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A characterization of the spent nuclear fuel (SNF) for its radionuclide (RN) inventory is vital for various back-end stages of the nuclear fuel cycle. It concerns both the fuel and the metallic (i.e., cladding and structural material) components of the spent fuel assemblies, where different calculation approaches and methods should be deployed for their characterization. This study concentrates on fuel traces and other impurities within the cladding. During the operating cycles, the Zircaloy cladding is exposed to a considerable amount of irradiation. The impact of the exposure should be checked to assure the integrity of the cladding and thus the safety of the stored spent fuel. Within the work package "Spent Nuclear Fuel Characterization and Evolution until Disposal" (SFC) of the EURAD project, dedicated samples were produced, irradiated and the radionuclide inventory of the cladding was analysed and compared. In parallel a blind test was performed, in which different partners used different codes to simulate the irradiation quantity. The blind test showed good agreement between most of the codes, in particular in view of the small amount of the evolved fuel traces. Furthermore, the presence of actinides, caused by precipitation of uranium on the inner surface of the cladding during manufacturing, was found to be negligible in comparison to precipitation of traces of fuel pellets on the cladding during operation. The good agreement between the simulating codes enables to depict further the initial amount of alloying elements of the cladding material itself in a better manner. In particular specific isotopes of cobalt, nickel and iron, which are directly connected to the unique properties of each cladding material can be better identified based on the accurate measuring techniques used in this study. [ABSTRACT FROM AUTHOR]

