146 research outputs found

    Surgical Standards for Management of the Axilla in Breast Cancer Clinical Trials with Pathological Complete Response Endpoint.

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    Advances in the surgical management of the axilla in patients treated with neoadjuvant chemotherapy, especially those with node positive disease at diagnosis, have led to changes in practice and more judicious use of axillary lymph node dissection that may minimize morbidity from surgery. However, there is still significant confusion about how to optimally manage the axilla, resulting in variation among practices. From the viewpoint of drug development, assessment of response to neoadjuvant chemotherapy remains paramount and appropriate assessment of residual disease-the primary endpoint of many drug therapy trials in the neoadjuvant setting-is critical. Therefore decreasing the variability, especially in a multicenter clinical trial setting, and establishing a minimum standard to ensure consistency in clinical trial data, without mandating axillary lymph node dissection, for all patients is necessary. The key elements which include proper staging and identification of nodal involvement at diagnosis, and appropriately targeted management of the axilla at the time of surgical resection are presented. The following protocols have been adopted as standard procedure by the I-SPY2 trial for management of axilla in patients with node positive disease, and present a framework for prospective clinical trials and practice

    Understanding the circumgalactic medium is critical for understanding galaxy evolution

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    Galaxies evolve under the influence of gas flows between their interstellar medium and their surrounding gaseous halos known as the circumgalactic medium (CGM). The CGM is a major reservoir of galactic baryons and metals, and plays a key role in the long cycles of accretion, feedback, and recycling of gas that drive star formation. In order to fully understand the physical processes at work within galaxies, it is therefore essential to have a firm understanding of the composition, structure, kinematics, thermodynamics, and evolution of the CGM. In this white paper we outline connections between the CGM and galactic star formation histories, internal kinematics, chemical evolution, quenching, satellite evolution, dark matter halo occupation, and the reionization of the larger-scale intergalactic medium in light of the advances that will be made on these topics in the 2020s. We argue that, in the next decade, fundamental progress on all of these major issues depends critically on improved empirical characterization and theoretical understanding of the CGM. In particular, we discuss how future advances in spatially-resolved CGM observations at high spectral resolution, broader characterization of the CGM across galaxy mass and redshift, and expected breakthroughs in cosmological hydrodynamic simulations will help resolve these major problems in galaxy evolution.Comment: Astro2020 Decadal Science White Pape

    Maternity management in SMEs: a transdisciplinary review and research agenda

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    This paper provides a transdisciplinary critical review of the literature on maternity management in small- and medium-sized enterprises (SMEs), embedded within the wider literatures on maternity in the workplace. The key objectives are to describe what is known about the relations that shape maternity management in smaller workplaces and to identify research directions to enhance this knowledge. The review is guided by theory of organizational gendering and small business management, conceptualising adaptions to maternity as a process of mutual adjustment and dynamic capability within smaller firms’ informally negotiated order, resource endowments and wider labour and product/service markets. A context sensitive lens is also applied. The review highlights the complex range of processes involved in SME maternity management and identifies major research gaps in relation to pregnancy, maternity leave and the return to work (family-friendly working and breastfeeding) in these contexts. This blind spot is surprising as SMEs employ the majority of women worldwide. A detailed agenda for future research is outlined, building on the gaps identified by the review and founded on renewed theoretical direction

    Episode 7: The clinic that would cause an uproar

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    Runtime 20:35"Dr. Todd Tuttle described the experience of taking a medical mission trip to Honduras as: ""No money. No insurance. Pure medicine."" Dr. Tuttle is a surgical oncologist at the University of Minnesota Department of Surgery.
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