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Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in survivors of childhood cancer compared with reference data using a standardized thermal and mechanical quantitative sensory testing (QST) protocol. The association between demographic, clinical (eg, leukemia vs other cancers and treatment exposures), and psychosocial (eg, anxiety and pain catastrophizing) variables and sensitivity to pain and sensory stimuli were also evaluated. Participants were 56 survivors of various types of childhood cancer (52% male, Mage = 13.5 years, SD = 3.2, range = 8-17 years). On average, children were 7 years (SD = 4.1, range = 1.2-16.5) post treatment. Almost all participants (86%) had at least 1 abnormal QST parameter compared with age- and sex-matched reference data; however, few participants self-reported the presence of sensory abnormalities. Generally, participants exhibited reduced sensitivity across the QST parameters examined (Ps < 0.05, ds = 0.40-3.45). A significant minority (45%) also exhibited pain sensitization (P

Objective Somatic symptoms (e.g., pain, fatigue) are common after childhood cancer and are associated with greater fear of cancer recurrence and poorer health-related quality of life (HRQoL). Qualitative studies indicate that survivors of childhood cancer (SCCs) worry about somatic symptoms as indicating cancer recurrence, which could in part explain associations between symptoms and poorer psychosocial outcomes. However, the prevalence, characteristics, and impact of symptom worry has not been quantitatively studied. Methods SCCs (N = 111; 52% female; Mage at study = 17.67 years, range = 8 - 25 years; Mage at diagnosis = 6.70 years) across a variety of diagnoses were recruited from a pediatric cancer center in Canada and completed self-report measures of symptom worry, symptom frequency, general anxiety, fear of cancer recurrence, and HRQoL. Results A majority (62%) of SCCs worried about at least one symptom as a sign of recurrence. Pain was the most worrisome symptom, but SCCs also reported worrying about symptoms that are rarely associated with cancer recurrence such as hunger, dizziness, and feeling cold. Symptom worry was more strongly associated with fear of cancer recurrence than the mere frequency of those symptoms, and this relationship held while controlling for treatment factors and general anxiety. Symptom worry and frequency each explained unique variance in HRQoL. Conclusions Worry about somatic symptoms as a sign of cancer recurrence is common and may be impactful after childhood cancer. Excessive worry about somatic symptoms could be an important target to reduce fear of recurrence and increase HRQoL in SCCs. This article is protected by copyright. All rights reserved.

Uncertainty affects all phases of the product life cycle of technical systems, from design and production to their usage, even beyond the phase boundaries. Its identification, analysis and representation are discussed in the previous chapter. Based on the gained knowledge, our specific approach on mastering uncertainty can be applied. These approaches follow common strategies that are described in the subsequent chapter, but require individual methods and technologies. In this chapter, first legal and technical aspects for mastering uncertainty are discussed. Then, techniques for product design of technical systems under uncertainty are presented. The propagation of uncertainty is analysed for particular examples of process chains. Finally, semi-active and active technical systems and their relation to uncertainty are discussed.

The resilience paradigm constitutes that systems can overcome arbitrary system failures and recover quickly. This paradigm has already been applied successfully in multiple disciplines outside the engineering domain. For the development and design of engineering systems the realization of this resilience concept is more challenging and often leads to confusion, because technical systems are characterized by a lower intrinsic complexity compared to, e.g., socio-technical systems. The transfer of the resilience paradigm to technical systems though also offers high potential for the engineering domain. We present results from four-year research on transferring the resilience paradigm to the engineering domain based on mechanical engineering systems and summarize relevant design approaches to quantify the potentials of this paradigm. Furthermore, we present important challenges we faced while transferring this paradigm and present the lessons learned from this interdisciplinary research.

Sensing machine elements offer the potential to upgrade conventional machine elements by extending their primary function to be able to measure a quantity of interest at its point of origin in a technical system, the so-called in situ measurement. To ensure the functionality of these next generation machine elements, special attention must be paid to uncertainty in terms of modelling to be able to correctly evaluate the provided signal and obtain reliable information. Consequently, this contribution describes an approach to classify uncertainty in sensing technology, especially in SMEs, based on the amount of available information, which can be used as a point of departure to reduce the impact of occurring uncertainty to improve the robustness of the obtained signal. Starting from the understanding of uncertainty and the corresponding classification scheme as well as its linkage to robust design from the Collaborative Research Centre 805, a quantitative model is presented to determine the impact of uncertainty on a measuring signal. The applicability of the proposed approach is demonstrated using the example of a sensing timing belt by taking into account the uncertainty from the SME itself and also from the surrounding technical system.

Additive manufacturing enables the production of defined cellular and lattice structures. These additively manufactured meso structures offer various potentials like lightweight design or defined inner properties. To reduce the design effort a methodological approach is derived to enable fit for purpose design of components with meso structures using analytical calculation rules. The analogy to the analytical calculation of solid components emphasises the relevant parameters for the design as well as their influence on the properties of meso structures. Furthermore, based on the streamlined preliminary design, indications for the selection of suitable elementary cells regarding arising, even inhomogeneous, stresses are provided. The design method is exemplary applied to a cantilever beam.

