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Take a sneak peek at the new NIST.gov and let us know what you think!
(Please note: some content may not be complete on the beta site.).
Sorted by AuthorTo select a specific author click on the author's name in the list below
Publications of the Statistical Engineering DivisionEach year the staff of the Statistical Engineering Division produces an annual report describing recent Division projects, publications and activities. Reports are produced in late winter or early spring each year. One of the primary audiences for the report is the NRC Board of Assessment of NIST Programs that that reviews NIST programs annually. However, over the years many other people have also found these reports useful as an overview of the mission and impact of the Division and as a way to keep up-to-date on Division work. PDF or HTML versions of the current report and reports from previous years are available here.
Sorted by SubjectTo select a specific subject click on the subject name in the list below
Methodological Papers


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I don't know about you, but I can't imagine doing my PHP development without an IDE with a debugger anymore.
It autocompletes for me, it lets me step through each line of code, jumping around the project, execute and change the code flow on the fly, and does many other things that make me feel cozy, comfortable, and efficient at PHP development (as opposed to, say, CPP which makes me feel cold and lonely).
There are many PHP IDEs out there and I've tried most of them (including the free PHPEclipse and …[Read more...]

subset: commoncrawl


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The Blues, Jazz and Folk Music Society will host its 19th annual River City Ohio Blues Competition Friday and Saturday, with local and regional blues acts competing for the chance to perform in an international blues competition.
"We can send up to two acts to the (2012) International Blues Challenge in Memphis, including a solo or duo act and a band, depending on how they place in the competition," said "Cobbler" John Bolen, president of the local Blues, Jazz and Folk Music Society.
He said the competition is a crowd-pleaser and each year draws audiences from several states.
Article Photos
Times file photo
Magic Mama Latte performs during a previous blues competition in Marietta. The River City Ohio Blues Competition is Friday and Saturday.
"The acts are limited to a 20-minute performance each, so if you don't like one, just wait 20 minutes and a different act will take the stage," Bolen said.
A total of 18 blues bands and performers from Ohio, West Virginia, Virginia, Indiana, Pennsylvania and Arkansas will compete in the two-day competition at the Lafayette Hotel in downtown Marietta.
The winner will compete for cash prizes and society sponsorship to the International Blues Challenge. The cash prizes are higher this year and include $1,200 for first place, $600 for second and $300 for third.
Fact Box
If you go
* What: 19th annual River City Ohio Blues Competition.
* When: 8 p.m. Friday (first preliminary), noon Saturday (second preliminary), 8 p.m. Saturday (finals).
* Where: Lafayette Hotel, 101 Front St., Marietta.
* Tickets: First preliminary, $5 for Blues, Jazz and Folk Music Society members, $10 for non-members; second preliminary, $10, $15; finals, $15, $20. Weekend passes are $25 for members and $40 for non-members.
* Tickets are available by contacting (304) 295-4323, email@example.com, 376-0222 (evenings) or firstname.lastname@example.com.
The competition begins Friday night with the first preliminary, followed by the second preliminary on Saturday afternoon. The finals on Saturday night will feature winners from the two preliminaries.
Tickets are $5 for society members and $10 for non-members for the Friday night show, $10 for members and $15 for non-members for Saturday afternoon and $15 for members and $20 for non-members for the Saturday night performances.
Weekend passes are $25 for members and $40 for non-members.
The schedule of performers for the weekend includes:
Friday (First Preliminary Round)
* 8 p.m. - Billy Reiter and Dodge Park (Thornville).
* 8:30 - The Shane Gang (St. Clairsville).
* 9 - Bourbon Dan and The Chasers (Columbus).
* 9:30 - The Noah Wotherspoon Band (Cincinnati).
* 10 - The Elm Street Blues Band (Cleveland).
* 10:30 - The Sufferin' Moses Blues Band (Athens).
Saturday (Second Preliminary Round)
* Noon - The Ray Cheney Trio (Lima).
* 12:30 p.m. - Motu (Long Island, N.Y.).
* 1 - Vinnie Mele and The Lubricators (Marietta).
* 1:30 - Blues Crossing (Ona, W.Va.).
* 2 - The Coyotes (Richlands, Va.).
* 2:30 - Mack Jump (Indianapolis).
* 3 - The Ray Fuller Band (Columbus).
* 3:30 - C&S Railroad (Lesage, W.Va.).
* 4 - Angel Blue and The Prophets (Pittsburgh).
* 4:30 - Jason Greenlaw and The Groove (McCrory, Ark.).
* 5 - The Code Blue Band (Columbus).
* 5:30 - Big Mike and the Mon Delta Allstars (Carmichaels, Pa.).
* 6:15 - Dinner break.
* 8 - Final competition between winners of first and second preliminary rounds.


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Shazam! Happy to see actor Jim Nabors is alive and well and retired to Hawaii. It's been years since we'd thought about Mr. Nabors, one of our favorite character actors from the 1960s, because it has been 20 years or more since he last was a regular on TV or in movies. He is best known and fondly remembered for his portrayal of Gomer Pyle, the rube auto mechanic on "The Andy Griffith Show" and later the bumbling U.S. Marine on "Gomer Pyle, U.S.M.C." Now comes word that Mr. Nabors and his partner of 38 years got "married" last month in civil ceremony in a Seattle hotel room not long after Washington state approved homosexual "marriage." As Gomer might have said: Sur-prise, sur-prise, sur-prise!
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George wrote on Feb 5, 2013 10:43 AM:
" Congratulations to the happy couple! It's great to hear that couples can marry openly, despite snarky announcements like the one which appeared here. Jim, I only wish you could have done so decades ago. "
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Veterans Day marks an opportunity to pause and to honor our veterans of past wars. We remember our venerated soldiers by marching in parades, visiting gravesites of loved ones who were in the military, and putting flags outside our homes and on monuments throughout the city. As patriotic Americans, we take pride in what our veterans have done for our country throughout history, and this is reflected in the many memorials we have in the city of New Bedford.
We are indeed fortunate to have these monuments dedicated to those who died in the Civil War, World War I, World War II, the Korean War, the Vietnam War, and the war in Iraq. It is through these monuments that we remember and reflect on history, and it is important that we take care of them.
Several weeks ago, the Holocaust monument was vandalized. To see such desecration on a beautiful and meaningful structure was indeed disheartening. This monument was dedicated in 1998 by Abraham Landau, a New Bedford tailor who survived 13 concentration camps during the Holocaust. It was Abe's dream that this monument remind passersby of the evils of the Holocaust and honor the memory of the 6 million Jews and 5 million other victims who died during World War II.
This week also marks the 74th anniversary of Kristallnacht ("night of the broken glass") on Nov. 9, 1938, with vandalism perpetrated against Jews and their property throughout Germany. At that time in history, anti-Semitism was at its peak and the beginning of World War II was less than a year away.
In New Bedford, we are fortunate to have many monuments that teach us about the soldiers who risked and sacrificed their lives to make a difference as they fought for freedom and security for us all during the past wars. Each monument tells about the soldiers who died in the wars that we have studied about in history classes. In addition, we have a superb military museum at Fort Taber Park that delineates the important stories of many of our veterans during these wars. It is time now to teach our young people about the monuments around our city and to reflect on the lives of those whose names are on them.
Desecrating a monument is not a way to express anger or disagreement. It is a hateful and criminal act! It would be better to express our opinions by writing a letter to the newspaper or by joining a cause that helps to make this world a better place for us all.
Location, ST | website.com


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Buffett Praises Dimon's Leadership at J.P. Morgan
Warren Buffett, chief executive of Berkshire Hathaway, said if he owned J.P. Morgan Chase & Co., he would keep Chief Executive James Dimon at the helm and would pay him even more than he's making now.
Earlier on Friday, the bank disclosed in a filing that Mr. Dimon received a 74% jump in compensation in 2013, a year in which J.P. Morgan agreed to more than $20 billion in legal payouts and posted its first quarterly loss since the financial crisis.
The increase brought Mr. Dimon's pay for 2013 to $20 million from the $11.5 million he pulled in for 2012. The board that year cut Mr. Dimon's pay in half due to a trading fiasco that cost the bank billions, saying he had "ultimate responsibility for the failures that led to the losses."
But in an interview Friday, Mr. Buffett called Mr. Dimon "a bargain."
"If I owned J.P. Morgan Chase, he would be running it and he would be making more money than the directors are paying him," said Mr. Buffett, who has publicly defended the bank executive before and owns J.P. Morgan shares.
He added J.P. Morgan was a "huge plus to the American financial system" during the financial crisis and did much better than other big banks through that period.
"If Jamie decides he wants to make more money, all he has to do is call me and I'd hire him at Berkshire," the billionaire investor added.


