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Many adolescents and young adults (AYAs; 15-39 years) with cancer receive high intensity (HI) care at the end of life (EOL). Palliative care (PC) involvement in this population is associated with lower risk of HI-EOL care. Whether this association differs by specialized versus generalist PC (SPC, GPC) is unknown.(1) To evaluate whether SPC had an impact on the intensity of EOL care received by AYAs with cancer; (2) to determine which subpopulations are at highest risk for reduced access to SPC.A decedent cohort of AYAs with cancer who died between 2000-2017 in Ontario, Canada was identified using registry and population-based data. The primary composite measure of HI-EOL care included any of: intravenous chemotherapy14 days from death; more than one ED visit, more than one hospitalization or any ICU admission30 days from death. Physician's billing codes were used to define SPC and GPC involvement.Of 7,122 AYA decedents, 2,140 (30%) received SPC and 943 (13%) received GPC. AYAs who died in earlier years, those with hematologic malignancies, males and rural AYAs were least likely to receive SPC. No PC involvement was associated with higher odds of receiving HI-EOL care (odds ratio (OR) 1.5; p0.0001). However, SPC was associated with the lowest risk of HI-EOL care (OR SPC versus GPC 0.8; p=0.007) and decreased odds of ICU admission (OR 0.7; p=0.006).SPC involvement was associated with the lowest risk of HI-EOL care in AYAs with cancer. However, access to SPC remains a challenge.

BACKGROUND: Coronary artery calcium (CAC) scoring can identify individuals who may benefit from aggressive prevention therapies. However, there is a paucity of contemporary data on the impact of CAC testing on patient management. METHODS: Retrospective cohort study of adults who underwent CAC testing at Brigham and Women’s Hospital between 2015 and 2019. Information on baseline medications, follow-up medications, lifestyle modification, and downstream cardiovascular testing within one-year post-CAC were obtained from electronic health records. RESULTS: Of the 839 patients with available baseline and follow-up data, 376 (45%) had a CAC = 0, 289 (34%) had CAC = 1–99, and 174 (21%) had CAC≥100. The mean age at time of CAC testing was 59 ± 9.7 years. Patients with higher CAC scores were more likely to be male, have diabetes and hypertension, and have higher low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol. A non-zero CAC score was associated with initiation of aspirin (41% increase, p < 0.001), anti-hypertensives (9% increase, p = 0.031), and lipid-lowering therapies (114% increase, p < 0.001), whereas CAC = 0 was not. Among individuals with CAC≥100, 75% were started on new or more intense lipid-lowering therapy. Higher calcium scores correlated with increased physician recommendations for diet (p = 0.008) and exercise (p = 0.004). The proportion of cardiovascular downstream testing following CAC was 9.1%, and the majority of patients who underwent additional testing post-CAC had CAC scores ≥100. CONCLUSION: Approximately half of individuals referred for CAC testing had evidence of calcified coronary plaque, and of those who had significant calcifications (CAC≥100), nearly 90% were prescribed lipid-lowering therapies post-CAC. Rates of downstream non-invasive testing were low and such testing was mostly performed in patients who had at least moderate CAC.

Bio-composites and Bio-materials has received a high attraction in the field of engineering and commercial applications due to their important properties like lightweight, low density, high specific strength, degradable, non-toxicity and environment friendly nature. These natural fiber reinforced polymer composites are now receiving a great attention from material scientist andare now replacing metallic materials in different applications which are used globally in structural and non-structural components. The present work represents the simulation of natural fiber based polymer composites for frictional and specific Wear Rate. In this study, composites were manufactured by jute, hemp, flax reinforced fibers with epoxy polymer using hand lay-up technique. ANOVA and TOPSIS methods are separate techniques for optimization and TOPSIS method provide much closer result as compared to ANOVA.

Natural fiber reinforced polymer composites are being used globally in every field of engineering and technology to develop structural and non-structural components. These composites are being extensively used in automobile sector, aerospace sector, shipping industries and medical equipment’s. Such type of materials has gained attention due to their massive properties such as partial bio-degradability, non-toxic and high specific strength. The present work represents the optimization of tribological performance (frictional force, coefficient of friction and specific wear rate) of polymer composites using ANOVA & TOPSIS methods. In this work, polymeric composites were fabricated by jute, hemp, flax reinforced fibers with epoxy polymer using hand lay-up technique. ANOVA and TOPSIS have been used as an efficient tool for optimizing the wear data. ANOVA tool represents that friction force, coefficient of friction and specific wear rate of the samples have discrete effect with the composition of samples as well as applied load. ANOVA technique only mentions the effect of variable but do not define which sample has maximum effect of variables. TOPSIS technique assigns the rank of the samples according to performance.