The COVID-19 pandemic poses an unprecedented health crisis in all socio-economic regions across the globe. While the pandemic has had a profound impact on access to and delivery of health care by all services, it has been particularly disruptive for the care of patients with life-threatening noncommunicable diseases (NCDs) such as the treatment of children and young people with cancer. The reduction in child mortality from preventable causes over the last 50 years has seen childhood cancer emerge as a major unmet health care need. Whilst survival rates of 85% have been achieved in high income countries, this has not yet been translated into similar outcomes for children with cancer in resource-limited settings where survival averages 30%. Launched in 2018, by the World Health Organization (WHO), the Global Initiative for Childhood Cancer (GICC) is a pivotal effort by the international community to achieve at least 60% survival for children with cancer by 2030. The WHO GICC is already making an impact in many countries but the disruption of cancer care during the COVID-19 pandemic threatens to set back this global effort to improve the outcome for children with cancer, wherever they may live. As representatives of the global community committed to fostering the goals of the GICC, we applaud the WHO response to the COVID-19 pandemic, in particular we support the WHO's call to ensure the needs of patients with life threatening NCDs including cancer are not compromised during the pandemic. Here, as collaborative partners in the GICC, we highlight specific areas of focus that need to be addressed to ensure the immediate care of children and adolescents with cancer is not disrupted during the pandemic; and measures to sustain the development of cancer care so the long-term goals of the GICC are not lost during this global health crisis. Fil: Pritchard Jones, Kathy. University College London; Estados Unidos Fil: de Abib, Simone C.V.. International Society Of Paediatric Surgical Oncology; Surinam. Universidade Federal de Sao Paulo; Brasil Fil: Esiashvili, Natia. University of Emory; Estados Unidos Fil: Kaspers, Gertjan J.L.. Princess Máxima Center for Pediatric Oncology; Países Bajos Fil: Rosser, Jon. No especifíca; Fil: van Doorninck, John A.. Rocky Mountain Hospital for Children; Estados Unidos Fil: Braganca, João M.L.. No especifíca; Fil: Hoffman, Ruth I.. No especifíca; Fil: Rodriguez Galindo, Carlos. St Jude Children’s Research Hospital; Estados Unidos Fil: Adams, Cary. Union for International Cancer Control; Suiza Fil: Connor, Stephen R.. Worldwide Hospice Palliative Care Alliance; Estados Unidos Fil: Abdelhafeez, Abdelhafeez H.. International Society of Paediatric Surgical Oncology; Suiza. St. Jude Children’s Research Hospital; Estados Unidos Fil: Bouffet, Eric. University Of Toronto. Hospital For Sick Children; Canadá. International Society of Paediatric Surgical Oncology; Suiza Fil: Howard, Scott C.. International Society of Paediatric Surgical Oncology; Suiza. University of Tennessee; Estados Unidos Fil: Challinor, Julia M.. International Society of Paediatric Surgical Oncology; Suiza. University of California; Estados Unidos Fil: Hessissen, Laila. Children Hospital of Rabat; Marruecos. International Society of Paediatric Surgical Oncology; Suiza Fil: Dalvi, Rashmi B.. Bombay Hospital Institute of Medical Sciences; India. International Society of Paediatric Surgical Oncology; Suiza Fil: Kearns, Pamela. International Society of Paediatric Surgical Oncology; Suiza Fil: Chantada, Guillermo Luis. International Society of Paediatric Surgical Oncology; Suiza. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Frazier, Lindsay A.. International Society of Paediatric Surgical Oncology; Suiza. Dana-Farber Cancer Institute; Estados Unidos Fil: Sullivan, Michael J.. University of Melbourne; Australia. International Society of Paediatric Surgical Oncology; Suiza Fil: Schulte, Fiona S.M.. University of Calgary; Canadá. International Society of Paediatric Surgical Oncology; Suiza Fil: Morrissey, Lisa K.. Boston Children’s Hospital; Estados Unidos. International Society of Paediatric Surgical Oncology; Suiza Fil: Kozhaeva, Olga. European Society for Paediatric Oncology; Bélgica Fil: Luna Fineman, Sandra. Children’s Hospital Colorado; Estados Unidos. International Society of Paediatric Oncology; Suiza Fil: Khan, Muhammad S.. Tawam Hospital; Emiratos Arabes Unidos

During the development of load-carrying systems uncertainty caused by nescience can be handled applying resilience design. With this systematic approach, in addition to robust design, resilient system properties can be achieved. The resilience design methodology comprises new and extended models and methods. The central aspect of resilient properties is an adaptivity of the system. The procedure for resilience design starts with choosing a ‘general coping strategy’ appropriate for the design task. Based on this, a more detailed ‘system coping strategy’ is developed. This concrete strategy is based on the resilience functions responding, monitoring, anticipating and learning. The coping strategies always contain the function ‘responding’ because it represents the actual adaption of the system. The central, most abstract synthesis model for developing robust and resilient systems is the functional structure model. In this model the system functions and their interconnection by signals, material and energy flows are depicted. However, the realisation of resilience properties requires additional signals and flows. Hitherto, the functional structure for robust systems is static, whereas adaptivity requires flexible control of functions and flows. Therefore, an extension of the functional structure model is proposed to be able to depict the resilient system coping strategy and adaptivity. Within the resilient system the coping strategy is depicted by adaption functions based on the four resilience functions. Via an introduced interface and an enabler-structure the adaption functions are connected to the robust functional structure. The application of the proposed extension is illustrated by the example of a by-wire car brake system.

Additive manufacturing (AM) offers a variety of potentials, especially the fabrication of lattice and cellular structures. The properties of lattices and cells can be influenced on purpose by designing their defined structure. To utilise the potentials in applications, it is important to identify them and point out possible applications with successful examples, which allow transferring approaches for the integration of lattice structures in components to new applications. Therefore, this contribution provides a collection of potentials of additively manufactured lattice structures from the state of research in a systematic review and examines their transferability to different applications.