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Beating Unusual Chess Openings
Dealing with the English, Reti, King's Indian Attack and Other Annoying SystemsProduct Code: B0155EM
Publisher: Everyman Chess
Pages: 223
Book DescriptionBeating Unusual Chess Openings is a godsend to those chess players fed up with struggling against all opening moves other than White's main two: 1 e4 and 1 d4. From the respectable (English Opening, Reti and King's Indian Attack) through to the off-beat (Nimzo-Larsen Attack, Bird's Opening) and the totally bizarre (Orangutan, Grob); everything Black needs to know about facing unusual openings is covered within these pages. Richard Palliser gets to grips with all of White's possibilities, examining their strengths and weaknesses and in turn organizing a reliable and practical repertoire for Black.
Returns & Exchanges
This is a Specialty Item and All Sales are Final. No refunds, returns or exchanges are allowed.
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February 09, 2013
According to the website for the Chris Sailer Kicking School, PK Elliott Fry of Carrollton, TX has accepted an offer as a preferred walk-on at USC. Sailer ranked Fry as the #8 kicker in his class and as a 5-star kicking prospect which equates to a Division One prospect. Here is what Sailer wrote on his site about Fry:
Elliott is simply an oustanding kicker. He has a big time leg and gets great height on his ball off the ground. Kicks well under pressure. One of the most consistent all around performers in the nation. Kickoffs and Field Goals are ready for D1 college football right now. He is also a great punter. His punting is also D1 ready. A top national combo player without a doubt. Has a great attitude and work ethic. Has proven he is worthy of a D1 scholarship. Great prospect. OFFER NOW!!! Turned down D1 offer and will commit to South Carolina as a preferred walk on. Huge pick up for South Carolina.
Fry will join Max Huggins of Myrtle Beach as invited walk-on kickers at USC in the fall.
Published August 23
Published August 22
Published August 22
Published August 19
Published August 19
Recruiting Notebook August 24th
Recruiting Notebook August 18th]}
Location, ST | website.com


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Understand permissions
Permissions in Google Groups dictate what actions people (members and visitors) can and cannot perform in the group. It is critical that administrators understand the permissions available in Google Groups and how they affect the options available to people using a group. Just about every action a person can perform in a group is controlled by a permission.
Permissions are assigned to Anyone (Group-wide permissions) and to roles (groups of people with specific permissions, such as all "Members" or all "Owners.").
Group-wide permissions
Group-wide permissions affect every person (members and visitors) trying to access a group. These are permissions assigned to "Anyone" when a group is created and can also be modified by clicking on the Manage button on the Topics screen.
Refer to Creating a group for more information on the permissions set when you create a group. The more permissions assigned to "Anyone," the more public your Google group.
Refer to Permissions for a list of all permissions.
Role-specific permissions
Role-specific permissions are permissions set on a grouping of people within a Google group. For example, the role "Owners of the group" or "Owners" will have certain permissions given to all its members while the role "All members of the group" or "Member" will have another set of permissions for its members. Three roles (Owner, Manager, and Member) are automatically created (with a set of default permissions) for every new Google group. These role-specific permissions can be edited by clicking on the Manage button within the Topics screen, expanding the Permissions section on the left-hand side, and clicking on one of the permissions categories, such as "Posting permissions."
Refer to Default roles for more information on the Owner, Manager, and Member roles.
Refer to Permissions for a list of all permissions.


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October 3, 2009 at 11pm to October 10, 2009 at 12pm – Findhorn Foundation A week-long conference exploring the building of resilience at all levels, inner and outer, in the face of peak oil and climate change. Presenters include Rob Hopkins Richard Olivier Judy Wicks (Busi… Organized by Jonathan Dawson | Type: international, conference
October 5, 2009 to October 18, 2009 – Cumbria Cumbria Green Build aims to show the public, business and communities what has already been achieved within the county and inspire them make changes themselves. Organized by Cumbria Action for Sustainability | Type: festival


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MINNEAPOLIS (AP) — Depleted by injuries to their biggest stars, the New York Yankees were sagging in the relentless AL East race when they arrived in Minnesota.
Four games against their longtime punching bag later, the Yankees have some momentum back.
Vernon Wells drove in three runs and the Yankees pounded rookie Kyle Gibson and the Twins 9-5 on Thursday to finish the sweep, their first series victory in almost four weeks.
"It's a new month, and hopefully this is a time that we're going to turn this around," Ichiro Suzuki said through his interpreter after tallying three hits, including a two-run triple.
Travis Hafner had three hits and scored twice, and Zoilo Almonte and Alberto Gonzalez also drove in runs for the Yankees, who scored 29 runs over the four games.
They didn't even need their usual super-sized contribution from Robinson Cano, whose streak of six straight multihit games ended without reaching base. He still batted .500 on this seven-game road trip with 11 RBIs.
"Everyone else seemed to pick it up around him today," manager Joe Girardi said.
The Yankees stayed six games behind first-place Boston in the division.
Since the start of 2002, including the postseason, they're 71-23 against Minnesota.
"They've always had great players over there since I became manager here," the Twins' Ron Gardenhire said. "Great players do good things."
Gibson's debut last weekend matched the anticipation of the 2009 first-round draft pick built up in the fan base, a winning performance with six sharp innings and two runs allowed.
This time, he was behind 3-0 after just his 17th pitch.
The first five batters produced two singles, two doubles and a soaring sacrifice fly by Cano that Oswaldo Arcia caught at the wall in left field. The next batter, Wells, hit a two-run single.
The game, though, was essentially decided in the third inning.
Gibson hit Hafner with a pitch and let him move up on a wild pitch. Then Wells sneaked a low-arc pop-up in the space between Arcia and the infield, just enough for Hafner to score, Arcia to miss a sliding catch by a few inches and Wells to get a double. Luis Cruz followed with an RBI single, his first hit for the Yankees, to stretch the lead to 5-0.
The Twins have lost 10 of their last 13 games.
Location, ST | website.com


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Google unveils the Nexus One. RMS explains his position on dual licensing. And more.
Follow 451 CAOS Links live @caostheory on Twitter and
"Tracking the open source news wires, so you don't have to."
For the latest on Oracle's acquisition of MySQL via Sun, see Everything you always wanted to know about MySQL but were afraid to ask… [Read more...]


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Sexy Tiffany Brookes is full of sexual confidence and this girl commands every scene she is in. She doesn't get on the Sybian just to ride it, she slides on to CONQUER It! Tiffany doesn't talk sweet, she talks dirty and when the Babe vs. the Machine, her tight pussy pumps it with everything she's got.
Tiffany Brookes sits casually on the back porch smoking a cigarette and talking to you through the camera. She rubs herself through her little shorts and reveals a sexy secret. Admitting herself to be a clinically proven nymphomaniac, she tells of a photo shoot where she hooked up with the photographer. She said it felt so good, that she didn't even stop when her boyfriend caught them! She rubs on her sweet wet pussy the whole time as she tells the naughty story.
Slender seductress Tiffany Brookes has a tight body and a super hot naughty mouth. It is such a turn on to hear Tiffany talk because she doesn't filter things. She speaks her mind – as dirty as it may be. She tells you how tight her pussy is and how much she loves hard cock. She is the kind of tough and thrilling babe that you know would be a challenge, but you also know would be totally worth the while.
Tiffany Brookes has such a great pair of legs that her little dress is great on her. What's even better is that she lifts that dress right up and spreads those lovely legs wide apart to reveal her smooth pussy without any panties. To make things absolutely perfect, this hottie uses a purple toy to pleasure herself.
Tiffany Brookes absolutely hates to wear panties, but loves to wear short skirts and entertain. What a fantastic combination! This Las Vegas Vixen lets you look up her skirt and tells the camera that if you're a pervert, she likes you ten times better. She wants you to experience the thrill with her. She keeps speaking to you as she pleasures her pink pussy and gets her natural boobs bouncing.