H3K27M and H3.3G34R/V mutations have been identified in pediatric high-grade gliomas (pHGG), though extraneural metastases are rarely reported and poorly characterized. Three pHGG patients from two institutions were identified with extraneural metastasis, harboring histone mutations. Their clinical, imaging and molecular characteristics are reported here. A 17-year old female presented with supratentorial H3.3G34R-mutant glioma with metastatic osseous lesions in the spine, pelvis, bone marrow, pleural effusion and soft tissue of pelvis. Bone marrow biopsy and soft tissue of pelvis biopsy showed neoplastic cells positive for P53. A 20-year old female was diagnosed with H3F3A H3K27M-mutant thalamic glioma. She developed diffuse sclerotic osseous lesions. Biopsy of an osseous lesion was non-diagnostic. A 17-year old female presented with a H3F3A H3K27M-mutant diffuse midline glioma with diffuse spinal cord metastasis. She further developed multifocal chest lymphadenopathy, pleural effusions, and a soft tissue mass in the abdominal wall. The latter was positive for H3K27M mutation. We present the first case series of pHGG with H3F3A mutation and diffuse extraneural dissemination, describing their clinical and molecular profile.

Bibliometric analysis focuses on the statistical analysis of publications published in a particular area. This method is used to classify the information with variables i.e. journals, institutions, authors and countries. This paper present the general overview of research that has been reported in the optimization techniques in various metal cutting operations. Optimization is becoming popular concept in the present time with its most common goal of optimizing the system by smarter use of both products and services. Optimization techniques are very popular in manufacturing industries as it is leads to time–cost savings, waste reduction and increased the quality level with higher customer satisfaction. These days optimization with the help of traditional approaches and machine learning approaches have become popular to achieve the sustainability in the manufacturing practices. The aim of present research work is to investigate the systematic literature review on optimization techniques applications in the cutting processes within the sustainable manufacturing context. This study reports the 20 years of bibliometric analysis of optimization techniques used in the metal cutting operations. The bibliometric analysis is done by using Scopus database with from the time period of 2000–2020. Keyword co-occurrence is found out with the help of network analysis. Top authors, institutes, countries and publication trends in cutting processes are investigated. It is found that majority of machine learning techniques have been applied in milling and turning applications. Optimization with machine learning techniques has enhanced the research area of metal cutting in last five years. Emerging economies like India and China are more focused towards the adoption of new optimization techniques in the machining area.

The purpose of this paper is to gather insights about recent progress of scientific research associated with life-cycle assessment (LCA) using bibliometric analysis. A total of 10,524 and 7726 articles were extracted from Scopus data base and web of science (WoS) data base respectively. The findings were evaluated on the basis of aspects such as the distribution of the journal articles obtained on the basis of language, total publication, discipline wise, journal wise, and citation wise in both databases over the years. Almost all of the articles are either in the field of engineering and environmental science. In addition, lists are provided of the most active writers, organizations and countries. The USA is the top nation in this area of research, however among all other institutes worldwide, the Technical University of Denmark has the maximum number of articles. Author keyword network and document co-citation network is visualized using VOS viewer. Finally, a lists of top 50 highly influential papers were generated using WoS and Scopus databases. Researchers would be able to draw measured judgments for their future research work by referring this study.

In the current scenario, Additive Manufacturing plays a vital role in the Biomedical application. Present research is focused on the production of additives and their processes in order to construct the 3D object and the comparison of the latest research in biomedical use. The aim is to define, compare and evaluate the appropriate biomedical application for additive production in biomedical applications. In this review our aim is to identify the sustainable and biodegradable material for which Polylactic acid and its characterization are compared and analyzed for biomedical applications and for the fabrication or reinforcement of materials with the basis material (PLA).