Sinonasal cancers (SC) are a rare, diverse disease group with a relatively poor prognosis. Local control (LC) has improved with advances in imaging, surgery, and radiotherapy including proton therapy (PT), albeit with increased risk of toxicity such as central nervous system (CNS) necrosis. Our objective was to assess CNS necrosis risk in patients who receive PT for SC and evaluate prognostic factors and DVH metrics. We reviewed 173 patients (age 18+ yrs) treated with PT (+/- chemo) for SC (excluding melanoma, lymphoma, sarcoma, distant metastasis, ≤ 6 mos follow-up, and reirradiation) at a single institution. We assessed CNS necrosis using CTCAEv5 and censored events at last primary site imaging, local recurrence, distant metastasis, or death. We estimated survival, disease control, and CNS necrosis rates using the cumulative incidence method. We used a Fine-Gray test to correlate prognostic univariate factors, competing risks proportional hazards regression for multivariate analysis, and correlated select whole-brain DVH parameters (V40-80, 5 GyE intervals, Dmax, and Dmean) with CNS necrosis using univariate logistic regression on 93 patients with >1-yr imaging follow-up and no competing events. Median age was 60 years (range, 18-86) with a median follow-up of 5 yrs among survivors (range, 0.5 – 13.5), most had T3-4 tumors (91%) and naso-ethmoid tumors (77%); 42% had intracranial and 34% had cranial nerve invasion. Most (80%) had surgery before PT; 69% received chemo. Most received passive-scatter PT (84%) at 1.2 GyE/fraction twice-daily (85%) to ≥70 GyE (79%; median, 73.2; range, 54 – 74.4). 5-yr LC (95% CI), disease-free, and overall survival rates were 84% (78-89%), 63% (56-71%), and 59% (51-77%). After gross-total resection, the 5-yr LC rate was 92% (95% CI, 86-96%). There were 72 (40%) CNS necrosis events at a median 2.6 yrs from end of PT (range, 1.1 – 9.1) with 14 (8%) grade 3+ events and 3 deaths. Most events (53%) were asymptomatic (grade 1). Freedom from CNS necrosis (grade 1+, 2+, and 3+ [95% CI]) at 5 years was 78% (72-85), 90% (85-94), and 92% (87-95). T3/4 disease, intracranial invasion, biopsy alone, total dose, and chemotherapy were negatively correlated prognostic factors. Nearly all DVH metrics showed strong correlation with CNS necrosis risk except Dmean. The receiver-operator curve characteristics for V65 showed the strongest correlation (AUC 0.83 grade 2+, AUC 0.78 grade 3+) and the model provided candidate DVH goals (V65 < 1mL, 5% risk of grade 3) with an acceptable deviation (V65 < 17mL, 15% risk of grade 3+) for those with gross skull base/intracranial tumor. PT +/- chemo in the primary and adjuvant settings yields high rates of LC for locally advanced SC. CNS toxicity is a significant risk, but most events are asymptomatic and self-limited. We intend to decrease treatment intensity after gross total resection given the favorable LC in this subset. These data provide updated DVH goals to decrease the risk of CNS toxicity. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): To compare patient-reported QOL/symptoms between DI IMPT(chemo) and IMRT(chemo) for HPV-OPC.Materials/methods: LCCC1612 is a multi-institutional phase II trial of DI RT(chemo) using 60 Gy/30 fx in 6 wk with weekly concurrent cisplatin, 30 mg/m2 for HPV-OPC. Eligible patients (AJCC 8 ed, T0-3, N0-2, M0, p16+, regardless of smoking history) received IMPT at one participating center. T0-2, N1 (single node, < 3 cm) received RT alone. ≥10 pk-y smokers underwent p53 mutation analysis, and only those with wild-type p53 received DI RT(chemo). The IMPT cohort (initial 25 patients with 1y f/u) were matched (2:1) to a randomly selected IMRT cohort using the following: T-class, N-class, and uni- vs. bi-lateral neck RT. QOL/symptoms assessed by EORTC QLQ30, HN35, and EAT-10 were compared at baseline, endRT, 3, 6, and 12 mo. Differences of ≥10 in QLQ30 and HN35 (range, 0-100) and ≥3 in EAT-10 (range, 0-40) were considered clinically relevant.Results: The IMRT cohort consisted of 46 matches (only 1:1 available for 4 IMPT pts). There were no significant differences between non-matched variables (RT dose, chemo, age, gender, smoking history, or primary site). 1-yr PFS was comparable (IMPT, 92%; IMRT, 93%). Only 2/25 (8%) IMPT and 18/46 (39%) IMRT patients required short-term feeding tubes. Both cohorts reported excellent QOL/symptom scores with worse mean scores at end of RT, which returned to baseline by 3 mo for most patients with some exceptions such as dry mouth, sticky saliva, and sensory changes. IMPT resulted in higher (better) mean scores for QLQ30 Global QOL at endRT (55.8/45.8), and role function at endRT (60.1/43.6) and 3 mo (91.7/80.4). Several HN35 mean symptom scores were lower (better) after IMPT including fatigue at endRT (49.3/60.4) and 3 mo (17.2/31.6); appetite loss at 3 mo (16.7/34.8), 6 mo (13.9/27.8), and 12 mo (5.8/16.7); impaired social eating at 3 mo (14.0/30.2) and 6 mo (11.1/22.8); coughing at endRT (29.0/43.2) and 6 mo (15.3/25.6); and feeding tube use at endRT (4.3/34.1) and 3 mo (4.5/15.6). IMPT patients reported less dysphagia with lower mean EAT-10 scores at 3 mo (5.8/10.0) and 6 mo (4.5/8). Narcotic use was higher with IMPT than IMRT at end RT and 3 mo without a difference in pain scores. There was no difference in financial difficulties despite the added costs with proton therapy.Conclusion: DI IMPT(chemo) and IMRT(chemo) resulted in favorable patient-reported QOL/symptoms with most patients reporting return to baseline QOL/symptom scores by 3 mo with some exceptions. DI IMPT(chemo) resulted in very low rate of feeding tube use and less swallowing/eating-related symptoms compared with IMRT(chemo) using independently validated instruments. Additional data and long-term follow-up will be needed to validate these findings and confirm the long-term safety/efficacy of DI RT(chemo). [ABSTRACT FROM AUTHOR]