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"For the past four years, Paul has led the Conservation Programs Committee, and under his watch, DU reached a milestone 76 years in the making when we surpassed 13 million acres of waterfowl habitat conserved," said John Newman, DU's chairman of the board. "He's a natural fit for his new position and I'm looking forward to working with him in the years to come."
As first vice president, Bonderson advises and represents DU's president. He will also work directly for the president on special assignments and represent the president at functions he is unable to attend.
"Paul is one of the most conservation-minded people I know," said DU President George Dunklin Jr. "His commitment to and passion for the outdoors are unsurpassed. He's a dedicated leader and true friend to DU. I'm excited to help continue the significant progress we've made under his leadership as Conservation Programs Committee chair."
Bonderson has been a member of DU's board of directors for the past seven years, serving as regional vice president, senior flyway vice president and senior advisory vice president for conservation. He is also a member of the Wetlands America Trust board. He is married with two children and is the retired founder and chief technology officer of Brocade Communications.
"My time spent on DU's board of directors has been amazing, and I look forward to continuing my work as first vice president," Bonderson said. "I can't wait to see all the great things we will accomplish over the next two years."
For more information about other newly elected directors, visit www.ducks.org.
Ducks Unlimited Inc. is the world's largest non-profit organization dedicated to conserving North America's continually disappearing waterfowl habitats. Established in 1937, Ducks Unlimited has conserved more than 13 million acres thanks to contributions from more than a million supporters across the continent. Guided by science and dedicated to program efficiency, DU works toward the vision of wetlands sufficient to fill the skies with waterfowl today, tomorrow and forever. For more information on our work, visit www.ducks.org. Connect with us on our Facebook page at facebook.com/DucksUnlimited, follow our tweets at twitter.com/DucksUnlimited and watch DU videos at youtube.com/DucksUnlimitedInc.
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President Franklin D. Roosevelt signs the Migratory Bird Hunting and Conservation Stamp Act into law.
First duck stamp, designed by Pulitzer-prize winning editorial cartoonist, Jay N. "Ding" Darling, issued.
Prairie drought peaks.


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Growing Focus on Inequality Puts Asia in Spotlight
A consensus that rising income inequality is hobbling the prospect for future economic growth is gaining traction with mainstream economists.
Asia has been the fastest-growing global region in recent years. But it's also a place where inequality – as measured by the range of disposable incomes – has risen fast.
The International Monetary Fund, in studies published this year, contends that inequality hurts growth in a number of ways. It reduces the education levels of poorer citizens, and saps their health, reducing the potential productivity of a workforce.
It also can cause political instability due to anger over income disparities, which leads to a falloff in investment. That's what appears to be happening in Thailand, where anti-government protests have spurred a decline in investment.
Some Asian nations already are facing growth constraints with roots in inequality. Take Indonesia, whose economy grew at 6% in recent years, fueled by exports of commodities like coal and nickel to China.
As China's growth slowed, Indonesia too has suffered. Two-thirds of the nation's exports come from energy or natural resources. The share of manufacturing in the economy, meanwhile, has declined. And that's partly due to a poorly-educated and unhealthy workforce.
Disparities of wealth in Indonesia have played a part in this. There are fewer Indonesians living below the poverty line than in the past. But look here to see how household expenditure inequality has worsened since 2001.
So what's the answer?
As David Lipton, the IMF's No. 2 official, said in a speech on Thursday, policies that redistribute income could hold the key, if done well.
Taxing the rich is a political hot potato. Mr. Lipton stressed that taxes that minimize incentives to work, save and invest aren't what the Fund is looking to promote. But the IMF believes that, done right, redistribution can make an economy more efficient.
He pointed to the experience of Brazil and Mexico, which have seen drastic reductions in inequality. Both countries have used conditional cash transfers, in which benefits are tied to attendance in school – policies which the fund estimates accounted for a fifth of reductions in inequality between 1995 and 2004. (See here for Brazil.)
Such an approach differs to Indonesia, which uses subsidies on energy as its main tool for redistributing income. These subsidies, which are popular across Asia, have been widely criticized for failing to target the poorest sectors and overly aiding middle-class citizens who own cars or motorbikes.
Inequality in Asia – as measured by differences in disposable income – is still lower than South America. But inequality is broadly declining there, while in Asia the trend is rising.
More recently, the global debate over inequality also is focusing on the rising share of income of the super-rich. In the U.S., the top 1% of income earners account for about 19% of total income, equal to levels in the Great Depression, according to the World Top Incomes Database.
In Indonesia, the top 1% accounted for 8.5% of total income in 2004, the last year for which data is available, according to the database. But the data is based on tax information, and the level of tax evasion in Indonesia is high, so these figures are likely lower than the reality.
Another way of looking at inequality is through wealth, which is more unequally distributed than income. As Mr. Lipton noted, Oxfam found in a recent study that the world's 85 richest people own the same amount of wealth as the bottom half of the global population.
Thomas Piketty, a French economist, argues in "Capital in the Twenty-First Century," which came out in English translation this month, that ownership of capital will become more crucial than incomes as economic growth rates decline in the West, increasing the importance of inheritance over individual effort.
His answer is a global progressive tax on wealth. Others say increasing workers' pay is the key.
Either way, these are going to be major questions for Asian governments in the years ahead.


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Knitter's Review
March 8, 2012
With Alice Starmore's books back in print and Jared Flood's Brooklyn Tweed yarns providing a mouth-watering palette, everything's in place for a color renaissance. Some would argue colorwork never went away in the first place.
When you use multiple colors within a project, you have two choices. Either you use the colors the designer chose for you, or you strike out on your own. We weren't all born with an equal gift for putting colors together.
Books and wheels teach us color theory, but sometimes we just want a simple gadget to get us on the right path. I've found one. Gail Callahan's Color Grid is no bigger than a take-out menu and costs less than a sandwich.
This Weekend in Indiana
In the Forums: The Day We Met
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As always, I thank you for your readership and your support.
Happy knitting, and I'll see you in the Forums,
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Participate in our Knitter's Review Poll and you'll see an instant tally of all the votes.
On the Cover
A hyacinth nestled atop two skeins of Foxfire Fiber Cormo Camel Silk
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© Copyright 2000-2012 by Clara H. Parkes. All rights reserved.


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The Indiana Mayhem Fastpitch 14U is looking for an athletic player who wants to work hard and improve her softball skills! We have 11 strong players and would like another girl to join our team. Playing time is earned first in practice and then based on performance in competition. Players will learn a primary and secondary position to better prepare them for their high school and college careers. Playing time must be earned throughout the year. The Mayhem organization emphasizes player development and teaches players all aspects of the game. We practice outdoors in the fall, spring, and summer; and indoors during the winter months. We practice twice per week and will play approximately 10 summer tournaments and a summer World Series.
** Due to an unfortunate injury, we are now looking for an athletic player to join our team for the Spring/Summer Tournament Season.
Call today for a private tryout or to come join us at a workout! **
Contact Coach Chris Norwood for more information or to schedule a private tryout - (317)590-9095 or firstname.lastname@example.com####
Due to an unforthunate injury on our team, we are seeking an athletic player to join our team for the remainder of the season.
Call TODAY ~ 317-590-9095!
ACTIVE is the leader in online event registrations from 5k running races and marathons to softball leagues and local events. ACTIVE also makes it easy to learn and prepare for all the things you love to do with expert resources, training plans and fitness calculators.


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BELVIDERE (WIFR) -- Kids at Meehan Elementary School got a jump on Veteran's Day.
Yesterday, they spent their lunch hour getting to know local veterans and active-duty personnel, before heading to an all-school assembly.
We caught up with one local vet who's been doing this for three years. He says it's a fun way to mark such an important holiday, and give the kids a better idea of what the military does and has done.
"My daughter's currently in second grades. I started coming when she was in Kindergarten. I look forward to doing it, it's fun with the kids. They have a lot of interesting questions about the uniform, and what I did while I was in the service, things of that nature. So I look forward to it and the kids do too," said Justin Revera, a veteran of the U.S. Marine Corps.
Veteran's day is Monday, November 12, 2012.