Introduction Blinatumomab is a CD19-targeting bi-specific T-cell engager antibody construct developed for the treatment of CD19-expressing B-cell malignancies. After early impressive in vitro and in vivo pre-clinical results,1–3 blinatumomab was quickly incorporated into clinical investigations. After a phase I non-Hodgkin lymphoma (NHL) trial established a safe and effective dose, delivered via continuous intravenous (IV) infusion,4 trials exploring its use in B-lymphoblastic leukemia (B-ALL) soon followed. The results of these trials have been largely positive, though the extent of response and benefit appears to vary based on disease status and burden at the time of treatment. Thus, the optimal incorporation of blinatumomab into B-ALL therapy is still being refined.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection. Prophylaxis is recommended for patients with malignancies and trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line agent. Many paediatric patients receive second-line agents due to perceived adverse reactions from TMP-SMX.The objective of the study is to determine the risk of PJP in patients receiving TMP-SMX vs. second-line medications for prophylaxis.We conducted a retrospective, single centre, case-control study of paediatric oncology patients. Cases included children diagnosed with PJP by microscopy between 2000 and 2018 while being treated for a malignancy. Controls were matched by age, oncologic diagnosis, treatment protocol, phase of treatment and oncologic diagnosis date. For each case, up to 5 controls were randomly selected. The index date was the date of the PJP diagnosis for cases and the equivalent dummy date for controls.Eleven cases with PJP were identified and matched with 50 controls. Six (55%) cases and 42 (84%) controls were on prophylaxis with TMP-SMX. The remaining patients received inhaled pentamidine (3 cases, 4 controls), dapsone (2 cases, 3 controls), or atovaquone (1 control). Myelosuppression was the most common reason to stop TMP-SMX. Cases with PJP were less likely to have been taking TMP-SMX in the 3 months before diagnosis when compared with controls (odds ratio: 0.15, 95% confidence interval: 0.01-0.97, p = 0.02).TMP-SMX prophylaxis was associated with a lower risk of developing PJP compared with second-line treatments. Although alternate agents may be required in certain situations, efforts should be made to rechallenge with TMP-SMX when possible.

Improvements in survival for children with cancer residing in high-income countries have been driven by the results of successive clinical trials conducted by large multi-center cooperative groups. These survival improvements have not translated to low- and middle-income countries (LMICs), where the majority of children with cancer live. The emergence of LMIC cooperative trial groups will help define the optimal treatment for their populations and improve survival. In this manuscript, we outline recent trends in the results of studies conducted by the Children’s Oncology Group (COG) Acute Lymphoblastic Leukemia (ALL) Committee as an example of what can be accomplished through collaborative multi-institutional trials. We also discuss what implications the COG ALL experience holds for trial groups in LMIC settings.

Objectives To develop an expert-group, consensus-based list of system performance indicators to be used for monitoring, evaluating, and benchmarking progress for cancer care and control in adolescents and young adults (AYAs) in Canada. Methods A national multidisciplinary panel of AYA oncology experts was convened; they prepared a literature review and undertook a brainstorming exercise to create a comprehensive list of indicators based on a previously defined framework for AYA cancer care and control in Canada. A modified Delphi process was then undertaken to cull the list based on 3 quick screen criteria. Three rounds of ranking were required. The fourth stage employed a face-to-face meeting, and the final stage utilized a survey to rank the indicators on the basis of importance and feasibility. Results Nineteen participants contributed to the 5-stage process. From an initial list of 114 indicators, 14 were ultimately endorsed, representing 5 themes: active care, survivorship, psychosocial issues, palliative care, and research. The 5 highest ranked indicators were assessed as very to moderately feasible, with only a single indicator (clinical trial enrollment) in the top 5 assigned a least feasible ranking. Conclusion The 14 indicators provide a starting point for the development of a standard set of metrics for AYA cancer care and control in Canada and have potential for international utility.

Cancer is now the second leading cause of death in the Caribbean. Despite this growing burden, many Caribbean small island nations have health systems that struggle to provide optimal cancer care for their populations. In this Series paper, we identify several promising strategies to improve cancer prevention and treatment that have emerged across small island nations that are part of the Caribbean Community. These strategies include the establishment of a Caribbean cancer registry hub, the development of resource-appropriate clinical guidelines, innovations in delivering specialty oncology services (eg, paediatric oncology and palliative care), improving access to opioids, and developing regional training capacity in palliative medicine. These developments emphasise the crucial role of public-private partnerships in improving health care for the region and show how fostering strategic collaborations with colleagues and centres in more developed countries, who can contribute specialised expertise and improve regional collaboration, can improve care across the cancer control continuum.

Even though the last decade has seen a surge in the identification of molecular targets and targeted therapies in pediatric brain tumors, the blood brain barrier (BBB) remains a significant challenge in systemic drug delivery. This continues to undermine therapeutic efficacy. Recent efforts have identified several strategies that can facilitate enhanced drug delivery into pediatric brain tumors. These include invasive methods such as intra-arterial, intrathecal, and convection enhanced delivery and non-invasive technologies that allow for transient access across the BBB, including focused ultrasound and nanotechnology. This review discusses current strategies that are being used to enhance delivery of different therapies across the BBB to the tumor site - a major unmet need in pediatric neuro-oncology.