This chapter describes three general strategies to master uncertainty in technical systems: robustness, flexibility and resilience. It builds on the previous chapters about methods to analyse and identify uncertainty and may rely on the availability of technologies for particular systems, such as active components. Robustness aims for the design of technical systems that are insensitive to anticipated uncertainties. Flexibility increases the ability of a system to work under different situations. Resilience extends this characteristic by requiring a given minimal functional performance, even after disturbances or failure of system components, and it may incorporate recovery. The three strategies are described and discussed in turn. Moreover, they are demonstrated on specific technical systems.

Diagnostic uncertainty is common among youth with chronic pain and their parents and is linked to worse youth pain, pain catastrophizing, and quality of life., Introduction: Diagnostic uncertainty (DU), which is the perception that a label or explanation for a patient's health problem is missing or inaccurate, has been linked to distress, anxiety, and difficulty coping among adults with pain. This study examined the prevalence of DU among youth with chronic pain and their parents and the relation of parent and youth DU with youth pain, pain-related constructs, and health-related quality of life (HRQoL). Methods: Participants included 174 youth with chronic pain (Mage = 14.28 years; 73% female) and one of their parents (91% mothers) recruited from a tertiary-level pediatric chronic pain program in Canada. Youth and parent DU was assessed using a brief measure of 3 empirically derived yes/no questions regarding whether the youth and parent had received a clear diagnosis/explanation for their/their child's pain and whether they believed there was something else happening with their/their child's pain that doctors had not yet found. Youth reported on their pain intensity, pain interference, pain catastrophizing, fear of pain, and HRQoL. Results: Thirty-one percent of youth and 28% of parents experienced DU. Seventy percent of parents and youth were in agreement regarding their experience of DU. Youth DU was linked to higher youth catastrophic thinking about their pain. Parent DU was linked to greater youth pain interference and intensity and lower youth HRQoL. Conclusion: Diagnostic uncertainty is experienced by nearly a third of youth with chronic pain and their parents and is linked to worse youth pain, pain catastrophizing, and HRQoL.

Survivors of childhood cancer are at risk of experiencing fatigue, pain, lower levels of physical activity, increased engagement in risky health behavior, and poor social adjustment, after finishing treatment. Risks are more pronounced for survivors of specific diagnoses or receiving specific treatment protocols. Interventions to address these outcomes are in their infancy. Future research should focus on exploring the antecedents and consequences of these outcomes. In the meantime, researchers and cancer centers should attempt to provide high-quality and accessible health information to survivors through various media outlets to encourage healthy behaviors.

Many long-term survivors of childhood cancer (LTSCC), individuals at least 5 years post-diagnosis or 2 years post-treatment, experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCC. The current study aimed to (1a) describe rates and multiple dimensions of pain; (1b) identify patterns of chronic pain; and (2) test correlates of chronic pain in LTSCC. Survivors (n = 140; 48.6% male, M

Childhood, adolescent, and young adult (CAYA) cancer survivors may be at risk for a severe course of COVID‐19. Little is known about the clinical course of COVID‐19 in CAYA cancer survivors, or if additional preventive measures are warranted. We established a working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) to summarize existing evidence and worldwide recommendations regarding evidence about factors/conditions associated with risk for a severe course of COVID‐19 in CAYA cancer survivors, and to develop a consensus statement to provide guidance for healthcare practitioners and CAYA cancer survivors regarding COVID‐19.

The unique psychosocial needs of parents and caregivers of young children with cancer are poorly understood. The aims of the present study were to examine health-related quality of life (hrqol), stress, and psychological distress in parents of young children (0&ndash, 4 years) diagnosed with cancer, and the associations between parent psychosocial functioning and child treatment characteristics. Parents (n = 35) with a child (n = 19 male, 54.3%) 0&ndash, 48 months of age (median: 31.06 months) on active cancer therapy were recruited. Parents completed questionnaires related to demographics, parent hrqol, parenting stress, posttraumatic stress symptoms, and parent psychological distress. Parents reported clinically elevated parenting stress (5.9%), posttraumatic stress symptoms (18.2%), and psychological distress (21.9%). Compared with population norms, parents reported lower hrqol in the vitality (t = 5.37, p < 0.001), mental health (t = 4.02, p < 0.001), role limitation&ndash, emotional (t = 3.52, p < 0.001), and general health perceptions (t = 2.25, p = 0.025) domains. Social functioning (&beta, = 0.33, p = 0.041) predicted general health perceptions, vitality (&beta, = 0.30, p = 0.134) and parent mental health (&beta, = 0.24, p = 0.285) did not [F(3,29) = 12.64, p < 0.001, R2 = 0.57]. A subset of parents of young children on active cancer treatment experience clinically elevated psychosocial symptoms. Having poor social connections put parents at risk of perceiving their health more poorly in general. Supports that focus on preventing the emergence of clinically significant distress should focus on parents of young children with cancer who are most at risk of poor outcomes.

Pediatric brain tumor survivors (PBTSs) may experience impairment in executive functions and social competence, but their interrelation is not well understood. This study aimed to address the specificity of this relationship. PBTSs (

The objective of this study was to assess resilience in parents of youth with chronic pain, as well as to examine the relationships between parental resilience and distress, and child pain. There is evidence that parents can play a critical role in how their children’s pain problems develop, are experienced, and are maintained, yet no study to date has quantitatively evaluated parental resilience. Participants were 135 parent–child dyads referred to a tertiary-level chronic pain program. Parents completed measures of post-traumatic growth (PTG), post-traumatic stress symptoms, anxiety, and depression. Youth (M age = 13.1) completed measures assessing pain intensity and interference. The most PTG was observed at moderate level of PTSS, suggesting that some stress was necessary to foster resilience. Parental PTG was positively associated with parental internalizing symptoms and child pain outcomes, and moderated the relationship between parental depressive symptoms and child pain intensity. Resilien...