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Religion Notes: Jan. 18
Published: Saturday, January 18, 2014 at 4:30 a.m.
Last Modified: Friday, January 17, 2014 at 2:44 p.m.
Mills River Puzzlefest to kick off Jan. 25
Mills River Presbyterian Church at 10 Presbyterian Church Road is hosting its fifth annual Puzzlefest starting Jan. 25.
Puzzlefest hours will be noon to 6 p.m. on weekends and noon to 8 p.m. on weekdays through Feb. 3.
Two different puzzles totaling 12,000 pieces will be put together in 10 days. Each puzzle will measure 3.5 feet high by 5 feet long when completed.
The first puzzle is titled "Sun's Out" and depicts Noah's Ark with a clearing sky. The second puzzle is "Butterfly Rainbow," depicting a rainbow of butterflies in an ancient Indian setting.
Participants can pick one puzzle to work on from start to finish or table-hop and work on both puzzles.
For more information, call 891-7101.
Union Grove to host MLK march, more
The Union Grove Angelic Choir will host a march and celebration in honor of Dr. Martin Luther King Jr. at 5:30 p.m. Monday.
The march and motorcade will leave the Henderson County Courthouse, 200 N. Grove St., and proceed to the Union Grove Missionary Baptist Church, 901 Robinson Terrace, Hendersonville.
The celebration will immediately follow the march at about 6 p.m. with this year's theme being "We Are the Dream." The Rev. Donald McDaniel will be a guest speaker at the event.
For more information, call Gloria Rudisill or Diane Caldwell at 696-0772 or 290-5838.
Greenville, S.C.
Mormon Tabernacle director to conduct
Furman University will present a concert to close its annual Church Music Conference at 7:30 p.m. Friday at First Baptist Church of Greenville, 847 Cleveland St.
Mack Wilberg, director of the Mormon Tabernacle Choir, will serve as guest conductor for the concert. He will also serve as featured clinician and Thomson Distinguished Lecturer in Church Music for the conference.
For more information, contact the Furman University Music Department at 864-294-2086 or firstname.lastname@example.com, or visit the music department's website at www.furman.edu/music.
Compiled from staff reports
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


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The Wieber family arrived in San Jose Thursday afternoon. They will be cheering Jordyn on when she competes Friday and Sunday nights.
"It's really surreal," Jordyn's older sister, Lindsay Wieber, said. "Every time it hits me, I just can't imagine that we're actually here and she's going to be competing [Friday] for the Olympic Trials. It's just so cool. I'm so proud of her and every time I see the commercials, I get all teared up and I just get so excited for her."
"It's weird," said Rita Wieber, Jordyn's mother. "I was just thinking that [Thursday] when we got off the airplane and we were at the airport and it was like 'Welcome to San Jose' and it was a picture of Jordyn. I never would have thought this 10 years ago, or whenever she first started gymnastics."
And here Jordyn is at the U.S. Olympic Trials. Her older brother, Ryan, has mixed feelings.
"It's nerve-wracking but it's also fun," he said. "It's a cool experience for all of us, especially Jordyn. But it's also nerve-wracking for me and the rest of my family, of course, because I want her to do well. She's trained so hard, she deserves it."
The Wieber family won't be able to spend time with Jordyn this weekend; just a few text messages and phone calls.
For her part, Jordyn is thrilled they're here.
"I'm so happy they're going to be watching. It's always nice to look up in the crowd and see friendly faces," said Jordyn. "For my whole family to be here to share this moment and to see this all happen, it's really exciting."
Jordyn competes Friday night at the U.S. Olympic Trials. We'll have complete coverage on News 10.


text:
Even so, let's take pregnancy out of the picture. When I did smoke, I always got a lot of nasty glares and over exaggerated coughs when people would walk by me when I was taking a smoke break at work. There was even a lady that gave me a pamphlet all about why I'm going to hell for smoking.
On one of the birth club boards, a woman was so angry her neighbor was smoking outside because her window was open. As simple as it should be to close the damn window, instead, she felt it was necessary to discuss how evil smokers are and how smoking shouldn't be allowed anywhere.
So, really what I'm getting at is, why are some non smokers so fucking psycho about someone else's choice to be a smoker?