We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020–50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.

Nano-composite films using methylated guar gum (MGG) were prepared by incorporating unmodified (nanofil 116) and organically modified (cloisite 20A) nanoclays. Changes in mechanical properties, water vapor transmission rate (WVTR), color and opacity of films due to incorporation of nanoclays were analyzed. The films were also examined by FTIR, X-ray diffraction (XRD) and scanning electron microscopy (SEM). A significant (p 0.05) affected by addition of the nanoclays. XRD analysis revealed an increased interstitial spacing for both the nanoclays due to intercalation of methylated guar gum which brought about improvement in barrier and mechanical properties of nanocomposite films.

Fourier transform infrared spectroscopy (FTIR) spectra were correlated with microbial quality of minimally processed pomegranate (Punica granatum) arils stored at 10 °C using chemometrics. FTIR data processed in three ways i.e. FTIR spectrum, first derivative for FTIR spectrum and peak integrated data of FTIR spectrum was used as independent variables for preparing regression models by partial Least Square Regression (PLS-R) and artificial neural networks (ANN) for predicting the total viable count (TVC) and yeast and mold count (Y&M). Models built with both ANN and PLS-R using FTIR data demonstrated a high correlation value of R2 > 0.85. Analysis of PLS-R results suggested the production of alcohols and acids with utilization of sugars during storage. This is a first report demonstrating use of FTIR as a nondestructive rapid method for microbial quality analysis of minimally processed fruits.

The principal concern of the present work is to investigate the effects of thermally developed Brownian motion and thermophoresis diffusion in non-Newtonian nanofluid through an inclined stretching surface with effect of chemical reaction and thermal radiation. By using compatible similarity transformations the governing equations of momentum, energy and concentration profiles are converted to a set of nonlinear differential equations. A Mathematica package BVPh 2.0 is applied to examine the given system of equations. Influences of developing parameters such as magnetic parameter, radiation, Lewis number, Prandtl number, mixed convective parameter, Brownian motion and thermophoresis parameter on velocity, temperature and nanoparticles concentration are displayed through graphical experiment. A comparative study between OHAM and previously published results is made. It is noticed that OHAM can overcome the earlier restriction, assumptions and limitation of classical perturbation schemes. The implementation of OHAM is reasonably simple through Mathematica package need to define the governing equations, boundary conditions; suitable auxiliary linear operator and initial guess etc. The key advantage of the suggested technique is that it can be used direct way in highly nonlinear differential equations without using discretization, linearization and round-off errors.

Colorimetric time temperature indicator (TTI) which changes colour from colourless to brown due to phenol oxidation in the presence of Na2CO3 and ammonium per sulphate (APS; free radical initiator) is developed. Twelve TTI prototypes were prepared by using different concentrations of Na2CO3 (23–59 mM), APS (21–43 mM) with 2% (wt/vol) phenol. Significant (p

Bitter gourd exhibits significant anti-diabetic activity. In the present study, pectinase concentration (4.04–15.92 ml kg −1 ), incubation time (48–191 min) and temperature (31–55 °C) were optimized using response surface methodology (RSM) for obtaining increased juice yield with higher anti-diabetic (α-amylase and α-glucosidase inhibition) activity, total phenolics and antioxidant activity. The optimum conditions i.e. pectinase concentration (10.2 ml kg −1 ), incubation time (140 min) and temperature (48.8 °C) resulted in juice yield of 82%, α–amylase and α-glucosidase inhibition activity of 23 and 59%, respectively, with total phenolic and antioxidant content of 710 and 198 μg GAE ml −1 , respectively. In comparison, control (prepared without enzyme treatment) had significantly (p −1 , respectively. RSM optimized juice also demonstrated significantly (p > 0.05) higher contents of phenolic acids as compared to control juice.