BACKGROUND The purpose of this study was to examine the prevalence and predictors of social difficulties in adolescent survivors of central nervous system (CNS) tumors. METHODS Six hundred sixty-five survivors of CNS tumors (53.8% male and 51.7% treated with cranial radiation therapy [CRT]), who had a current median age of 15.0 years (range, 2.0-17.0 years) and were a median of 12.1 years (range, 8.0-17.7 years) from their diagnosis, were compared with 1376 survivors of solid tumors (50.4% male), who had a median age of 15.0 years (range, 12.0-17.0 years) and were a median of 13.2 years (range, 8.3-17.9 years) from their diagnosis, and 726 siblings (52.2% male), who had a median age of 15.0 years (range, 12.0-17.0 years). Social adjustment was measured with parent-proxy responses to the Behavior Problems Index. Latent profile analysis defined social classes. Multinomial logistic regression, adjusted for age, sex, and age at diagnosis, identified predictors of class membership. Path analyses tested mediating effects of physical limitations, sensory loss, and cognitive impairment on social outcomes. RESULTS Caregivers reported that survivors of CNS tumors were more likely to have 0 friends (15.3%) and to interact with friends less than once per week (41.0%) in comparison with survivors of solid tumors (2.9% and 13.6%, respectively) and siblings (2.3% and 8.7%, respectively). Latent profile analysis identified 3 social classes for survivors of CNS tumors: well-adjusted (53.4%), social deficits (16.2%), and poor peer relationships (30.4%). However, 2 classes were identified for survivors of solid tumors and siblings: well-adjusted (86.2% and 91.1%, respectively) and social deficits (13.8% and 8.9%, respectively). CRT predicted class membership for CNS survivors (odds ratio [OR] for poor peer relationships, 1.16/10 Gy; 95% confidence interval [CI], 1.08-1.25; OR for social deficits 1.14/10 Gy; 95% CI, 1.04-1.25; reference, well-adjusted). Cognitive impairment mediated the association between all social outcomes and CRT (P values < .001). CONCLUSION Almost 50% of survivors of CNS tumors experience social difficulties; the pattern is unique in comparison with solid tumor and sibling groups. Cognitive impairment is associated with increased risk, and this highlights the need for multitargeted interventions.

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

Objective The objective of this study was to (1) assess the effects of a group intervention called Siblings Coping Together on siblings' psychosocial adjustment compared with controls; (2) explore the potential moderating effect of siblings' gender; and (3) investigate whether the intervention was more effective for siblings with more depressive symptoms at baseline. Methods This was a repeated measure, parallel randomized controlled trial (RCT) with two groups. Seventy-five healthy siblings (7-16 years old, 41 males) participated. Both groups had 8 weekly 2-hr sessions. Intervention sessions had psychoeducational, social, and therapeutic problem-solving goals taught through games and crafts (n = 41); controls (n = 34) had games and crafts only. Self-reported symptoms of depression (Children's Depression Inventory, CDI) and self- and proxy-reported quality of life (QOL) (Pediatric Quality of Life Inventory, PedsQL) were obtained at baseline, postintervention, and 3 months later. Multivariable analyses with a mixed effects model were performed. Results No significant main group effect or group × time interactions were found for any of the scales assessed. Significant improvement over time was found for total CDI (p

Compared to the general pediatric population, pediatric cancer patients are at increased risk of experiencing depressive symptoms during and after their treatment. Clinically, there exist few resources to guide health care professionals in the care of children with cancer who report depressive symptomatology. Pediatric cancer patients experience unique inflammatory changes secondary to their disease and accompanying treatments. It has been reported that inflammatory changes in the context of illness are related to cytokine dysregulation which in turn may influence the expression of depressive symptoms. In this review of current literature, we summarize the existing knowledge, relevant models and studies in progress with respect to this concept.

Pain is common during childhood cancer treatment, can persist into survivorship, and is under-managed in young survivors of childhood cancer (SCCs). Pain may influence health-related quality of life in SCCs simply via its frequency, and/or by triggering worries about cancer recurrence. The purpose of this study was to explore proximal associations between pain frequency, pain-related worry, and health-related quality of life in SCCs. In this study, 111 SCCs (52% female, Mage: 17.67 years, range 8-25 years) were recruited from a Canadian Children's Hospital and completed self-report measures of pain frequency, pain-related worry, and health-related quality of life. Descriptive statistics, bivariate correlations, chi-square analyses and a hierarchical linear regression were performed. Pain was frequently experienced in SCCs (70% reported pain in previous month) and was commonly worried about as a sign of cancer recurrence (39% of sample endorsed some degree of worry). Those who endorsed worrying about pain were 95% more likely to endorse experiencing that symptom over the previous month, X2(1, N = 110) = 21.13, p

ABSTARCTSocial isolation and high levels of psychosocial stress are common among parents of children who are hospitalized for cancer treatment. Many hospital-based programs offer support groups for parents, however there is little published guidance or systematic evidence on their effectiveness. This study describes the development and program evaluation of a 16-week parent support group offered to parents (N = 10) of children hospitalized for pediatric cancer or bone-marrow transplant. A summary of the pilot evaluation is provided and successes, barriers, and areas for future improvement are discussed.