text:
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Home > Wellness > Health Library > Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Cancer in children and adolescents is rare, although the overall incidence of childhood cancer has slowly increased since 1975.[1] Children and adolescents with cancer should be referred to medical centers that have a multidisciplinary team of cancer specialists with experience treating the cancers that occur during childhood and adolescence. This multidisciplinary team approach incorporates the skills of the following health care professionals and others to ensure that children receive treatment, supportive care, and rehabilitation that will achieve optimal survival and quality of life:
Guidelines for pediatric cancer centers and their role in the treatment of pediatric patients with cancer have been outlined by the American Academy of Pediatrics.[2] At these pediatric cancer centers, clinical trials are available for most of the cancer types that occur in children and adolescents, and the opportunity to participate in these trials is offered to most patients and families. Clinical trials for children and adolescents with cancer are generally designed to compare potentially better therapy with therapy that is currently accepted as standard. Most of the progress made in identifying curative therapies for childhood cancers has been achieved through clinical trials. Information about ongoing clinical trials is available from the NCI website.
Dramatic improvements in survival have been achieved for children and adolescents with cancer.[3] Between 1975 and 2010, childhood cancer mortality decreased by more than 50%.[3] During the period from 2002 to 2010, cancer mortality continued to decrease by 2.4% per year for children and adolescents with acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin and non-Hodgkin lymphoma, neuroblastoma, central nervous system tumors, and gonadal tumors, as compared with the period from 1975 to 1998 (plateauing from 1998 to 2001).[3] Childhood and adolescent cancer survivors require close monitoring because cancer therapy side effects may persist or develop months or years after treatment. (Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for specific information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors.)
GCTs arise from primordial germ cells, which migrate during embryogenesis from the yolk sac through the mesentery to the gonads.[4,5] Childhood extracranial GCTs can be divided into the following two types:
Most childhood extragonadal GCTs arise in midline sites (i.e., sacrococcygeal, mediastinal, and retroperitoneal); the midline location may represent aberrant embryonic migration of the primordial germ cells.
Childhood extracranial GCTs are broadly classified as the following:
GCTs comprise a variety of histologic diagnoses and can also be divided into the following histologic types:
(Refer to the PDQ summary on Childhood Central Nervous System Germ Cell Tumors Treatment for information about the treatment of intracranial germ cell tumors.)
Childhood GCTs are rare in children younger than 15 years, accounting for approximately 3% of cancers in this age group.[6,7,8] In the fetal/neonatal age group, most extracranial GCTs are benign teratomas occurring at midline locations, including sacrococcygeal, retroperitoneal, mediastinal, and cervical regions. Despite the small percentage of malignant teratomas that occur in this age group, perinatal tumors have a high morbidity rate caused by hydrops fetalis and premature delivery.[9,10]
Extracranial GCTs (particularly testicular GCTs) are much more common among adolescents aged 15 to 19 years, representing approximately 14% of cancers in this age group.
The incidence of extracranial GCTs by 5-year age group and gender is shown in Table 1.
Histologic Classification of Childhood Extracranial GCTs
Childhood extracranial GCTs comprise a variety of histologic diagnoses and can be broadly classified as the following:
The histologic properties of these tumors are heterogeneous and vary by primary tumor site and the gender and age of the patient.[11,12] Histologically identical GCTs that arise in younger children have different biological characteristics from those that arise in adolescents and young adults.[13]
Mature teratomas
Mature teratomas usually occur in the ovary or at extragonadal locations. They are the most common histological subtype of childhood GCT.[14,15,16] Mature teratomas usually contain well-differentiated tissues from the ectodermal, mesodermal, and endodermal germ cell layers, and any tissue type may be found within the tumor.
Mature teratomas are benign, although some mature teratomas may secrete enzymes or hormones, including insulin, growth hormone, androgens, and prolactin.[17,18]
Immature teratomas
Immature teratomas contain tissues from the ectodermal, mesodermal, and endodermal germ cell layers, but immature tissues, primarily neuroepithelial, are also present. Immature teratomas are graded from 0 to 3 on the basis of the amount of immature neural tissue found in the tumor specimen.[19] Tumors of higher grade are more likely to have foci of yolk sac tumor.[20] Immature teratomas may be classified as malignant tumors.
Immature teratomas occur primarily in young children at extragonadal sites and in the ovaries of girls near the age of puberty, but there is no correlation between tumor grade and patient age.[20,21] Some immature teratomas may secrete enzymes or hormones, such as vasopressin.[22]
Malignant GCTs
GCTs contain frankly malignant tissues of germ cell origin and, rarely, tissues of somatic origin. Isolated malignant elements may constitute a small fraction of a predominantly mature or immature teratoma.[21,23]
Malignant germ cell elements of children, adolescents, and young adults can be grouped broadly by location (refer to Tables 2 and 3).
Adolescent and young adult males present with more germinomas (testicular and mediastinal seminomas), and females present with more ovarian dysgerminomas.
Pediatric GCT Biology
The following biologically distinct subtypes of GCTs are found in children and adolescents:
It should be emphasized that very few pediatric GCT specimens have been analyzed to date. Biologic distinctions between GCTs in children and GCTs in adults may not be absolute, and biologic factors have not been shown to predict risk.[25,26,27]
Testicular GCTs
Ovarian GCTs
Ovarian GCTs occur primarily in adolescent and young adult females. While most ovarian GCTs are benign mature teratomas, a heterogeneous group of malignant GCTs, including immature teratomas, dysgerminomas, yolk sac tumors, and mixed GCTs, do occur in females. The malignant ovarian GCT commonly shows increased copies of the short arm of chromosome 12.[38]
Patients with pediatric ovarian GCTs have an excellent prognosis. One series of 66 patients monitored for more than 44 years reported recurrence rates of 4.5% and mortality rates of 3%.[39]
(Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.)
Extragonadal extracranial GCTs
Extragonadal extracranial GCTs occur outside of the brain and gonads.
There are few data about the potential genetic or environmental factors associated with childhood extragonadal extracranial GCTs. Patients with the following syndromes are at an increased risk of extragonadal extracranial GCTs:
Clinical Features
Childhood extracranial GCTs develop at diffuse sites that include the testicles, ovaries, mediastinum, retroperitoneum, sacrum, and coccyx. The clinical features at presentation are specific for each site.
Figure 1. Extracranial germ cell tumors form in parts of the body other than the brain. This includes the testicles, ovaries, sacrum (lower part of the spine), coccyx (tailbone), mediastinum (area between the lungs), and retroperitoneum (the back wall of the abdomen).
Diagnostic and Staging Evaluation
Diagnostic evaluation of GCTs includes imaging studies and measurement of tumor markers. In suspected cases, tumor markers can suggest the diagnosis before surgery and/or biopsy. This information can be used by the multidisciplinary team to make appropriate treatment choices.
Tumor markers
Yolk sac tumors produce alpha-fetoprotein (AFP), while germinomas (seminomas and dysgerminomas), and especially choriocarcinomas, produce beta-human chorionic gonadotropin (beta-HCG), resulting in elevated serum levels of these substances. Most children with malignant GCTs will have a component of yolk sac tumor and have elevations of AFP levels,[53,54] which are serially monitored during treatment to help assess response to therapy.[21,23,53] Benign teratomas and immature teratomas may produce small elevations of AFP and beta-HCG.
During the first year of life, infants have a wide range of serum AFP levels, which are not associated with the presence of a GCT. Normal ranges have been described but are based on limited data.[55,56] The serum half-life of AFP is 5 to 7 days, and the serum half-life of beta-HCG is 1 to 2 days. Even though the data are limited, tumor markers are measured with each cycle of chemotherapy for all pediatric patients with malignant GCTs. It should be recognized that after initial chemotherapy, tumor markers may show a transient elevation.[57]
Although few pediatric data exist, adult studies have shown that an unsatisfactory decline of elevated tumor markers is a poor prognostic finding.[58]
Imaging tests
Imaging tests may include the following:
Prognosis and Prognostic Factors
Prognosis and prognostic factors for extracranial GCTs depend on many circumstances, including the following:
(Refer to the Treatment of Mature and Immature Teratomas in Children, Treatment of Malignant Gonadal GCTs in Children, and Treatment of Malignant Extragonadal Extracranial GCTs in Children sections of this summary for more information about prognosis and prognostic factors for childhood extragonadal extracranial GCTs.)
Follow-up After Treatment
There is little evidence to provide guidance on the follow-up care of children with extracranial GCTs.
The following tests and procedures may be performed at the physician's discretion when tumor markers are elevated at diagnosis:
The following tests and procedures may be performed at the physician's discretion when tumor markers are normal at diagnosis:
As with other childhood solid tumors, stage directly impacts the outcome of patients with malignant germ cell tumors (GCTs).[1,2,3] The most commonly used staging systems in the United States are as follows:[4]
Nonseminoma Testicular GCT Staging From the COG
Retroperitoneal lymph node dissection has not been required in pediatric germ cell trials to stage disease in males younger than 15 years. Data on adolescent males with testicular GCTs are limited. Retroperitoneal lymph node dissection is used for both staging and treatment in adult testicular GCT trials.[5] (Refer to the PDQ summary on Testicular Cancer Treatment for more information about the staging of adult testicular GCTs.)
Ovarian GCT Staging From the COG
Ovarian GCT Staging From the FIGO
Another ovarian GCT staging system used frequently by gynecologic oncologists is the FIGO staging system, which is based on adequate surgical staging at the time of diagnosis.[6] (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.) This system has also been used by some pediatric centers [2] and is as follows:
Extragonadal Extracranial GCT Staging From the COG