The probability of cure after hypofractionated larynx radiotherapy (RT) decreases among patients with T2 glottic cancers with impaired cord mobility. The role of concurrent chemotherapy in this setting is unclear. We report outcomes of patients with T2 (and T3 based on paraglottic space invasion alone) N0 glottic squamous cell carcinoma (SCC) treated with curative-intent hypofractionated larynx RT with or without chemotherapy. We retrospectively reviewed the medical records of all patients with AJCC 8th edition stage T2-T3 N0 M0 SCC of the glottic larynx treated with curative intent at a single institution between 2000 and 2020. T3 patients were included if they were upstaged by paraglottic space invasion alone. All patients received hypofractionated RT (2.25 Gy/fraction) to the larynx to 63 - 65.25 Gy, with or without concurrent systemic therapy, and had at least 6 months of follow-up. Disease control and survival outcomes were calculated by the Kaplan-Meier method, and we used descriptive analysis to compare prognostic factors since more robust statistics were limited by sample size. The study population included 71 patients with a median follow-up time of 3.8 (range, 0.1 – 17.2) years. Major 2-year outcomes (95% CI) were as follows: local control, 74% (62% - 83%); regional control, 92% (83% - 97%); laryngectomy-free survival, 70% (58% - 80%); and overall survival, 82% (71% - 90%). Among the 23 patients who received systemic therapy (92% received weekly cisplatin or carboplatin), a greater proportion had impaired mobility (70% vs. 40%, p=0.02), larger median gross tumor volume (3.0 vs 1.6 cc, p=0.003), and subglottic extension (61% vs. 25%, p=0.008). Despite their worse prognostic factors, patients with impaired cord mobility who received chemotherapy experienced better local control and avoided total laryngectomy, without increased toxicity (see Table). One patient (4%) treated with chemotherapy required gastrostomy tube and tracheostomy during RT (both removed within 1 year). All but 6 late grade 3+ adverse events occurred after salvage laryngectomy for local recurrence. There were only 2 isolated regional relapses despite limited use of elective nodal RT (n=2). The addition of concurrent platinum-based chemotherapy to hypofractionated larynx RT among patients with early-stage glottic SCC with impaired cord mobility appears safe, effective, and worthy of additional investigation. [ABSTRACT FROM AUTHOR]

Abstract: New pneumococcal conjugate vaccines (PCVs) are now becoming available. These formulations differ from the heptavalent diphtheria toxin variant conjugate vaccine (7vCRM, Prevenar™/Prevnar™) both in the number of serotypes and in serotype-specific immunogenicity. This review proposes an algorithm that attempts to predict the overall impact of these differences in vaccine formulation and immunogenicity on invasive pneumococcal disease (IPD) effectiveness. It builds on the principles underlying WHO licensure criteria for new PCVs, that serotype-specific anti-polysaccharide immunogenicity is potentially predictive of effectiveness. The algorithm used three sources of information: serotype-specific effectiveness data for 7vCRM, serotype-specific head-to-head immunogenicity data with 7vCRM and a recently licensed 10-valent pneumococcal non-typeable H. influenzae protein D-conjugate vaccine (PHiD-CV, Synflorix™), and epidemiological information regarding the serotypes causing IPD in young children. Based on this algorithm, PHiD-CV and 7vCRM are predicted to prevent approximately 60–80% and 45–80%, respectively of IPD in young children worldwide, with significant variability by country and region. [Copyright &y& Elsevier]

Abstract: The ideal gas, scattering kernel for heavy nuclei with pronounced resonances was developed [Rothenstein, W., Dagan, R., 1998. Ann. Nucl. Energy 25, 209–222], proved and implemented [Rothenstein, W., 2004 Ann. Nucl. Energy 31, 9–23] in the data processing code NJOY [Macfarlane, R.E., Muir, D.W., 1994. The NJOY Nuclear Data Processing System Version 91, LA-12740-M] from which the scattering probability tables were prepared [Dagan, R., 2005. Ann. Nucl. Energy 32, 367–377]. Those tables were introduced to the well known MCNP code [X-5 Monte Carlo Team. MCNP – A General Monte Carlo N-Particle Transport Code version 5 LA-UR-03-1987 code] via the “mt” input cards in the same manner as it is done for light nuclei in the thermal energy range. In this study we present an alternative methodology for solving the double differential energy dependent scattering kernel which is based solely on stochastic consideration as far as the scattering probabilities are concerned. The solution scheme is based on an alternative rejection scheme suggested by Rothenstein [Rothenstein, W. ENS conference 1994 Tel Aviv]. Based on comparison with the above mentioned analytical (probability S(α,β)-tables) approach it is confirmed that the suggested rejection scheme provides accurate results. The uncertainty concerning the magnitude of the bias due to the enhanced multiple rejections during the sampling procedure are proved to lie within 1–2 standard deviations for all practical cases that were analysed. [Copyright &y& Elsevier]

