Background
Efforts to improve the quality of end‐of‐life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high‐intensity ...EOL (HI‐EOL) care. The objective was to assess the rates of HI‐EOL care in this population and to determine patient‐ and hospital‐related predictors of HI‐EOL from the French national hospital database.
Methods
This was a population‐based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI‐EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life.
Results
The study included 1899 individuals from 345 hospitals; 61.4% experienced HI‐EOL care. HI‐EOL was increased with social disadvantage (adjusted odds ratio AOR, 1.30; 95% confidence interval CI, 1.03‐1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57‐2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23‐2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22‐2.36; P = .001). HI‐EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24‐0.41; P < .001).
Conclusion
A majority of children, adolescents, and young adults experience HI‐EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI‐EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL.
A nationwide population‐based retrospective cohort study of 1899 patients from 345 hospitals reveals that 61.4% of patients received high‐intensity end‐of‐life (HI‐EOL) care. After adjustment, it is shown that HI‐EOL care decreased in cases of palliative care and increased in cases of social disadvantage, hematological malignancies, complex chronic conditions, and specialty center care.
Abstract The Parker Solar Probe's discovery that magnetic switchbacks and velocity spikes in the young solar wind are abundant has prompted intensive research into their origin(s) and formation ...mechanism(s) in the solar atmosphere. Recent studies, based on in situ measurements and numerical simulations, argue that velocity spikes are produced through interchange magnetic reconnection. Our work studies the relationship between interplanetary velocity spikes and coronal brightenings induced by changes in the photospheric magnetic field. Our analysis focuses on the characteristic periodicities of velocity spikes detected by the Proton Alpha Sensor on the Solar Orbiter during its fifth perihelion pass. Throughout the time period analyzed here, we estimate their origin along the boundary of a coronal hole. Around the boundary region, we identify periodic variations in coronal brightening activity observed by the Atmospheric Imaging Assembly onboard the Solar Dynamics Observatory. The spectral characteristics of the time series of in situ velocity spikes, remote coronal brightenings, and remote photospheric magnetic flux exhibit correspondence in their periodicities. Therefore, we suggest that the localized small-scale magnetic flux within coronal holes fuels a magnetic reconnection process that can be observed as slight brightness augmentations and outward fluctuations or jets. These dynamic elements may act as mediators, bonding magnetic reconnection with the genesis of velocity spikes and magnetic switchbacks.
...fuelled by frustration, a large proportion of parents—with frequent input from well-meaning relatives and friends—actively and desperately seek therapeutic alternatives to the current (lack of) ...standard of care, which has remained unchanged for the past 30 years. Since parents post regular updates about their child online, the date of diagnosis, date of first treatment at the Institute of Interventional Oncology, and date of death were available for almost all children. ...although they should be discouraged as much as possible, off-trial experimental treatments for incurable diseases will continue to exist.
The brain is highly vulnerable to neurotoxic agents during the prime learning period of a child's life. Paediatric patients with brain tumours who are treated with cranial radiation therapy (CRT) ...often go on to develop neurocognitive deficits, which are reflected in poor academic achievement and impaired memory, attention and processing speed. The extent of these delayed effects varies with radiation dose, brain volume irradiated, and age at treatment, and might also be influenced by genetic factors and individual susceptibility. CRT-induced impairment involves axonal damage and disruption of white matter growth, and can affect brain structures implicated in memory function and neurogenesis, such as the hippocampus. In this article, we review the underlying mechanisms and clinical consequences of CRT-induced neurocognitive damage in survivors of paediatric brain tumours. We discuss the recent application of neuroimaging technologies to identify white matter injury following CRT, and highlight new radiation techniques, pharmacological and neurological interventions, as well as rehabilitation programmes that have potential to minimize neurocognitive impairment following CRT.