Childhood extracranial germ cell tumors (GCTs) are very heterogenous. The benefits and limitations of therapy are related to differences in histology. For example, pediatric GCTs, such as mature and immature teratomas, may not respond to chemotherapy.
Prognosis and appropriate treatment for extracranial GCTs depend on many factors, including the following:[1,2,3,4]
To maximize the likelihood of long-term survival while minimizing the likelihood of treatment-related long-term sequelae (e.g., secondary leukemias, infertility, hearing loss, and renal dysfunction), children with extracranial malignant GCTs need to be cared for at pediatric cancer centers with experience treating these rare tumors.
On the basis of clinical factors, appropriate treatment for extracranial GCTs may involve one of the following:
For patients with completely resected immature teratomas at any location (even those with malignant elements) and patients with localized, completely resected (stage I) gonadal tumors, additional therapy may not be necessary; however, close monitoring is important.[6,7] The watch-and-wait approach requires scheduled serial physical examination, tumor marker determination, and primary tumor imaging to ensure that a recurrent tumor is detected without delay.
Surgery is an essential component of treatment. Specific treatments will be discussed for each tumor type.
Radiation Therapy
Testicular and mediastinal seminomas in males and ovarian dysgerminomas in females are sensitive to radiation, but radiation therapy is rarely recommended. With the advent of effective chemotherapy, it became possible for patients to avoid the toxic effects of radiation.
Before effective chemotherapy became available, children with extracranial malignant GCTs had 3-year survival rates of 15% to 20% with surgery and radiation therapy,[8,9,10] although young boys with localized testicular tumors did well with surgical resection.[11,12] Cisplatin-based chemotherapy has significantly improved outcomes for most children and adolescents with extracranial GCTs; 5-year survival rates now exceed 90%.
The standard chemotherapy regimen for both adults and children with malignant nonseminomatous GCTs includes cisplatin, etoposide, and bleomycin. Adult patients receive weekly bleomycin throughout treatment (bleomycin, etoposide, and cisplatin [BEP]). Pediatric patients do not receive bleomycin during the weeks between cycles (cisplatin, etoposide, and bleomycin [PEB]). (Refer to Table 5 for adult BEP and pediatric PEB and JEB chemotherapy dosing schedules.)[1,2,13,14,15] The combination of carboplatin, etoposide, and bleomycin (JEB) underwent clinical investigation in the United Kingdom in children younger than 16 years and was reported to have an event-free survival (EFS) by site and stage similar to that of PEB.[3,16] The use of JEB appears to be associated with fewer otologic toxic effects and renal toxic effects than does the use of PEB.[3] PEB and JEB have not been compared in a randomized pediatric GCT trial.
Adult studies have substituted standard-dose carboplatin for cisplatin in combination with etoposide alone and in combination with etoposide and low-dose bleomycin,[17] but the carboplatin regimens demonstrated inferior EFS and overall survival (OS) compared with cisplatin-containing therapy among patients with malignant GCTs.
Refer to Table 5 for adult BEP and pediatric PEB and JEB chemotherapy dosing schedules.
The approach to the management of extracranial GCTs has been derived from the results of several intergroup studies conducted by the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG).[1,2,6] These studies explored the use of PEB for the treatment of localized gonadal GCT [1] and the benefit of increasing the dose of cisplatin (high-dose PEB [HD-PEB]: a cisplatin concentration of 200 mg/m2 vs. PEB: a cisplatin concentration of 100 mg/m2) in a randomized manner in patients with extragonadal and advanced gonadal GCTs.[2] The intensification of cisplatin in the HD-PEB regimen provided some improvement in EFS but no difference in OS; however, the use of HD-PEB was associated with a significantly higher incidence and severity of otologic toxic effects and renal toxic effects. In a subsequent study, amifostine was not effective in preventing hearing loss in patients who received HD-PEB.[19]
Table 6 provides an overview of standard treatment options for children with extracranial GCTs. Specific details of treatment by primary site and clinical condition are described in subsequent sections.
GCT With Non-GCT Elements
The treatment of GCTs with other non-GCT elements is complex, and few data exist to direct treatment. In adolescents, central primitive neuroectodermal tumors and sarcomas have been found in teratomas.[20,21] The Italian Pediatric Germ Cell Tumor group identified 14 patients with malignant somatic tumors, such as neuroblastoma and rhabdomyosarcoma, embedded in teratomas (<2% of extracranial GCTs).[22] The optimal treatment strategy for GCTs with non-GCT elements has not been determined, and separate treatments for both malignant GCTs and non-GCT elements may be required.
Mature and immature teratomas arise primarily in the sacrococcygeal region of neonates and young children and in the ovaries of pubescent girls. Less commonly, these tumors are found in the testicular region of boys younger than 4 years, the mediastinum of adolescents, and other sites.[1,2,3] The primary treatment for teratomas is surgery and depends on whether the tumor forms in a nonsacrococcygeal or sacrococcygeal site. Surgical options for sacrococcygeal teratomas are complex. The number of pediatric patients with postoperative residual mature or immature teratomas is very small.
Mature Teratomas (Nonsacrococcygeal Sites)
Standard treatment options for mature teratomas (nonsacrococcygeal sites)
Standard treatment options for mature teratomas in a nonsacrococcygeal site include the following:
Children with mature teratomas, including mature teratomas of the mediastinum, can be treated with surgery and observation, with an excellent prognosis.[1,4] In a review of 153 children with nontesticular mature teratoma, the 6-year relapse-free survival was 96% for completely resected disease and 55% for incompletely resected disease.[2]
Head and neck germ cell tumors (GCTs) in neonates should be cared for by a multidisciplinary team. Although most head and neck GCTs are benign, they present significant challenges to surgeons. Some tumors develop malignant elements, which may change the treatment strategy.[5]
Mature teratomas in the prepubertal testis are relatively common benign lesions and may be amenable to testis-sparing surgery.[6]
Immature Teratomas (Nonsacrococcygeal Sites)
Standard treatment options for immature teratomas (nonsacrococcygeal sites)
Standard treatment options for immature teratomas in a nonsacrococcygeal site include the following:
The treatment options for immature teratomas at a nonsacrococcygeal site differ by stage of disease.
Stage I
Infants and young children with immature teratomas have an excellent prognosis if the tumor can be completely resected.[7,8,9] For these patients, the current standard of treatment is surgery and observation.
Evidence (surgery and observation for stage I disease):
Stages II through IV
There is significant debate on the responsiveness of immature teratomas to chemotherapy. In adults, and perhaps adolescents, immature teratomas (primarily ovarian) reportedly have an aggressive clinical behavior [11] requiring surgery and chemotherapy. The decision to use chemotherapy is based on the tumor stage (II through IV) and grade. In a pediatric report from the United Kingdom, immature teratomas did not respond to chemotherapy.[12] This study did not include patients older than 15 years. Further studies on the treatment of ovarian immature teratomas with chemotherapy are needed. (Refer to the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information about the treatment of ovarian immature teratomas in postpubertal females.)
Mature and Immature Teratomas (Sacrococcygeal Site)
The sacrococcygeal region is the primary tumor site for most benign and malignant GCTs diagnosed in neonates, infants, and children younger than 4 years. These tumors occur more often in girls than in boys; ratios of 3:1 to 4:1 have been reported.[13]
Sacrococcygeal tumors present in the following two clinical patterns related to the child's age, tumor location, and likelihood of tumor malignancy:[1]
Standard treatment options for mature and immature teratomas (sacrococcygeal sites)
Standard treatment options for mature and immature teratomas in a sacrococcygeal site include the following:
Surgery is an essential component of treatment. Complete resection of the coccyx is vital to minimize the likelihood of tumor recurrence;[2] however, one study reported that 11 of 12 patients with microscopic residual benign immature teratomas had no recurrence.[18]
After successful resection, neonates diagnosed with benign mature and immature teratomas are closely observed with follow-up exams and serial serum AFP determinations for several years to ensure that the expected physiological normalization of AFP levels occurs and to facilitate early detection of tumor relapse.[19] A significant rate of recurrence among these benign tumors, ranging from 10% to 21%, has been reported by several groups, with most relapses occurring within 3 years of resection.[9,13,19,20]
While there is no standard follow-up schedule, tumor markers are measured frequently for 3 years in all children. Recurrent tumors will be malignant in 43% to 50% of cases, and yolk sac tumor is the most common histology. With early detection, recurrent malignant GCTs can be treated successfully with surgery and chemotherapy (overall survival, 92%).[21] Long-term survivors are monitored for complications of extensive surgery, which include constipation, fecal and urinary incontinence, and psychologically unacceptable cosmetic scars.[22]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood teratoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Malignant Testicular GCTs
Malignant testicular GCTs in prepubertal males
Testicular germ cell tumors (GCTs) in children occur almost exclusively in boys younger than 4 years.[1,2] The initial surgical approach to evaluate a testicular mass in a young boy is important because a transscrotal biopsy can risk inguinal node metastasis.[3,4] Radical inguinal orchiectomy with initial high ligation of the spermatic cord is the procedure of choice.[5]
Computed tomography or magnetic resonance imaging evaluation, with the additional information provided by elevated tumor markers, appears adequate for staging. Retroperitoneal dissection of lymph nodes is not beneficial in the staging of testicular GCTs in young boys.[3,4] Therefore, there is no reason to risk the potential morbidity (e.g., impotence and retrograde ejaculation) associated with lymph node dissection.[6,7]
The role of surgery at diagnosis for GCTs is age- and site-dependent and must be individualized. All malignant testicular GCTs should be resected. Primary resection of other areas of disease may be appropriate when feasible, without undue risk of damage to adjacent structures; otherwise, an appropriate strategy is resection of the testis for diagnosis followed by subsequent excision in selected patients who have residual masses after undergoing chemotherapy.
