Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

Objective: Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. Methods: Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin\u2013etoposide\u2013cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease. Results: Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT+AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4\u201392.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescuedwith chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II\u2013IV, 48 (98%) achieved complete remission after chemotherapy \ub1 surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6\u2013100%) and 84.5% (95% CI: 76.5\u2013 93.5%). Conclusions:We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists,we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers

Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

<p>Abstract</p> <p>Background</p> <p>This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration.</p> <p>Methods</p> <p>Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis.</p> <p>Results</p> <p>The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error.</p> <p>Conclusions</p> <p>The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.</p

Pollination and dispersal trait spectra recover faster than the growth form spectrum during spontaneous succession in sandy old‐fields

Question: Spontaneous succession is the most natural and cost‐effective solution for grassland restoration. However, little is known about the time required for the recovery of grassland functionality, i.e., for the recovery of reproductive and vegetative processes typical of pristine grasslands. Since these processes operate at different scales, we addressed the question: do reproductive and vegetative processes require different recovery times during spontaneous succession? Location: Kiskunság sand region (Central Hungary). Methods: As combinations of plant traits can be used to highlight general patterns in ecological processes, we compared reproductive (pollination‐ and dispersal‐related) and vegetative (growth form) traits between recovered grasslands of different age (&lt;10 years old; 10–20 years old; 20–40 years old) and pristine grasslands. Results: During spontaneous succession, the reproductive trait spectra became similar to those of pristine grasslands earlier than the vegetative ones. In arable land abandoned for 10 years, pollination‐ and dispersal‐related trait spectra did not show significant difference to those of pristine grasslands; anemophily and anemochory were the prevailing strategies. Contrarily, significant differences in the growth form spectrum could be observed even after 40 years of abandonment; in recovered grasslands erect leafy species prevailed, while the fraction of dwarf shrubs and tussock‐forming species was significantly lower than in pristine grasslands. Conclusions: The recovery of the ecological processes of pristine grasslands might require different amounts of time, depending on the spatial scale at which they operate. The reproductive trait spectra recovered earlier than the vegetative one, since reproductive attributes first determine plant species sorting at the regional level towards their respective habitats. The recovery of the vegetative trait spectrum needs more time as vegetative‐based interactions operate on a smaller spatial scale. Thus, vegetative traits might be more effective in the long‐term assessment of restoration success than the reproductive ones

Invariant states in inclined layer convection Part 2: Bifurcations and connections between branches of invariant states

Convection in a layer inclined against gravity is a thermally driven non-equilibrium system, in which both buoyancy and shear forces drive spatio-temporally complex flows. As a function of the strength of thermal driving and the angle of inclination, a multitude of convection patterns is observed in experiments and numerical simulations. Several observed patterns have been linked to exact invariant states of the fully nonlinear three-dimensional Oberbeck–Boussinesq equations. These exact equilibria, travelling waves and periodic orbits reside in state space and, depending on their stability properties, are transiently visited by the dynamics or act as attractors. To explain the dependence of observed convection patterns on control parameters, we study the parameter dependence of the state space structure. Specifically, we identify the bifurcations that modify the existence, stability and connectivity of invariant states. We numerically continue exact invariant states underlying spatially periodic convection patterns at =1.07 under changing control parameters for a temperature difference between the walls and inclination angle. The resulting state branches cover various inclinations from horizontal layer convection to vertical layer convection and beyond. The collection of all computed branches represents an extensive bifurcation network connecting 16 different invariant states across control parameter values. Individual bifurcation structures are discussed in detail and related to the observed complex dynamics of individual convection patterns. Together, the bifurcations and associated state branches indicate at what control parameter values which invariant states coexist. This provides a nonlinear framework to explain the multitude of complex flow dynamics arising in inclined layer convection

Schlussbericht Astrone-KI-Teilvorhaben Bewegungsplanung und Lenkung

Dieser Bericht fasst die Kernergebnisse des Teilvorhabens Astrone-KI – Bewegungsplanung und Lenkung zusammen. Ziel war die Entwicklung KI-gestützter Verfahren zur autonomen Navigation und Steuerung eines schwebenden Erkundungssystems auf kleinen Himmelskörpern. Im Fokus standen sensorbasierte Flugplanung, schnelle Landeplatzerkennung sowie robuste Notlandestrategien. Die Ergebnisse zeigen, dass KI-Methoden gegenüber klassischen Ansätzen deutliche Vorteile in Echtzeitfähigkeit, Robustheit und Autonomie bieten. Damit leistet das Projekt einen wichtigen Beitrag zur Vorbereitung zukünftiger Missionen im Bereich Entry, Descent & Landing sowie planetarer Exploration.This report summarizes the key findings of the Astrone-AI subproject – Motion Planning and Control. The goal was to develop AI-based methods for autonomous navigation and control of a hovering exploration system on small celestial bodies. The focus here was on sensor-based flight planning, fast landing site detection, and robust emergency landing strategies. The results show that AI methods offer significant advantages over traditional approaches in terms of real-time capability, robustness, and autonomy. The project thus makes an important contribution to the preparation of future missions in the field of entry, descent, and landing, as well as planetary exploration