Studies have shown that vaccination with seven-valent pneumococcal conjugate vaccine (PCV7) results in a decline in nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae, in carriage of vaccine-type pneumococci, and in replacement by non-vaccine serotypes. Vaccines can reduce pneumococcal resistance in vaccinated and unvaccinated populations by reducing the carriage of antibiotic-resistant serotypes, which protects the vaccinated population and prevents spread of disease to others, and by decreasing antibiotic resistance through overall reduction in antibiotic use. However, while reducing the level of vaccine serotypes and drug-resistant serotypes in the nasopharynx, PCV7 also causes non-vaccine pneumococci replacement. The impact of serotype replacement on disease is not clearly understood. Pelton et al. surveyed two communities shortly after the introduction of the PCV7 immunization programme and found that while colonization with vaccine serotypes declined from 22% to 2% from 2000 to 2003, prevalence of non-vaccine serotypes increased from 7% to 16%. Although penicillin-resistant colonizing S. pneumoniae isolates initially declined, penicillin-intermediate isolates increased 2 years following PCV7 introduction. The change was primarily accounted for by an increase in penicillin-intermediate serotype 19A. Serotype 19A is the only serotype not affected by PCV7 that is prevalent worldwide, clinically important, and highly multidrug-resistant. A study by Hicks et al. established serotype 19A as the predominant post-PCV7 cause of invasive pneumococcal disease (IPD) in children and the elderly. An increase in IPD rates caused by antibiotic-resistant serotype 19A isolates can also occur without vaccination; reports indicate increases in regions characterized by extensive antibiotic use, underscoring the importance of strategies to contain antibiotic resistance. [ABSTRACT FROM AUTHOR]

Abstract: The importance of an advanced neutron scattering treatment for heavy nuclei with strong energy dependent cross-sections such as the pronounced resonances of 238U has been discussed in various publications where the full double differential scattering kernel was derived. In this study the double differential kernel is confirmed by a purely stochastic approach. We evaluate the impact of this improved resonance kernel on High Temperature Reactors (HTR) using the Monte Carlo Code MCNPX. A comparison between the standard MCNPX scattering kernel and the new one is introduced. For the analyzed HTR-10 unit cells the new kernel leads to a decrease in criticality of 170–600pcm depending on TRISO packing factor and fuel temperature and to an increase in magnitude of the Doppler reactivity coefficient by about 10%. The 239Pu inventory increases by up to 2.5% at the end of cycle. Full core models of the test reactors HTR-10 and HTTR are analyzed. As expected the impact of the improved kernel is low for the HTR-10 because of an enhanced thermal flux. However, for the HTTR the effective multiplication factor decreases by 200–400pcm and Doppler reactivity becomes more negative by 14%. [Copyright &y& Elsevier]

Abstract: The paper is a sequel to the papers by Rothenstein and Dagan [Rothenstein, W., Dagan, R., 1998a. Ann. Nucl. Energy. 25, 209–222; Rothenstein, W., Dagan R., 1998b. Int. Conf. Phys. Nucl. Sci. Tech. 1251–1258] and Rothenstein [Rothenstein, W., 2004. Ann. Nucl. Energy. 31, 9–23] where the scattering kernel for scatterers with pronounced energy dependent cross-sections was introduced utilizing the free gas model as far as the thermal agitation of the target nucleus is concerned. The improved kernel emphasizes the increased probabilities for up-scattering within the energy range of a resonance and the different angular distribution of the scattered neutron. The angular distribution involves the polar and the azimuth angles. The azimuth angle is the angle between the plane containing the velocity vectors of the incident neutron and the target nucleus and the plane containing the velocity vector of the scattered neutron and the velocity vector of the centre of mass. In the above papers the probability of the polar angle of the scattered neutron was predicted explicitly and the improved associated cosine bins were generated. The azimuth angle was introduced as an integration variable for the generation of the energy and the polar cosine bins. In the current study we treat the above azimuth angle of the emitted neutron differently, namely as an additional scattering parameter. The mutual dependence between the scattered neutron velocity, the polar and azimuth angles is discussed, also in view of the angular distribution treatment in the MCNP [Briesmeister, J.F. (Ed.), 1997. MCNP – A General Monte Carlo N-Particle Transport Code, LA-12625-M] code, when a specific target nucleus thermal velocity vector is sampled and treated. For several energies in the vicinity of the resonances of U238, the probability of a neutron to be scattered in a specific energy is calculated together with the probabilities of the polar as well as the above defined azimuth angle. For several energies of the scattered neutron, this azimuth angle is shown to be mutually dependent on the polar angle and consequently the angular distribution of both angles is in general not isotropic. Moreover, the angular distribution depends on the temperature and the characteristics of the resonance. It is confirmed mathematically and numerically that at 0K the new solution technique degenerates to the classical two body kinetics approach where the target nucleus is at rest and the azimuth scattering angle is independently isotropic. [Copyright &y& Elsevier]