Standard treatment options for malignant GCTs in prepubertal males
Standard treatment options for malignant GCTs in prepubertal males (younger than 15 years) include the following:
The treatment options for malignant GCTs in prepubertal males differ by stage of disease.
Surgery and close follow-up observation are indicated to document that a normalization of the tumor markers occurs after resection.[3,8]
Surgery and chemotherapy with four cycles of standard PEB is a common treatment regimen. Patients treated with this regimen have an overall survival (OS) outcome greater than 90%, suggesting that a reduction in therapy could be considered.[10,11]
Surgery and treatment with four to six cycles of carboplatin, etoposide, and bleomycin (JEB) is an alternative treatment regimen.[8]
Evidence (surgery and chemotherapy for stages II–IV disease):
Malignant testicular GCTs in postpubertal males
The treatment options described above for young boys may not be strictly applicable to adolescent males (aged 15 years and older). In particular, the use of retroperitoneal lymph node dissection may play a crucial role in the evaluation of early-stage testicular GCT [12] and for residual disease after chemotherapy for the treatment of metastatic GCT.[13,14]
In this age group, the presence of a sarcomatous component in the primary testis GCT does not alter the prognosis; however, if a sarcomatous component is found in a metastatic lesion, survival is likely to be compromised.[15]
Standard treatment options for malignant testicular GCTs in postpubertal males
Refer to the PDQ summary on Testicular Cancer Treatment for more information about the treatment of malignant testicular GCTs in postpubertal males.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood malignant testicular germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Childhood Malignant Ovarian GCTs
Most ovarian neoplasms in children and adolescents are of germ cell origin.[1] Ovarian GCTs are very rare in young girls, but the incidence begins to increase in children aged approximately 8 or 9 years and continues to rise throughout adulthood.[1]
Childhood malignant ovarian GCTs can be divided into germinomatous (dysgerminomas) and nongerminomatous malignant GCTs (i.e., yolk sac carcinomas, mixed GCTs, choriocarcinoma, and embryonal carcinomas).
(Refer to the Mature Teratomas [Nonsacrococcygeal Sites] section of this summary for more information about childhood mature and immature teratomas arising in the ovary and the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information about the treatment of ovarian GCT in postpubertal females.)
Dysgerminomas of the ovary
Standard treatment options for dysgerminomas of the ovary
Standard treatment options for dysgerminomas of the ovary include the following:
The treatment options for dysgerminomas of the ovary differ by stage of disease.
For stage I ovarian dysgerminomas of the ovary, cure can usually be achieved by unilateral salpingo-oophorectomy, conserving the uterus and opposite ovary, and close follow-up observation.[8,16,17,18,19]
Chemotherapy may be given if tumor markers do not normalize or if the tumor recurs.
While advanced-stage ovarian dysgerminomas, like testicular seminomas, are highly curable with surgery and radiation therapy, the effects on growth, fertility, and risk of treatment-induced second malignancy in these young patients [20,21] make chemotherapy a more attractive adjunct to surgery.[22,23] Complete tumor resection is the goal for advanced dysgerminomas; platinum-based chemotherapy can be given preoperatively to facilitate resection or postoperatively (after debulking surgery) to avoid mutilating surgical procedures.[19] This approach results in a high rate of cure and the preservation of menstrual function and fertility in most patients with dysgerminomas.[22,24]
Malignant nongerminomatous ovarian GCTs
A multidisciplinary approach is essential for treatment of ovarian GCTs. Various surgical subspecialists and the pediatric oncologist must be involved in clinical decisions. The surgical approach for pediatric ovarian GCTs is often guided by the hope that reproductive function can be preserved.
Standard treatment options for malignant nongerminomatous ovarian GCTs
Standard treatment options for malignant nongerminomatous ovarian GCTs include the following:
The treatment of ovarian malignant GCTs that are not dysgerminomas or immature teratomas generally involves surgical resection and adjuvant chemotherapy.[25,26]
The role for surgery at diagnosis is age- and site-dependent and must be individualized. The use of laparoscopy in children with ovarian GCTs has not been well studied.
Pediatric surgical guidelines to determine stage I disease have been published.[27] Adult surgical guidelines to determine stage are more extensive. (Refer to the Stage Information for Ovarian Germ Cell Tumors section of the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information about staging of ovarian GCTs in postpubertal females.) Strict surgical staging guidelines need to be followed to determine true stage I disease. Historically, in both pediatric and adult studies, comprehensive staging guidelines have not been followed. If strict surgical staging guidelines are not followed, surgery followed by chemotherapy, rather than surgery followed by observation, is the standard treatment.[8,28] A goal of surgical therapy for pediatric GCTs is to preserve reproductive function. If conservative surgery is the choice, a high rate of cure can be obtained with adjuvant chemotherapy, and adherence to strict surgical guidelines is not necessary.[29]
Platinum-based chemotherapy regimens such as PEB or JEB have been used successfully in children.[8,10,11,16] BEP is a common regimen in young women with ovarian GCTs.[30,31] BEP differs from PEB with the addition of weekly bleomycin. This approach results in a high rate of cure and the preservation of menstrual function and fertility in most patients with nondysgerminomas.[26,28] (Refer to Table 5 for more information about the dosing schedules for BEP, PEB, and JEB.)
When strict surgical staging guidelines are followed, surgery followed by observation may be an appropriate treatment choice.
Similar results have been reported in other international pediatric trials, but the number of patients has been small.[8]
When strict surgical staging guidelines are not followed, surgery followed by chemotherapy is an appropriate treatment choice. Chemotherapy consists of four cycles of PEB.[10,11]
Evidence (surgery and chemotherapy for stage I disease):
Surgery and chemotherapy with four to six cycles of standard PEB in younger girls [10,11] and BEP in postpubertal girls are considered standard treatments.[30,31] Patients with normalization of tumor markers are imaged after four cycles of PEB, and any residual tumor is removed. If the tumor is completely resected but the specimen contains viable tumor, two additional cycles of PEB can be given.[11] Any persistent viable tumor that remains indicates that the treatment has failed.
Alternatively, surgery and chemotherapy with four to six cycles of JEB is also a treatment option (patients were all younger than 15 years).[8]
Initially unresectable tumor
Primary resection of ovarian GCT is usually attempted. In rare instances where primary resection of the ovary is not possible without undue risk of damage to adjacent structures, an appropriate strategy is biopsy for diagnosis followed by subsequent surgery in patients who have residual masses after undergoing chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood malignant ovarian germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Extragonadal extracranial germ cell tumors (GCTs) (i.e., sacrococcygeal, mediastinal, and retroperitoneal) are more common in children than in adults.[1] Children with extragonadal malignant GCTs, particularly those with advanced-stage disease, have the highest risk of treatment failure for any GCT presentation.[2,3]
In a study of prognostic factors in pediatric extragonadal malignant GCTs, age older than 12 years was the most important prognostic factor. In a multivariate analysis, children aged 12 years or older with thoracic tumors had six times the risk of death compared with children younger than 12 years with primary nonthoracic tumors.[4]
Standard Treatment Options for Malignant Extragonadal Extracranial GCTs
Standard treatment options for malignant extragonadal extracranial GCTs include the following:
Outcome has improved remarkably since the advent of platinum-based chemotherapy and the use of a multidisciplinary treatment approach.[2,5] Complete resection before chemotherapy may be possible in some patients without major morbidity. For patients with locally advanced sacrococcygeal tumors, mediastinal tumors, or large pelvic tumors, tumor biopsy followed by preoperative chemotherapy can facilitate subsequent complete tumor resection and improve ultimate patient outcome.[5,6,7,8]
The role for surgery at diagnosis for extragonadal tumors is age- and site-dependent and must be individualized. Depending on the clinical setting, the appropriate surgical approach may be primary resection, biopsy before chemotherapy, or no surgery (e.g., mediastinal primary tumor in a patient with a compromised airway and elevated tumor markers). An appropriate strategy may be biopsy at diagnosis followed by chemotherapy and subsequent surgery in selected patients who have residual masses after chemotherapy.
Stages I and II
Surgery and chemotherapy with four to six cycles of standard cisplatin, etoposide, and bleomycin (PEB) is one treatment alternative. Patients treated with this regimen have an overall survival (OS) outcome greater than 90%, suggesting that a reduction in therapy could be considered.[2,9] An alternative treatment option is surgery and chemotherapy with six cycles of carboplatin, etoposide, and bleomycin (JEB).[5]
Stages III and IV
A treatment option for stage III and stage IV disease is surgery and chemotherapy with four to six cycles of standard PEB. Patients have an OS outcome approaching 80% with this regimen.[2] Another treatment option is surgery and chemotherapy with six cycles of JEB, which has an OS similar to that of the PEB regimen.[5]
A Children's Oncology Group trial investigated the addition of cyclophosphamide to standard-dose PEB. The addition of cyclophosphamide was feasible and well tolerated at all dose levels, but there was no evidence that adding cyclophosphamide improves efficacy.[10]
Malignant Extragonadal Extracranial GCTs (Sacrococcygeal Sites)
Sacrococcygeal GCTs are common extragonadal tumors that occur in very young children, predominantly young females.[11] The tumors are usually diagnosed at birth, when large external lesions predominate (usually mature or immature teratomas), or later in the first years of life, when presacral lesions with higher malignancy rates predominate.[11]
Malignant sacrococcygeal tumors are usually very advanced at diagnosis; two-thirds of patients have locoregional disease, and metastases are present in 50% of patients.[7,12,13] Because of their advanced stage at presentation, the management of sacrococcygeal tumors requires a multimodal approach with platinum-based chemotherapy followed by delayed tumor resection.
