening performed best, followed by whole slide/random and then turret. One minute was the optimum time and there was a significant fall in performance once individuals attempted to rescreen large numbers (>50). The most significant finding was the marked variation in the performance of individuals using the same slide sets.

Policy development Statement of policy No action is requiredThis document sets out our strategy and implementation plan for supporting higher education institutions to develop and embed e-learning over the next 10 years. It reflects responses to the consultation on our draft strategy, and has been developed jointly with the Higher Education Academy and the Joint Information Systems Committee. HEFCE strategy for e-learning Higher Education Funding Council for EnglandJoint Information Systems Committee Higher Education Academy Foreword'People use the internet and new technologies every day -for finding information, communicating, and seeking entertainment, goods and services. Learners are bringing new expectations of the power of technology into higher education. And the curiosity and innovation of those in higher education is driving them to explore new approaches to learning supported by technologies. It is the excitement and interest of learners, teachers and the sector in general that drives our e-learning strategy. Our goal is to help the sector use new technology as effectively as they can, so that it becomes a 'normal' or embedded part of their activities. That does not mean telling universities and colleges what their aims for e-learning should be, nor how they should go about reaching them. But it is about describing overall aspirations for how e-learning can transform learning and teaching, and about supporting institutions in setting their own visions and plans.'We recognise that we cannot deliver and develop our strategy alone. We will work closely with our implementation partners, the Higher Education Academy and the Joint Information Systems Committee (JISC). We will seek to learn from and get the best out of joined-up approaches to the exploration of e-learning, working with the DfES e-learning strategy. Above all, we will put institutions, their teachers and learners, at the heart of our strategy, and ensure we review and develop it over its 10-year horizons, taking account of the real impact we have made on teaching and learning.' Liz Beaty Director, Learning and Teaching, HEFCE'Many universities and colleges we work with have highlighted the need to understand more about effective ways of using information and communications technology to enhance the student learning experience. This national strategy will provide a broad framework for bodies such as the Higher Education Academy and JISC to dovetail our efforts, to ensure that institutions carry forward strategies based on evidence of what works, advice and guidance from around the sector and beyond.' Cliff Allan Director of Programmes, Higher Education Academy'UK education and research has benefited enormously from its investment in ICT over many years and remains at the forefront of the innovative use of technology. HEFCE's e-Learning strategy, which emphasises many things central to JISC's own activities -such as the provision of personalised user experiences, supporting student progression, and supporting institutions in the innovative use of...

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Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.