Abstract: The use of S(α,β) tables for evaluating the secondary energy distribution is restricted in the MCNP code [Briesmeister, J.F. (Ed.), 1997. MCNP – A General Monte Carlo N-Particle Transport Code, LA-12625-M] to light isotopes only. The reason is the free gas model in NJOY, [Macfarlane, R.E., Muir, D.W., 1994. The NJOY Nuclear Data Processing System Version 91, LA-12740-M] which does not account for heavy isotopes with strongly energy dependent cross-sections. The joint scattering kernel developed by [Rothenstein, W., Dagan, R., 1998. Ann. Nucl. Energ. 25, 209–222] improved the secondary energy distribution treatment in a manner consistent with the BROADR module in NJOY. [Rothenstein, W., 2004. Ann. Nucl. Energ. 31, 9–23] enabled the generation of S(α,β) by implementing a new formalism for the modified kernel into the NJOY module THERMR. The new generated S(α,β) tables for heavy isotopes with pronounced resolved resonances were added to the MCNP library data files and the MCNP code itself, was modified accordingly. The quantitative effects of using scattering kernel tables in the vicinity of resonances were analyzed by introducing them into the Tellier et al. [Tellier, H., Costa, M., Raepsaet, C., Van der Gucht, C., 1993. 113, 20–30] benchmark problem. The absorption rate and the Doppler effect were calculated for the pronounced eight S-type resonances of 238U within the energy range 2.7–210 eV. The introduced S(α,β) tables for 238U increases the Doppler effect by 23.5% in comparison with the existing MCNP calculation method. Over the entire Resolved Resonance Region (RRR) this means an increase of 17.5%. The overall absorption rate over the entire RRR is increased by 1.4% at 1200 K and by 2.1% at 1800 K. [Copyright &y& Elsevier]

Background: Antimicrobial resistance in respiratory pathogens has become a common clinical problem that has serious public health implications. Inappropriate use of antibiotics for the treatment of viral upper respiratory tract infections (URTIs) has contributed to the development of resistant microorganisms. Health care providers can help control the spread of resistance by limiting the use of antimicrobial agents to infections that meet clinical guidelines for a bacterial cause.Objective: This article examines the means of accurately diagnosing and appropriately treating acute bacterial rhinosinusitis (ABRS) in an effort to control increasing levels of resistance.Methods: This article discusses current treatment guidelines that provide the evidenced-based rationale for choosing the most appropriate antimicrobial agents for suspected ABRS in adults and children. An evidence-based approach can help minimize the public health threat posed by the continuing increase in microbial resistance.Results: Although definitive clinical criteria that differentiate between ABRS and viral URTI are lacking, careful evaluation of the duration and severity of symptoms provides a rational basis for diagnosing ABRS in primary care settings.Conclusions: Once a diagnosis of ABRS has been made, empiric antibiotic therapy may be justified. When it is, the first-line agent should be the narrowest spectrum antibiotic that would be expected to eradicate the most common causative organisms. The antibiotic selection process should take into account prevailing patterns of resistance and the presence of risk factors for infection with resistant pathogens, as well as published evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pneumoniae is a common cause of respiratory tract infections and acute otitis media. The main reservoir of S pneumoniae is the nasopharynx. From there, it can spread to cause disease in various foci.Objective: This article reviews studies on the use of vaccines to prevent the spread of S pneumoniae, particularly antibiotic-resistant serotypes.Methods: Published data were identified using a PubMed search of the literature published from 1995 to the present in all languages, using the search terms S pneumoniae, vaccines, and antibiotic resistance. Relevant conference presentations were also included.Results: Most children are colonized during the first years of life. Antibiotic resistance to S pneumoniae is prevalent and increasing, which affects clinical outcomes and antibiotic use. In clinical studies, conjugate pneumococcal vaccines reduced the rates of carriage of those pneumococcal serotypes included in the vaccines. They also appeared to increase the rates of carriage of pneumococcal serotypes not related antigenically to those in the vaccines (a replacement phenomenon). Antibiotic resistance is most prevalent among serotypes included in the conjugate vaccines. Studies have also shown that conjugate pneumococcal vaccines reduced the carriage and spread of antibiotic-resistant S pneumoniae, including among younger siblings of toddlers in day care. The reduction in carriage of antibiotic-resistant S pneumoniae was associated with a reduction in the number of respiratory infections and use of antibiotics in day care centers.Conclusions: Preliminary studies of conjugate pneumococcal vaccines suggest that they may help prevent the spread of antibiotic-resistant serotypes and reduce the need for antibiotic therapy for S pneumoniae infections. [ABSTRACT FROM AUTHOR]

