Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .)

Pension reform, the stock market, capital formation and economic growth: a critical commentary on the World Bank's proposals

Abstract Proposing far-reaching reforms to the pension systems, the World Bank has recently suggested that the existing pay-as-you-go pension systems in many rich as well as poor countries, should be replaced by fully funded, mandatory, preferably private pensions, as the main pillars of the new system. It argues that these reforms will not only benefit the pensioners, but also enhance savings, promote capital formation and economic development. This paper provides a critical examination of the Bank's theses and concludes that it has adopted a one-sided view of the relationships between the key critical variables. The proposed reform may therefore neither protect the old nor achieve faster economic growth

First measurement of Xi(-) polarization in photoproduction

Despite decades of studies of the photoproduction of hyperons, both their production mechanisms and their spectra of excited states are still largely unknown. While the parity-violating weak decay of hyperons offers a means of measuring their polarization, which could help discern their production mechanisms and identify their excitation spectra, no such study has been possible for doubly strange baryons in photoproduction, due to low production cross sections. However, by making use of the reaction γp→K+K+Ξ−, we have measured, for the first time, the induced polarization, P, and the transferred polarization from circularly polarized real photons, characterized by Cx and Cz, to recoiling Ξ−s. The data were obtained using the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab for photon energies from just over threshold (2.4 GeV) to 5.45 GeV. These first-time measurements are compared, and are shown to broadly agree, with model predictions in which cascade photoproduction proceeds through the decay of intermediate hyperon resonances that are produced via relativistic meson exchange, offering a new step forward in the understanding of the production and polarization of doubly-strange baryons

First measurement of the helicity asymmetry E in eta photoproduction on the proton

Results are presented for the first measurement of the double-polarization helicity asymmetry E for the $\eta$ photoproduction reaction $\gamma p \rightarrow \eta p$. Data were obtained using the FROzen Spin Target (FROST) with the CLAS spectrometer in Hall B at Jefferson Lab, covering a range of center-of-mass energy W from threshold to 2.15 GeV and a large range in center-of-mass polar angle. As an initial application of these data, the results have been incorporated into the J\"ulich model to examine the case for the existence of a narrow $N^*$ resonance between 1.66 and 1.70 GeV. The addition of these data to the world database results in marked changes in the predictions for the E observable using that model. Further comparison with several theoretical approaches indicates these data will significantly enhance our understanding of nucleon resonances

A Review of the Neurobiological Basis of Trauma-Related Dissociation and Its Relation to Cannabinoid- and Opioid-Mediated Stress Response: a Transdiagnostic, Translational Approach

Stress-related psychiatric disorders across the life spa