The inorganic characterization of 74 samples of switchgrass using laser-induced breakdown spectroscopy (LIBS) was undertaken. Determination of ash and inorganic elements content in biomass materials ...is vital for feedstock screening for bioconversion processes. Hierarchical models using principal component analysis (PCA) and partial least square analysis (PLS) were used to determine the presence of specific elemental micronutrients that are important in determining plant health for robust biomass production. LIBS uses a 532 nm laser with 45 mJ of laser power to excite the samples of switchgrass plant material and the emission of all the elements present in the plant samples were recorded in single spectra with a wide wavelength range of 200–800 nm. The results were compared to the laboratory standard technique, e.g., ICP-OES technique, to determine the true values for major micronutrients such as, silicon (Si), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), and sulfur (S). Our objectives were: 1) To determine the spectral features of switchgrass containing different amounts of these elements and 2) To examine the viability of this technique for determining the quality of the feedstock in terms of its inorganic composition. Cross-validation results showed that the broad-based model developed is promising for inorganics prediction in switchgrass. The LIBS validation prediction for the micronutrient elements mentioned here have been obtained. The regression coefficients for Si, were obtained to be 0.995, 0.994 for calibration and validation respectively, in case of Ca the regression coefficients were, 0.994 and 0.992 for calibration and validation. Similarly, in the case of Mg and K these were calculated to be 0.992 and 0.985, and 0.994 and 0.993 respectively. The regression coefficients are not as good as those for the elements mentioned, in case of the two elements S and P. They are 0.957, and 0.878, and 0.952 and 0.894 respectively for calibration, validation for the two elements. This demonstrates that LIBS-based techniques are inherently well suited for diverse environmental applications. Furthermore, LIBS along with PLS model can show capability in determining the viability of switchgrass as a biomass in the production of biofuels and survivability of switchgrass in processes associated with climate change. LIBS can help determining which switchgrass would be appropriate for a specific conversion process that favors low ash content overall or low value of specific inorganics.
The inorganic characterization of 74 samples of switchgrass using laser-induced breakdown spectroscopy (LIBS) was undertaken. Determination of ash and inorganic elements content in biomass materials is vital for feedstock screening for bioconversion processes. Hierarchical models using principal component analysis (PCA) and partial least square analysis (PLS) were used to determine the presence of specific elemental micronutrients that are important in determining plant health for robust biomass production. LIBS uses a 532 nm laser with 45 mJ of laser power to excite the samples of switchgrass plant material and the emission of all the elements present in the plant samples were recorded in single spectra with a wide wavelength range of 200–800 nm. The results were compared to the laboratory standard technique, e.g., ICP-OES technique, to determine the true values for major micronutrients such as, silicon (Si), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), and sulfur (S).
High, medium and low ash content for switch grass and inset highlighting the sulfur peak at 469.5 nm. Display omitted
•The composition of ash when switchgrass is used in biofuel production has been determined using the LIBS technique.•Regression coefficients have been obtained for six elements switchgrass using LIBS technique in a large sample set.•Both PCA and PLS models have been constructed to correlate LIBS and ICP-OES techniques for switchgrass for the first time.
Jupiter's auroral parameters are estimated from observations by a spectrometer EXCEED (Extreme Ultraviolet Spectroscope for Exospheric Dynamics) on board Japanese Aerospace Exploration Agency's ...Earth‐orbiting planetary space telescope Hisaki. EXCEED provides continuous auroral spectra covering the wavelength range over 80–148 nm from the whole northern polar region. The auroral electron energy is estimated using a hydrocarbon color ratio adopted for the wavelength range of EXCEED, and the emission power in the long wavelength range 138.5–144.8 nm is used as an indicator of total emitted power before hydrocarbon absorption and auroral electron energy flux. The quasi‐continuous observations by Hisaki provide the auroral electron parameters and their relation under different auroral activity levels. Short‐ (within < one planetary rotation) and long‐term (> one planetary rotation) enhancements of auroral power accompany increases of the electron number flux rather than the electron energy variations. The relationships between the auroral electron energy (~70–400 keV) and flux (1026–1027/s, 0.08–0.9 μA/m2) estimated from the observations over a 40 day interval are in agreement with field‐aligned acceleration theory when incorporating probable magnetospheric parameters. Applying the electron acceleration theory to each observation point, we explore the magnetospheric source plasma variation during these power‐enhanced events. Possible scenarios to explain the derived variations are (i) an adiabatic variation of the magnetospheric plasma under a magnetospheric compression and/or plasma injection, and (ii) a change of the dominant auroral component from the main emission (main aurora) to the emission at the open‐closed boundary.