We established a linear accelerator-based stereotactic radiosurgery (SRS) program using the universal inflatable headrest developed for patient immobilization and automatic planning. The patient's motion during treatment was evaluated using mid-SRS cone-beam computed tomography (CBCT) to demonstrate the inflatable headrest's clinical utility and accuracy. We implemented automated planning to improve plan integrity and the effectiveness of dose optimization. The universal inflatable headrest consists of a blood pressure cuff, an air pump, and a pressure meter. The cuff with a small adult size (12 cm × 22 cm) was customized to fit an indexed base-of-skull headframe. The headrest was designed to immobilize patients' head motions and chin movements using adjustable air pressures (80–100 mmHg) within a thermoplastic mask. The effectiveness of the immobilization system was evaluated in 45 SRS cases using mid-SRS CBCT acquired after half of the treatment beams were delivered. Compared to the initial setup, the translational and rotational variations in the mid-SRS CBCT were used as surrogates of patient motions during treatment. In addition, the automatic SRS planning script was developed to create pseudo-planning structures and beams. The optimal dose objectives and beam weightings were determined using a heuristic algorithm to achieve dose conformity (CI) and gradient index (DGI). The inflatable headrest showed a patient immobilization error of 0.6 mm (95% confidence interval) and a maximum of 1 mm in Cartesian coordinates from 140 mid-SRS CBCT images. The headrest demonstrated an effective reduction in anterior-posterior movement with air pressure adjustments. The developed immobilization allowed universal application for single and fractionated SRS cases with photons and protons. The automatic planning enabled initial planning and optimization in 3.5 minutes, including 40 seconds for structure creation. The heuristic algorithm successfully created optimized doses to meet CI = 0.8–0.9, DGI = 0.3–0.4, and a maximum target dose of 125–135%. The inflatable headrest showed statistically significant precision in immobilizing SRS patients with less than 1 mm error in retrospective data analysis. It provided a comfortable and reliable posterior neck and chin position with a noticeable reduction of anterior-posterior motions. It can be clinically utilized for brain cancer treatment that requires high precision for critical organ-sparing and particle therapy. The automatic SRS planning led to standardizing the SRS protocol and effectively finding the optimal solution to achieve dose conformity and sharp gradients to critical organs. [ABSTRACT FROM AUTHOR]

The aim was to compare incidences of respiratory syncytial virus (RSV) bronchiolitis in late preterm vs. term infants (33–36 vs. >36 weeks of gestational age (WGA)). This was a population-based retrospective study including all infants <12 months hospitalized at Soroka medical centre with bronchiolitis between 2004 and 2012. Infants with comorbidities were excluded. RSV bronchiolitis rates were calculated by extrapolating the proportion of positive tests among tested infants. Population denominator for incidence rates was calculated from hospital records. During the study, 374 late preterm and 2948 term infants were hospitalized with bronchiolitis. Out of 229 (61.2%) late preterm infants and 1738 (59%) term infants tested for RSV, 164 (71.6%) and 1266 (72.8%) were positive for RSV respectively. The mean yearly incidences per 1000 children of RSV bronchiolitis hospitalizations of late preterm and term infants were 35.8 ± 13.0 and 19.6 ± 4.1 respectively (p 0.009). During RSV seasons the mean incidence rate ratio between groups was 1.82 (95% CI 1.60–2.08). Duration of hospitalization was 4.8 ± 7.0 and 3.9 ± 4.9 in late preterm and term infants, respectively (p 0.003). Late preterm-born infants (33–36 WGA) had a higher rate of hospitalization for overall and RSV bronchiolitis during the first year of life compared to those born at term. [ABSTRACT FROM AUTHOR]

