We report one teacher's response to a top-down shift from external examinations to internal teacher assessment for summative purposes in the Republic of Ireland. The teacher adopted a comparative judgement approach to the assessment of secondary students' understanding of a chemistry experiment. The aims of the research were to investigate whether comparative judgement can produce assessment outcomes that are valid and reliable without producing undue workload for the teachers involved.Comparative judgement outcomes correlated as expected with both test marks and with existing student achievement data, supporting the validity of the approach.Further analysis suggested that teacher judgement privileged scientific understanding, whereas marking privileged factual recall. The estimated reliability of the outcome was acceptably high, but comparative judgement was notably more time consuming than marking. We consider how validity and efficiency might be improved, and the contributions that comparative judgement might offer to summative assessment, moderation of teacher assessment, and peer assessment.

Intravascular extension of Wilms’ tumor is a well-recognized phenomenon. Intravascular extension into the vena cava occurs in only 4-8% of patients with Wilms’ tumors and intraatrial extension occurs in around 1-3% of patients. This review of the published literature in this cohort aims to summarize the findings of different case series to provide an optimum management plan. A literature search was performed and index papers were retrieved for review. The search included the following terms: Intracaval, intravascular, intraatrial and intracardiac extension of Wilms’ tumor or nephroblastoma. The management of patients with intravascular tumor thrombus in Wilms’ tumor is complex. A skilled multi-disciplinary team at a tertiary referral center with cardiothoracic surgery available should manage these patients. Multi-modal diagnostic and preoperative imaging are required to confirm and define the extent of the extension. Preoperative chemotherapy is advocated for all but exceptional circumstances and must be followed closely. Surgical resection should be planned according to the stage of intravascular extension with possible need for cardiopulmonary bypass and deep hypothermia with cardiac arrest if required. Surgical complications are more common in this group of patients, but outcome is comparable to those without intravascular extension, and is more closely correlated with the histological subtype then stage of intravascular extension. Operative imaging are required to confirm and define the extent of the extension.

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