This prospective study describes disease/treatment, personal characteristics, and social/family contextual variables as risk and resilience factors that predict social competence in pediatric brain tumor survivors (PBTS). Ninety-one PBTS (51% male, mean age 11.21 years, off-treatment, attending a regular classroom >50% of the time) participated. PBTS and their primary caregivers (proxy) completed the Social Skills Rating System (SSRS) to assess social competence at baseline, 2, and 8 months follow-up. At baseline, medical information (e.g., tumor type and location, cranial irradiation therapy (CIT)), personal characteristics (e.g., child’s age and gender, intelligence, executive function, attention, and memory), and social/family factors (family income and ethnicity) were obtained. Using mixed model multivariable analyses with a longitudinal component, tumor type (medulloblastoma) (p

This qualitative study employed hermeneutic phenomenology and narrative inquiry to examine the topic of sexuality and adolescents with cancer from the perspectives of survivors who had experienced cancer as adolescents. This investigation examined the potentially sensitive, disquieting, and often taboo issue of sexuality in the interest of optimizing wellness in young people, and, ultimately, in the health of adults. Understanding the adolescent body as a sensitive, sexual, and developing self can enrich our understanding of adolescent cancer and promote best health care and practices, examining ways that we might mitigate the long-term effects of arrested or delayed development of sexual identity. In this article, we discuss phase 1 of the study, which used hermeneutics as the method of inquiry. Findings included a general experience of adolescents having a sense of “losing themselves” while at the same time finding themselves in a new light. Other findings include the connection between sexuality, self, and identity; the unique “tribe” of adolescents with cancer; the necessity for sexuality to take a backseat to cancer; the changing mirror images from self and others; sexuality and fertility; and, ultimately, that sexuality is a relational experience.

Research in the area of pediatric oncology has shown that although some children and youth diagnosed with this disease cope adaptively after their diagnosis, others continue to have long-term psychosocial difficulties. The potential mechanisms that may protect against the experience of psychopathology and poor quality of life within this population are not well known. The purpose of this pilot study was to utilize a new comprehensive measure of positive schemas to better understand the relationship between positive schemas, quality of life, and psychopathology, for children on active treatment for cancer.Participants were 22 patients, aged 8-18 years, being treated in a pediatric oncology clinic. Patients and parents completed measures of positive schemas, quality of life, and psychopathology.The mean age at time of initial diagnosis of the patient sample was 11.6 years. Child-reported positive schemas were significantly related to child-reported child quality of life (r = 0.46, p = 0.03).This is the first study to examine positive schemas within a pediatric oncology sample. Future research is needed to further explore facets of positive schemas that may be particularly relevant to child psychological functioning in a pediatric oncology population.

Background:Physical activity has emerged as a promising intervention to decrease the severity of cancer side effects. To date, only a few community-based exercise programs have been described in the literature. Of these, none have been designed to be sustainable and available as programs for pediatr

Unter Verwendung der additiven Fertigung lassen sich Bauteile mit komplexen Geometrien herstellen. Die hieraus resultierenden gestalterischen Freiheiten wie Hinterschneidungen, Hohlraume oder das Einbringen gezielter Porositat konnen zur Erweiterung des Losungsraums in der Produktentwicklung verwendet werden. Um die Erweiterung des Losungsraums systematisch zu unterstutzen, bietet sich die Theorie des erfinderischen Problemlosens TRIZ an. Diese stellt dem Entwickler Losungsprinzipien aus Patenten, aufbereitet zur Uberwindung von Widerspruchen in der Produktentwicklung, zur Verfugung.

Objectives Fear of cancer recurrence (FCR) has not been widely explored in survivors of childhood cancer. Yet, childhood survivors are at risk of experiencing late effects and may be especially vulnerable. The aims of the current study were to conduct a retrospective chart review to determine the prevalence and persistence of FCR among survivors of childhood cancer and to examine factors that may be related to FCR. Methods Survivors of childhood cancer (n = 228, mean attained age = 14.5 years [range = 4.7-21 years]; mean diagnosis age = 4.4 years [range = 0-16.5 years]; mean time off treatment = 8.7 years [range = 2.8-19.3 years]) seen in a Long-Term Survivor Clinic (LTSC) completed questionnaires at each clinic visit detailing their current health. FCR was measured with a single item. Data from questionnaires from 2011 to 2018 were analyzed retrospectively. Descriptive statistics and a random effects model were used to address study aims. Results FCR was reported in 43% (n = 98) of survivors at least once across all clinic visits. Among survivors reporting FCR at least once, 66% were diagnosed with cancer under the age of 5, and 64% were 13 years or older at their most recent follow-up. Twenty-one percent of survivors (n = 48/224) reported FCR during at least 50% of their visits. Survivors with a higher number of depressive symptoms were more likely to report FCR (OR = 1.66, P = .03). Conclusions FCR is prevalent among survivors of childhood cancer and is related to other health concerns. Research is needed to understand who is at risk and how to.