To report long-term outcomes of patients with adenoid cystic carcinoma (ACC) of the head and neck treated with proton radiotherapy. On this IRB-approved, single institutional prospective outcomes registry, 56 patients were included with de novo, nonmetastatic adenoid carcinoma of the head and neck treated with primary (n = 9) or adjuvant proton therapy from June 2007 to December 2021. The cohort had 30 women and 26 men with a median age of 57 years (range, 10-81 years). Twenty-nine percent (n = 16) had intracranial extension, 23% (n = 13) had orbital extension, and 55% (n = 31) had clinical cranial nerve involvement at the time of radiotherapy. Thirty patients underwent gross total resection (GTR), 26 had gross disease at the time of treatment undergoing a subtotal resection (STR) (n = 17) or biopsy alone (n = 9). The median dose to the primary site was 72.6 GyRBE (range, 64-74.4 GyRBE) delivered in either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received either elective nodal irradiation (ENI) in a node negative neck or concurrent chemotherapy. With a median follow-up of 6.2 years (range, 0.9 - 14.7 years), the 5-year local-regional control (LRC), disease free survival (DFS), cause-specific survival (CCS) and overall survival (OS) were 88%, 85%, 89%, and 89%, respectively. Cranial extension (p = 0.003) and gross residual tumor (p = 0.0388) were factors associated with decreased LRC. While LRC for those with a GTR was 96%, those with STR or biopsy alone were 81% and 76%, respectively. T-stage (p = 0.0154), cranial extension (p = 0.0056), extent of resection (p = 0.0355), and gross residual tumor (p = 0.0094) were associated with decreased DFS. T-stage (p = 0.0099), extent of surgery (p = 0.029) and gross residual tumor (p.0071) were associated with decreased CCS. The 5-year cumulative incidence of clinically significant late grade ³3 toxicity was 15% and the crude incidence at most recent follow-up was 23% (n = 13). There was no LRC benefit with ENI (p = 0.94). Proton therapy provides excellent disease control for head and neck ACC with acceptable toxicity. Gross residual disease at the time of treatment and intracranial involvement were significant prognostic features for worse outcomes. STR did not confer benefit over biopsy only at 5-years and may question the role of extensive and morbid operations if GTR is not technically feasible. [ABSTRACT FROM AUTHOR]

Given its tendency to abut and infiltrate critical skull base anatomy, pediatric esthesioneuroblastoma (EN) presents a local control challenge, particularly given the high dose of radiation historically utilized in adult patients and the sensitivity of developing pediatric normal tissue. The purpose of this study was to report the outcomes of pediatric EN treated with proton radiotherapy. Using an IRB-approved, single institutional prospective outcomes registry, we analyzed disease control and toxicity in pediatric patients with non-metastatic EN treated with a multimodality approach, including proton radiotherapy, between March 2008 and March 2022. Of the 15 patients, 8 were female, and 7 were male. The median age was 16 years (range, 3–21 years). Patients were Kadish stage B (n = 2), C (n = 8), and D (n = 5) and Hyams low-grade (n = 9), high-grade (n = 5), and not specified (n = 1). Six patients had intracranial involvement, 4 had cranial nerve deficits, and 4 had positive cervical lymph nodes. Prior to radiation, 2 patients had a subtotal resection and 13 had a gross total resection via either endoscopic (n = 8) or craniofacial (n = 7) approaches. Two patients underwent neck dissection (one unilateral and one bilateral). A total of 11 patients received chemotherapy before (n = 5), concurrent (n = 4) with radiation, or both (n = 2). The median total radiation dose delivered to the primary site was 66 Gy/CGE (range, 59.4-72.8 Gy/CGE) for patients with gross disease and 54 Gy/CGE (range, 54-74.4 Gy/CGE) for patients with microscopic disease. With a median follow-up of 4.8 years (range, 0.1–12.2 years), both the 5-year disease free and overall survival rates were 86%. There were no local or regional recurrences. Two patients with Kadish D, high grade tumors developed vertebral metastases and died with disease. Serious acute toxicity included 2 patients requiring a temporary feeding tube for oral mucositis/dysphagia. Serious late toxicity included symptomatic retinopathy (n = 3), major reconstructive surgery (n = 2), cataracts requiring intervention (n = 2), chronic otitis media (n = 2), chronic keratoconjunctivitis (n = 2), hypothyroidism (n = 2), and in-field basal cell skin cancer (n = 1). A multimodality approach to pediatric EN results in excellent local control. Despite the use of moderate dose proton therapy, serious radiation toxicity was observed and thus select patients may benefit from further dose and target volume reduction. Longer follow-up and comparative data from modern photon series are necessary to fully characterize any relative advantage of proton therapy. [ABSTRACT FROM AUTHOR]