Key Points
Auroral electron energy and flux are estimated from Hisaki/EXCEED observations
Aurora power enhancements are mainly due to increased electron flux, not energy
Possible explanations for variations of estimated parameters are discussed
This work introduces a new measurement methodology for enhancing gas detection by tuning the magnitude and polarity of back-gate voltage of a field-effect transistor (FET)-based sensor. The aim is to ...simultaneously strengthen the sensor response and accelerate the sensor recovery. In addition, this methodology can consume less energy compared with conventional measurements by direct current bias. To illustrate the benefits of the proposed methodology, we fabricated and characterized a polypyrrole/graphene (PPy/G) FET sensor for ammonia (NH3) detection. Our experiment, simulation and calculation results demonstrated that the redox reaction between the NH3 molecules and the PPy/G sensitive layer could be controlled by altering the polarity and the magnitude of the back-gate voltage. This proof-of-principle measurement methodology, which solves the inherent contradiction between high response and slow recovery of the chemiresistive sensor, could be extended to detect other gases, so as to improve global gas measurement systems. It opens up a new route for FET-based gas sensors in practical applications.
Despite recent advances in deciphering cancer drug resistance mechanisms, relapse is a widely observed phenomenon in advanced cancers, mainly due to intratumor clonal heterogeneity. How tumor clones ...progress and impact each other remains elusive. In this study, we developed 2D and 3D non-small cell lung cancer co-culture systems and defined a phenomenological mathematical model to better understand clone dynamics. Our results demonstrated that the drug-sensitive clones inhibit the proliferation of the drug-resistant ones under untreated conditions. Model predictions and their experimental in vitro and in vivo validations indicated that a metronomic schedule leads to a better regulation of tumor cell heterogeneity over time than a maximum-tolerated dose schedule, while achieving control of tumor progression. We finally showed that drug-sensitive and -resistant clones exhibited different metabolic statuses that could be involved in controlling the intratumor heterogeneity dynamics. Our data suggested that the glycolytic activity of drug-sensitive clones could play a major role in inhibiting the drug-resistant clone proliferation. Altogether, these computational and experimental approaches provide foundations for using metronomic therapy to control drug-sensitive and -resistant clone balance and highlight the potential of targeting cell metabolism to manage intratumor heterogeneity.
The central nervous system (CNS) high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR) is a recently described molecular entity. We report 3 new CNS HGNET-BCOR cases sharing common ...clinical presentation and pathologic features. The 3 cases concerned children aged 3 to 7 years who presented with a voluminous mass of the cerebellum. Pathologic features included proliferation of uniform spindle to ovoid cells with fine chromatin associated with a rich arborizing capillary network. Methylation profiling classified these cases as CNS HGNET-BCOR tumors. Polymerase chain reaction analysis confirmed the presence of internal tandem duplications in the C-terminus of BCOR (BCOR-ITD), a characteristic of these tumors, in all 3 cases. Immunohistochemistry showed a strong nuclear BCOR expression. In 2 cases, local recurrence occurred within 6 months. The third case, a patient who received a craniospinal irradiation after total surgical removal followed by a metronomics maintenance with irinotecan, temozolomide, and itraconazole, is still free of disease 14 months after diagnosis. In summary, CNS HGNET-BCOR represents a rare tumor occurring in young patients with dismal prognosis. BCOR nuclear immunoreactivity is highly suggestive of a BCOR-ITD. Whether CNS HGNET-BCOR should be classified among the category of "embryonal tumors" or within the category of "mesenchymal, nonmeningothelial tumors" remains to be clarified. Because CNS HGNET-BCOR share pathologic features and characteristic BCOR-ITD with clear cell sarcoma of the kidney, these tumors may represent local variants of the same entity.
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