Pediatric brain tumor survivors (PBTSs) are at risk for impairments in social adjustment and psychological distress. This study investigated longitudinal associations between symptoms of social withdrawal and anxiety/depression in PBTS, as well as medical, demographic, and personal characteristics that may also influence reports of social withdrawal and anxiety/depression.About 91 PBTS (51% male, mean age 11.21 years, off-treatment) participated. At baseline and 8 months follow-up, primary caregivers of PBTS completed measures of social withdrawal, anxiety, and depression symptoms. Medical information (e.g. tumor type and location, cranial irradiation therapy) and child personal characteristics (e.g. child's age and gender, executive function, social skills) were obtained at baseline.Baseline reports of depression symptoms and social skills predicted social withdrawal 8 months later. Social withdrawal at baseline predicted greater combined anxiety and depression symptoms 8 months later. Depression alone predicted greater anxiety symptoms at follow-up. Anxiety symptoms and poor global executive functioning predicted greater depression symptoms at follow-up.The social adjustment and psychological distress of PBTSs are interrelated and can influence each other across time. These findings support the importance of multifaceted interventions targeting both psychological distress and social adjustment, in order to support the optimal psychosocial adjustment of PBTSs.

Objective The purpose of this systematic review was to describe the occurrence of sleep disruptions in pediatric cancer patients and to identify and discuss the factors related to the hospital sleep environment that may be associated with disturbed sleep. Methods A total of 108 articles were located in five databases (PubMed, PsychINFO, Medline, CancerLit, and Google Scholar), and seven met our inclusion criteria and formed the basis of this review. Results Participants ranged from 1 to 18 years (n = 147). Data from objective and subjective assessments of sleep showed that child sleep was disrupted in the hospital when compared to previously established age-related norms. Noise, light levels, and staff room interruptions were associated with decreased total sleep minutes and increased nighttime awakenings. Methodological limitations of the current research as well as potential directions for future research are discussed. Conclusions Investigations into the sources of increased sleep difficulties can be used to inform hospital procedures to create a more supportive sleep environment and more effective screening tools for patients who may be at greater risk for sleep difficulties. This may help to minimize the role that hospitalization plays in precipitating and perpetuating chronic sleep disturbances in pediatric cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

Objectives To examine the discrepancy between survivor–parent and sibling–parent reports of health-related quality of life (HRQL) and the level of agreement (i.e., correlation) between child reports (i.e., survivor and sibling) and parent-proxy reports of HRQL. Methods Fifty-one families participated. Pediatric cancer survivors (49% male; 6–18 years of age) and one sibling (47% male; 9–18 years of age) completed a measure of their HRQL. As well, one parent (14% male; 27–65 years of age) from each family completed a proxy report of their children's (i.e., survivor and sibling) HRQL. Consensus was determined through discrepancy and agreement scores, between parent-proxy and children's (i.e., survivors and siblings) self-reports of total HRQL, and physical, emotional, social, and school functioning subscales. Results Repeated-measures analysis of variance (ANOVA) revealed significant group differences for total HRQL (F = 6.79, P ≤ 0.01). Repeated-measure ANOVAs of subscale discrepancy scores revealed significant group differences for physical functioning scores (F = 6.39, P < 0.01). A significant interaction was also found for social functioning when age at diagnosis was considered as a covariate (F = 10.30, P < 0.01). Zero-order and intraclass correlation coefficients revealed different levels of agreement between parent and child reports. Specifically, there was poorer agreement between parent-proxy and sibling's self-reports, particularly on social and emotional subscales. Conclusions Discrepancy and agreement are both important indices to consider when examining consensus between parent-proxy and child self-reports. The findings from this study have important implications for future research and suggest that the impact of cancer on siblings should be further investigated.

Problem Compassion has been described as a central construct or essential feature of quality healthcare and is as important to patients' and families' overall healthcare experience as the health interventions and treatments they receive. However, there is little shared understanding of what constitutes compassion, how it is delivered within a pediatric setting, and pediatric patients' and families perspectives and preferences for receiving it. Eligibility criteria Studies that (1) described the nature of the existing literature on compassion in pediatric healthcare; (2) summarized key concepts in the existing evidence base that pertain to compassion in pediatric healthcare; and 3) identified factors that are associated with compassion in pediatric healthcare were eligible for inclusion in this review. Sample Twenty-nine papers were included in the review. Results Findings revealed several factors are associated with compassion in pediatric healthcare, including continuity of care, communication, and coordination of care. Most notably, identified studies treated compassion in a subsidiary fashion, and this review revealed no studies that provided a patient-informed evidence-based definition of compassion in the pediatric healthcare setting. Conclusion Future research is required to generate a comprehensive and accurate understanding of the terms ‘compassion’ and ‘compassionate care’ when used in the context of pediatric healthcare. Implications This research will inform the therapeutic processes and ultimately enable the development of strategies to improve the delivery of compassionate healthcare to pediatric patients.

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

The purpose of this study was to examine the prevalence and predictors of social difficulties in adolescent survivors of central nervous system (CNS) tumors.Six hundred sixty-five survivors of CNS tumors (53.8% male and 51.7% treated with cranial radiation therapy [CRT]), who had a current median age of 15.0 years (range, 2.0-17.0 years) and were a median of 12.1 years (range, 8.0-17.7 years) from their diagnosis, were compared with 1376 survivors of solid tumors (50.4% male), who had a median age of 15.0 years (range, 12.0-17.0 years) and were a median of 13.2 years (range, 8.3-17.9 years) from their diagnosis, and 726 siblings (52.2% male), who had a median age of 15.0 years (range, 12.0-17.0 years). Social adjustment was measured with parent-proxy responses to the Behavior Problems Index. Latent profile analysis defined social classes. Multinomial logistic regression, adjusted for age, sex, and age at diagnosis, identified predictors of class membership. Path analyses tested mediating effects of physical limitations, sensory loss, and cognitive impairment on social outcomes.Caregivers reported that survivors of CNS tumors were more likely to have 0 friends (15.3%) and to interact with friends less than once per week (41.0%) in comparison with survivors of solid tumors (2.9% and 13.6%, respectively) and siblings (2.3% and 8.7%, respectively). Latent profile analysis identified 3 social classes for survivors of CNS tumors: well-adjusted (53.4%), social deficits (16.2%), and poor peer relationships (30.4%). However, 2 classes were identified for survivors of solid tumors and siblings: well-adjusted (86.2% and 91.1%, respectively) and social deficits (13.8% and 8.9%, respectively). CRT predicted class membership for CNS survivors (odds ratio [OR] for poor peer relationships, 1.16/10 Gy; 95% confidence interval [CI], 1.08-1.25; OR for social deficits 1.14/10 Gy; 95% CI, 1.04-1.25; reference, well-adjusted). Cognitive impairment mediated the association between all social outcomes and CRT (P values.001).Almost 50% of survivors of CNS tumors experience social difficulties; the pattern is unique in comparison with solid tumor and sibling groups. Cognitive impairment is associated with increased risk, and this highlights the need for multitargeted interventions.