Pneumonia is the most important killer of children <5 years old nowadays and the most important bacterial organism in early childhood pneumonia is S. pneumoniae. When trying to determine the extent of potential reduction of pneumonia burden in children one encounters real difficulties, some of which are the absence of definition of pneumonia, the absence of radiologic diagnosis of pneumonia, the differences between populations, the paucity of positive cultures and environmental considerations that could determine outcome of pneumonia and antibiotic use. Initially, efficacy studies were aimed mainly at invasive pneumococcal pneumonia (S. pneumoniae usually isolated from blood or pleural fluid) or alveolar pneumonia (mostly identified with bacterial pneumonia when organisms were not included). However, using PCVs, we have learned within 2 decades from a variety of advanced studies and introduction to the National Immunization Program, that PCVs impact on prevention of respiratory infections much beyond what was expected (Using PCVs to learn about pneumococcal involvement in disease and vaccination impact is termed "PCV vaccine probe studies"). We currently can point out to the remarkable impact of PCVs on the following pneumonia-related endpoints: Reduction of invasive pneumococcal pneumonia, culture-negative alveolar pneumonia, all-cause pneumonia, all-cause lower respiratory infections, bacterial-viral mixed infections, pleuropneumonia and more. Moreover, PCVs reduce carriage and spread of vaccine type pneumococcal strains, resulting in protection not only among the vaccinated children but also from diseases in all ages (herd protection). Influenza vaccines may in turn reduce pneumonia through the reduction of acute influenza illness, often responsible for severe secondary bacterial infections. However, studies demonstrating this effect are lagging behind the studies with PCVs. [ABSTRACT FROM AUTHOR]

Owing to the dramatic rise in opiate-related deaths, the use of online prescription drug monitoring programs (PDMPs) concurrent with new laws restricting opiate administration has become commonplace across the U.S. Some oncologists, however, have expressed concerns that they may unintentionally limit treatment access to at-risk oncology populations. As opiates are frequently used in the acute management strategies for those undergoing radiotherapy for squamous cell carcinoma of the oropharynx, we sought to evaluate changes in short-term opiate prescription use following the implementation of mandated use of an online PDMP in an outpatient radiation oncology practice. Between July of 2017 and December of 2019, 64 patients with biopsy-confirmed oropharyngeal squamous cell carcinoma undergoing curative-intent radiotherapy were evaluated and divided into two cohorts: (1) 26 patients treated 1 year before and (2) 38 patients treated 1.5 years following mandated PDMP use and implementation of new opiate prescription laws. The primary endpoint was opiate prescriptions during therapy and within 3 months after therapy as well as patient-reported pain per the Defense and Veterans Pain Rating Scale. Opiate doses were treated as the response in a series of chi-square tests using a three-level format: no vs. 40 to 3000 vs. 3000+ MME. Cochran-Mantel-Haenszel chi-square analysis with the row mean score test statistic assessed any proportional shifts in dose rates between strata of selected prognostic factors. The median total opiate doses were 975 MME and 1025 MME in the pre- and postintervention groups with no significant differences in MMEs prescribed (p=0.8441). There was also no difference in patient-reported uncontrolled pain (p=0.38) between the treatment cohorts. Univariate analysis showed tonsillar/soft-palate subsite (p<0.01) and alcohol use (p=0.04) were associated with higher rates of prescribed opioids. While 75% of patients (n=48) received opiates during their acute care, 78% (n=50) were off all prescription narcotics by 3 months or sooner following treatment. Although potential concerns that mandated PDMP use would affect opiate utilization, there was no associated change in total opiate use by MME for the management of acute pain during radiotherapy for patients with oropharyngeal squamous cell carcinoma nor differences in patient-reported uncontrolled pain. Furthermore, despite high utilization of opiates during radiotherapy, few patients continued use past 3 months after treatment. [ABSTRACT FROM AUTHOR]