The objective of this work is to develop a non-contact, non-invasive technique for monitoring human-prosthesis interfaces, such as the development of infection. The monitoring scheme proposed works by coupling electrical capacitance tomography (ECT) with a pH-sensitive nanocomposite thin film applied at the human-prosthesis interface. In short, ECT uses applied electrical excitations and measurements at the boundaries to reconstruct the spatial permittivity distribution inside the sensing region. The pH-sensitive nanocomposite pronounces permittivity changes due to issues occurring at the human-prosthesis interface, thereby enhancing detection sensitivity and resolution. First, numerical simulations were performed by altering the permittivity at selected locations in a mathematical model to simulate the effect of infections near a prosthesis. The extent and shape of the perturbed permittivity was captured by numerical simulations of ECT. Second, experiments were conducted in the laboratory to validate the monitoring system and sensing scheme. Here, a pH-sensitive thin film was fabricated using carbon nanotubes and polyaniline. The thin film's pH sensitivity was characterized by exposing it to different pH buffer solutions and measuring its corresponding dielectric property changes. A circular plastic rod was then used as a phantom for a human prosthesis, for example, to simulate the portion of an artificial limb that would be embedded in and bonded to the human body. The thin film was then deposited onto the surface of the prosthetic phantom and exposed to different pH buffer solutions. For each case, the ECT monitoring system was used to interrogate the prosthetic phantom placed in the sensing area. Not only did the system detect changes in permittivity due to different pH buffers, but the reconstructed permittivity maps also identified the location of the permittivity changes, as well as the prosthesis itself.

Volatile aroma compounds of three varieties of red kidney beans (Phaseolus vulgaris) namely Kashmiri red, Sharmili and Chitra were extracted in raw state using solid-phase microextraction (SPME) and cooked state using simultaneous distillation extraction (SDE). During cooking a significant (p

In infrastructure project, every investment needs to be justified so that feasibility studies are conducted. Feasibility studies play an important role for completion of project, so it is important to do every investment with feasibility studies. The paper is an attempt to present modern methodology for financial viability applied before execution. Now, firstly evaluating the data and process it into proper perspective, which gives financial results in various parameters such as net present value, internal rate of return, payback period, discounted payback period. Now the investor compares financial results with his specified criteria. One can find out whether the project is possible or to go for a better option for investment to get a good return which draws the viability in terms of benefits in near future. To put these aspects in a nut shell and the factual situation about how does the project work? It gives us the realistic approach.

Short seasonal and post-harvest perishable features of underutilized Java Plum (Syzygium cumini) fruits, known for tremendous ethno-medicinal importance, significantly limits their sustained market availability and trade. To address this concern, a chemical preservative free value added dehydrated product was developed from fruit pulp and gamma irradiated (5 kGy) to ensure microbial safety and extended shelf-life. Microbial load was ~ 4.7 log cfu/g in non-irradiated samples that reduced to below detectable level upon irradiation treatment (5 kGy) and organoleptic quality was maintained up to 5 months as evidenced by retention of aroma components (41 Nos) upon radiation processing. No significant (P

Effect of addition of nanoclay (nanofil-116), beeswax, tween-80 and glycerol on physicochemical properties of guar gum (GG) films was studied using response surface methodology (RSM). Beeswax produced reduction in water vapor transmission rate (WVTR) and tensile strength (TS). An improvement in TS with reduction in WVTR was observed due to nanoclay. Concentrations of various additives were optimized to prepare films with improved properties. Optimized concentrations (beeswax: 0.63%; nanoclay: 2.5%; tween-80: 0.63%; glycerol: 11.87% w/w GG) resulted in TS of 98 MPa and WVTR of 89 g/m2/d. Compatibility between GG and beeswax was further increased using gamma irradiation. RSM study with 50 kGy irradiated beeswax was performed and optimum concentration of tween-80 (0.88%), irradiated beeswax (50 kGy) (1.21%), glycerol (13.91%), nanoclay (3.07%) w/w of GG resulted in films having TS of 122 MPa and WVTR of 69 g/m2/d. Guar gum based films with improved mechanical and barrier properties were successfully prepared.

Summary Investments in cancer control—prevention, detection, diagnosis, surgery, other treatment, and palliative care—are increasingly needed in low-income and particularly in middle-income countries, where most of the world's cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities , 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.

Population-based cancer registries generate estimates of incidence and survival that are essential for cancer surveillance, research, and control strategies. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, stage is not recorded by most population-based cancer registries. The main method of staging adult cancers is the TNM classification. The criteria for staging paediatric cancers, however, vary by diagnosis, have evolved over time, and sometimes vary by cooperative trial group. Consistency in the collection of staging data has therefore been challenging for population-based cancer registries. We assembled key experts and stakeholders (oncologists, cancer registrars, epidemiologists) and used a modified Delphi approach to establish principles for paediatric cancer stage collection. In this Review, we make recommendations on which staging systems should be adopted by population-based cancer registries for the major childhood cancers, including adaptations for low-income countries. Wide adoption of these guidelines in registries will ease international comparative incidence and outcome studies.