The aim of the study was to explore the relationship between repressive adaptive style and self-reports of social adjustment in survivors of pediatric cancer compared to their siblings. We hypothesized that there would be a greater proportion of repressors among survivors of pediatric cancer compared to siblings, and that repressive adaptive style would be significantly associated with more positive self-reports of social adjustment.We utilized a cross-sectional approach. Seventy-seven families participated. Survivors of pediatric cancer (n = 77, 48% male; 8-18 years of age) and one sibling (n = 50, 48% male; 8-18 years of age) completed measures assessing repressive adaptive style and social adjustment. As well, one parent from each family completed a socio-demographic questionnaire. Questionnaire packages were mailed to eligible families who agreed to participate, and were mailed back to investigators in a pre-addressed, pre-stamped envelope.Chi-square analyses revealed there was no significant difference in the proportion of repressors among survivors and siblings. Social adjustment scores were subjected to a two (group: survivor, sibling) by two (repressor, nonrepressor) ANCOVA with gender and age as covariates. There was a significant main effect of repressive adaptive style (F = 5.69, p.05, ηRepressive adaptive style explains some of the variance in survivors and siblings' self-reports of social adjustment. Future research should aim to better understand the role of the repressive adaptive style in survivors and siblings of children with cancer.

Background: Pediatric survivors of childhood cancer are at increased risk of poor quality of life and social-emotional outcomes following treatment. The relationship between parent psychological distress and child adjustment in pediatric cancer survivors has been well established. However, limited research has examined the factors that may buffer this association. The current study examined the associations between psychosocial family risk factors, parental psychological distress, and health-related quality of life (HRQL) in pediatric cancer survivors. Methods: Fifty-two pediatric cancer survivors (34 males, 18 females, mean age = 11.92) and their parents were recruited from a long-term cancer survivor clinic. Children and their parents who consented to participate completed the Pediatric Quality of Life Inventory 4.0. Parents completed a demographic information form, the Psychosocial Assessment Tool (PAT 2.0) and the Brief Symptom Inventory (BSI). The Intensity of Treatment Rating (itr-3) was evaluated by the research team. Results: Multiple regression analyses revealed that parental psychological distress negatively predicted parent-reported hrql, while treatment intensity, gender, and psychosocial risk negatively predicted parent and child-reported hrql. Psychosocial risk moderated the association between parent psychological distress and parent-reported child hrql (p = 0.03), whereby parents with high psychological distress but low levels of psychosocial risk reported their children to have higher HRQL. Conclusion: Low levels of family psychosocial risk buffer the impact of parent psychological distress on child HRQL in pediatric cancer survivors. The findings highlight the importance of identifying parents and families with at-risk psychological distress and psychosocial risk in order to provide targeted support interventions to mitigate the impact on HRQL.

This case study describes the use of patient-reported outcome (PRO) in conjunction with psychosocial treatment for an adolescent oncology patient presenting with comorbid mental health difficulties. A nine-session evidence-based cognitive-behavioral treatment was implemented and PROs were used to document progress. Results demonstrated an overall pattern of increase in health-related quality of life and decrease in mood and anxiety symptoms as treatment progressed, with increases occurring after disease recurrence. This case study demonstrates the importance and utility of PROs. Implications for psychosocial treatment of adolescent and young adult patients and directions for future research are discussed.

PURPOSE OF REVIEW The purpose of this article is to review the literature in the area of social competence in pediatric brain tumor survivors published in the last year. RECENT FINDINGS Research published over the past year examining the social competence of pediatric brain tumor survivors has seen the consistent application of a comprehensive conceptual framework that pertains specifically to children with brain disorders. Subsequent to the application of a comprehensive conceptual framework, more sophisticated research approaches have begun to advance our understanding of deficits among this population. Specifically, operationalization of social competence is evolving. SUMMARY Continued application of a conceptual framework and investigation into the components that comprise the framework will enhance the depth of our understanding of social competence deficits among this population. Research must continue to use innovative approaches to measuring social competence. Considerable gaps still exist with respect to identifying risk and resilience factors for social competence deficits.