Platinum-based therapies, with either cisplatin or carboplatin, are the cornerstone of treatment. The PEB regimen or the JEB regimen produces event-free survival (EFS) rates of 75% to 85% and OS rates of 80% to 90%.[7,8] Surgery may be facilitated by preoperative chemotherapy. In any patient with a sacrococcygeal GCT, resection of the coccyx is mandatory.[7,8]
Completeness of surgical resection is an important prognostic factor, as shown in the following circumstances:[7,8]
Malignant Extragonadal Extracranial GCTs (Mediastinal)
Mediastinal GCTs account for 15% to 20% of malignant extragonadal extracranial GCTs in children.[5] The histology of mediastinal GCT is dependent on age, with teratomas predominating among infants and yolk sac tumor histology predominating among children aged 1 to 4 years.[6]
Children with mediastinal teratomas are treated with tumor resection, which is curative in almost all patients.[6] Children with malignant, nonmetastatic mediastinal GCTs who receive cisplatin-based chemotherapy have 5-year EFS and OS rates of 90%; however, metastatic mediastinal tumors have an EFS closer to 70%.[5,6]
Most mediastinal GCTs in adolescents and young adults occur in males, and 22% to 50% have cytogenetic changes consistent with Klinefelter syndrome.[14,15] The age of presentation is younger in patients with Klinefelter syndrome.[14,15] As with sacrococcygeal tumors, primary chemotherapy is usually necessary to facilitate surgical resection of mediastinal GCTs, and the completeness of resection is a very important prognostic indicator.[6,16] Survival rates for the older adolescent and young adult population with mediastinal tumors are generally lower than 60%.[4,17,18,19]; [20][Level of evidence: 3iiA]
Patients with a malignant mediastinal primary tumor and extracranial metastases are at the highest risk of developing brain metastases and are monitored closely for signs and symptoms of central nervous system involvement.[21][Level of evidence: 3iiB] (Refer to the PDQ summary on Extragonadal Germ Cell Tumors Treatment for more information about the treatment of adult patients.)
Malignant Extragonadal Extracranial GCTs (Retroperitoneum)
Malignant GCTs located in the retroperitoneum or abdomen usually present in children younger than 5 years; most tumors are advanced stage and locally unresectable at diagnosis.[22] A limited biopsy followed by platinum-based chemotherapy to shrink tumor bulk can lead to complete tumor resection in most patients. Despite the advanced-stage disease in most patients, the 6-year EFS using PEB was 83% in the Pediatric Oncology Group/Children's Cancer Group intergroup study.[22]
Malignant Extragonadal Extracranial GCTs (Head and Neck Sites)
Although rare, benign and malignant GCTs can occur in the head and neck region, especially in infants. The airway is often threatened. Surgery for nonmalignant tumors and surgery plus chemotherapy for malignant tumors can be curative.[23][Level of evidence: 3iiiDii]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood extragonadal germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Only a small number of children and adolescents with extracranial germ cell tumors (GCTs) have a recurrence.[1,2] However, the approach to the treatment of recurrent disease and its success depend on the initial treatment regimen and on the response of the tumor to treatment.
There are no standard treatment options for recurrent pediatric GCTs. Information about ongoing clinical trials is available from the NCI website.
Treatment Options for Recurrent Malignant GCTs in Children
Treatment options for recurrent childhood malignant GCTs include the following:
Despite overall cure rates higher than 80%, children with extracranial GCTs who have disease recurrence after surgery and three-agent, platinum-based combination chemotherapy (cisplatin, etoposide, and bleomycin [PEB] or carboplatin, etoposide, and bleomycin [JEB]) have an unfavorable prognosis. Reports regarding the treatment and outcome of these children are based on small studies.[3]
Reports of salvage treatment strategies used in adult recurrent GCTs include larger numbers of patients, but the differences between children and adults regarding the location of the primary GCT site, pattern of relapse, and the biology of childhood GCTs may limit the applicability of adult salvage approaches to children. In adults with recurrent GCTs, several chemotherapy combinations have achieved relatively good disease-free status.[4,5,6,7,8,9] A combination of paclitaxel and gemcitabine has demonstrated activity in adults with testicular GCTs who relapsed after HD chemotherapy and hematopoietic stem cell transplant (HSCT).[10]
Surgery followed by chemotherapy
If a tumor recurs, boys with stage I testicular disease originally treated with surgical resection and observation can usually undergo salvage therapy with further surgical excision and standard PEB or JEB chemotherapy.[11,12]
For stage I ovarian GCT patients originally treated with surgery and observation, several European studies have reported encouraging salvage rates with further surgical excision and chemotherapy.[13,14]
In a Children's Oncology Group trial (AGCT0521 [NCT00467051]), patients who relapsed after PEB therapy received two cycles of paclitaxel, ifosfamide, and carboplatin. Study results are pending.
Chemotherapy followed by surgery and possibly radiation therapy
Most children with benign sacrococcygeal tumors experience recurrence with a malignant component at the primary tumor site. For these children, complete surgical resection of the recurrent tumor and coccyx (if not done originally) is the basis of salvage treatment; preoperative chemotherapy with PEB may assist the surgical resection. In patients who had a malignant sacrococcygeal tumor that recurred after PEB treatment, surgery and additional chemotherapy may be warranted; when a complete salvage resection is not achieved, postoperative local radiation therapy may be an option.[3]
HD chemotherapy and hematopoietic stem cell rescue
The role of HD chemotherapy and hematopoietic stem cell rescue for recurrent pediatric GCTs is not established, despite anecdotal reports. (Refer to the Autologous Hematopoietic Cell Transplantation section of the PDQ summary on Childhood Hematopoietic Cell Transplantation for more information about transplantation.) In one European series, 10 of 23 children with relapsed extragonadal GCTs achieved long-term disease-free survival (median follow-up, 66 months) after receiving HD chemotherapy with stem cell support.[15] Further study in children and adolescents is needed.
HD chemotherapy with autologous stem cell rescue has been explored as a treatment for adults with recurrent testicular GCTs. HD chemotherapy plus hematopoietic stem cell rescue has been reported to cure adult patients with relapsed testicular GCTs, even as third-line therapy and in cisplatin-refractory patients.[16] While several other studies support this approach,[10,17,18,19,20] others do not.[21,22] Salvage attempts using HD-chemotherapy regimens may be of little benefit if the patient is not clinically disease free at the time of HSCT.[16,23]
Radiation therapy followed by surgery (for brain metastases)
Patients with nongerminomatous brain metastases may respond to radiation therapy. In the German Maligne Keimzelltümoren (MAKEI) studies, radiation therapy and surgery for patients with brain metastases provided palliation and occasional long-term survival.[24,25][Level of evidence: 3iiiA]
Treatment Options Under Clinical Evaluation for Recurrent Malignant GCTs in Children
Treatment options under clinical evaluation for recurrent malignant GCTs in children include the following:
Information about ongoing clinical trials is available from the NCI website.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood malignant germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was reformatted.
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood extracranial germ cell tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Childhood Extracranial Germ Cell Tumors Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Childhood Extracranial Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/types/extracranial-germ-cell/hp/germ-cell-treatment-pdq. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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Last Revised: 2015-06-17
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This Hanukkah craft activity for kids is brought to you by Melissa & Doug, written by our Blog Ambassador Allison McDonald.
"Everyday play is what childhood should be about." -Allison
Get your littlest friends excited about Hanukkah by making a pretty Star of David painting. Making specific shapes can be tricky for toddlers, but this craft makes it easy.
You will need some good-quality paper or canvas, watercolors and water, painters tape, and markers or crayons.
STEP 1: Start by placing the tape: Taping two overlapping triangles to make your Star of David.
STEP 2: Paint! There is no need to worry about lines to stay in or "right" colors to use–there is no wrong way to do this.
Talk about all the shapes and colors you see while painting. My daughter loved mixing the colors and watching them blend.
Step 3: Let dry for no more than a few hours, or the tape could be tricky to take off. Then . . .
. . . Peel the tape off! Do not fret about any paint leaking under.
Step 4: Add accents and contrast by outlining the star with a marker or crayon.
If your kids love this craft as much as we do, encourage them to make their own variations! They can use this technique to make holiday cards, gift tags, and even wrapping paper. (Just use extra-large paper, such as the Melissa & Doug Easel Pad.)
Happy Hanukkah!
Allison McDonald is founder and editor of No Time For Flash Cards. She has been teaching children in various capacities since 1993, so she has done her share of crafts, songs and circle times! Her son's birth brought her home, and her love of teaching and helping other parents sparked the idea for No Time for Flash Cards. Early-childhood education is her passion . . . her heart belongs to the little guys! Get to know Allie and see her creative kids' crafts and educational activities on Facebook, Twitter, and Pinterest.


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The city of Canton will receive a $232,549 infrastructure grant through the Safe Routes to School program for new ADA accessible sidewalks to begin at Seventh and Nesmith Streets and run along Seventh, White, Sixth and Washington Streets and end at the Canton R-V School.
The SRTS program is focused on providing safety improvements, ADA improvements, safety education and encouragement for grade school (K-8) children to be able to walk to school safely.
Location, ST | website.com


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I did some testing too.
I reproduced the AC3 issue you describe and went a little further in understanding why the mp2 is not played.
According to the VLC streaming features page:
the PS output doesn't support anything else then AC3. Which means mp2 and aac are NOT supported using PS.
Following this hint I changed the code to use mp2a and TS as output method.
My video played perfectly.
I don't know if this can break things on other platforms but it surely works for me.
Now that I started to dirt my hands on the code I'll test with other video formats too