Impact of central surgical review in a study of malignant germ cell tumors

BACKGROUND: Verification of surgical staging has received little attention in clinical oncology trials. Central surgical review was undertaken during a study of malignant pediatric germ cell tumors. METHODS: Children's Oncology Group study AGCT0132 included central surgical review during the study. Completeness of submitted data and confirmation of assigned stage were assessed. Review responses were: assigned status confirmed, assignment withheld pending review of additional information requested, or institutional assignment of stage disputed with explanation given. Changes in stage assignment were at the discretion of the enrolling institution. RESULTS: A total of 206 patients underwent central review. Failure to submit required data elements or need for clarification was noted in 40%. Disagreement with stage assignment occurred in 10% with 17/21 discordant patients reassigned to stage recommended by central review. Four ovarian tumor patients not meeting review criteria for Stage I remained in that stratum by institutional decision. Two-year event free survival in Stage I ovarian patients was 25% for discordant patients compared to 57% for those meeting Stage I criteria by central review. CONCLUSIONS: Central review of stage assignment improved complete data collection and assignment of correct tumor stage at study entry, and allowed for prompt initiation of chemotherapy in patients determined not to have Stage I disease

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Labor And The Politics Of Structural Adjustment In Australia And Indonesia

The labour forces of Australia and Indonesia are compared for the period from the late 1960s to the 1990s. The position of labour in a global economy is also considered. It is determined that the outlook for organised labour is bleak, however its position is also contingent upon national circumstance

Integrating cardiac MRI into pre-operative planning for patients with pectus excavatum and right ventricular dysfunction

A 16-year old male presented with severe pectus excavatum (PE) with a Haller index of 3.4. The patient was a physically fit individual, with no identifiable limitation in his daily activities. However, despite his level of fitness, he experienced significant and reproducible exercise limitation at peak exertion. The patient was evaluated with a static echocardiogram that showed a normal right ventricle (RV), with reduced systolic function—RV fractional area change (FAC) measuring 20% (normal >35%). A pre-operative cardiac MRI confirmed reduced RV function (RV ejection fraction (EF) 35% - normal >50%), dilated RV, and reduced left ventricular (LV) function (LV EF 43% - normal >55%). He proceeded with a Nuss bar repair. Post-operative echocardiogram revealed improved RV function with RV FAC greater than 35%. We show that in patients with PE and minimal symptoms at rest, cardiac MRI may reveal additional functional information in addition to echocardiography, to explain exertional symptoms. We also demonstrate resolution of cardiac dysfunction with surgical repair of PE. Keywords: Pectus excavatum, Cardiac dysfunction, MR

Benign giant mediastinal lipoblastoma

We report a rare case of a benign giant mediastinal lipoblastoma in an older Pediatric patient (12-year-old male) presenting with mild cough, fatigue, and shortness of breath on exertion. Of note, the patient, although complained of cough with supine positioning, was able to lie flat. Initial chest x-ray revealed near opacification of the left hemithorax, with contralateral mediastinal shift. The patient was transferred to a tertiary care children's hospital and underwent computed tomography (CT) imaging. CT was most compatible with a teratoma; however, operative management and histological analysis confirmed a diagnosis of lipoblastoma. Lipoblastomas are a rare, benign, rapidly growing tumor most often found in the extremities, and almost exclusively affecting children under the age of 5 years. We discuss our case of an uncommon tumor in an older patient, in a rare location. We review the literature of all previously reported mediastinal lipoblastomas in the Pediatric population. Keywords: Giant mediastinal lipoblastoma, Pediatric surgery, General surger

Pneumonectomy in a Child with Multilobar Pneumatocele Secondary to Necrotizing Pneumonia: Case Report and Review of the Literature

Background. Community-acquired pneumonia (CAP) is common within pediatrics and contributes disproportionately to morbidity and mortality. Necrotizing pneumonia is a well-documented complication of CAP. It is thought to be caused by necrosis and liquefaction of consolidated lung and can result in damage to lung parenchyma, including pneumatocele development. Management of necrotizing pneumonia with pneumatocele may include hospitalization, intensive care unit admission, and lengthy antibiotic courses. Severe cases may need invasive procedures. Case Presentation. We present a case of severe necrotizing pneumonia requiring prolonged venovenous extracorporeal membrane oxygenation (V-V ECMO) with development of persistent pneumatoceles, requiring pneumonectomy while on ECMO support to allow for decannulation and extubation. Conclusions. In critically ill patients with extensive unilateral necrotizing pneumonia with pneumatocele development, surgical intervention can be considered when attempts to wean ventilation have been unsuccessful. This case provides evidence that V-V ECMO and pneumonectomy is a viable salvage therapy in the most critically unwell children.Peer Reviewe