OBJECTIVE This study assessed the effects of a group intervention-Siblings Coping Together (SibCT)-on siblings' and caregivers' anxiety symptoms compared to controls, and potential moderators. METHODS Seventy healthy siblings of children on or off treatment (7-16 y old, 41 males) participated in a randomized controlled trial (RCT) with 2 arms/groups: SibCT (n = 41) and an attention control (CG) (n = 34). Both groups had eight 2-hour weekly sessions. EG followed SibCT's educational, social, and problem-solving activities. CG had planned games and crafts. Siblings and caregivers self-reported on anxiety symptoms at baseline, intervention end, and 3 months later. Multivariable mixed model analyses examined the intervention effect over time, and potential moderators (gender, on/off ill child's treatment). RESULTS No main effects of group or time were found in sibling scores. A group × gender interaction (P

Introduction Methodology Results and discussion Conclusions Competing interests Funding sources References OPEN ACCESS PEER REVIEWED Accelerated thermal profiling of gas turbine components using luminescent thermal history paints Silvia Araguás Rodríguez 1, 2, Tomáš Jelínek 3, Jan Michálek 3, Álvaro Yáñez González 1, Fiona Schulte 1, Christopher Pilgrim 1, Jorg Feist 1 and Stephen J. Skinner 4 1 Sensor Coating Systems, Imperial College London, London, SW7 2AZ, UK 2 Londoneast-UK, The Cube, Yewtree Avenue, Dagenham East, RM10 7FN, UK 3 VZLU – Czech Aerospace Research Centre, Czech Republic 4 Department of Materials, Imperial College London, Exhibition Road, London, SW7 2AZ, UK ARTICLE TYPE: ORIGINAL ARTICLE PUBLISHED: 25 APRIL 2018 DOI: https://doi.org/10.22261/JGPPS.S3KTGK VOLUME: 2 Abstract Environmental requirements to reduce CO2 emissions and the drive towards higher efficiencies have resulted in increased operating temperatures in gas turbines. Subsequently, Original Equipment Manufacturer (OEMs) require improved component design and material selection to withstand the harsher conditions. This demands rapid evaluation of new components and their surface temperature to accelerate their market entry. Accurate temperature information proves key in the design of more efficient, longer-lasting machinery and in monitoring thermal damage. A number of traditional temperature measurement techniques are available, but can incur a number of limitations. Online temperature measurements, such as pyrometry or phosphor thermography, often require optical access to the component during operation and are therefore not suitable for inaccessible components. Other options including thermocouples can only provide point measurements and cannot deliver profiles across the surface. Offline techniques store temperature information that can be measured and analysed following operation. Several of these, however, are of destructive nature, can affect local thermal gradients and only provide point measurements. This article discusses an innovative offline measurement technique: luminescent Thermal History Paints (THPs). THPs are comprised of ceramic pigments in a binder matrix that can be applied to any hot component as a thin coating. These pigments are doped with optically active ions, which will phosphoresce when excited with a light source. The coating material experiences irreversible structural changes depending on the temperature it is exposed to. Changes in the material structure are reflected in its phosphorescent properties, which are measured with standard optical instrumentation at any surface location. Since the changes are permanent, the temperature information is stored in the coating and can be extracted after operation. Following calibration, it is therefore possible to relate phosphorescent behaviour to the past maximum temperature experienced at each location. This is done with Sensor Coating Systems Ltd. (SCS)’s portable instrumentation, which can provide rapid, automated and objective measurements across a component surface. Unlike the more traditional thermal paints, THPs are non-toxic, and provide a continuous measurement capability across the range 150°C–900°C with significantly improved durability. This article describes the underlying principles behind this novel technology and the advantages it provides over existing state-of-the-art methods. The benefits will be demonstrated through measurements on nozzle guide vanes (NGVs), with the view to compare and validate them against thermocouple measurements. The results show that the THP extends the limited information from thermocouples to provide a more complete view of the thermal processes on the component.

Background Increasing rates of survival present a new set of psychosocial and physical challenges for children undergoing treatment for cancer. Physical activity (PA) has been shown to be a safe and effective strategy to mitigate the significant burden of cancer and its treatments, with yoga increasingly gaining recognition as a gentle alternative. The purpose of this study was to determine the feasibility and benefits of a 12-week community-based yoga intervention on health-related quality of life (HRQL), select physical fitness outcomes and PA levels (PAL). Procedure Eight pediatric cancer out-patients (4 male; 4 female; Mage = 11.88, SD = 4.26) participated in the 12-week intervention consisting of supervised yoga sessions 2 times/week. Participants (patients and parent proxies) completed measures assessing HRQL, physical fitness and PAL at baseline and post-intervention. Results Rates of recruitment, retention, attendance and adverse events indicated the program was feasible. Wilcoxon Signed Rank tests indicated significant improvements for patient (P = 0.02) and parent reported HRQL (P = 0.03), functional mobility (P = 0.01), hamstring flexibility (left, P = 0.01 and right P = 0.02), and total PAL (P = 0.02) pre to post intervention. Conclusion This 12-week community-based yoga intervention was feasible and provides preliminary evidence for the benefits of yoga on HRQL, physical fitness and PAL in pediatric cancer out-patients. In a population where sedentary behavior and the associated co-morbidities are a growing concern, these results promote the continued exploration of yoga programming. Pediatr Blood Cancer 2014; 61:1828–1834. © 2014 Wiley Periodicals, Inc.

Purpose The aim of this study was to explore the ability of a group social skills intervention program for childhood brain tumor survivors to effect two steps of the social information processing model: social problem solving and social performance. Methods Participants were 15 survivors (eight men and seven women) aged 7–15 years. The intervention consisted of eight 2-h weekly sessions focused on social skills including friendship making. Social problem solving, using hypothetical scenarios, was assessed during sessions 1 and 8. Social performance was observed during intervention sessions 1, 4, and 8. Results Compared with session 1, significant increases were found in social performance: frequency of maintaining eye contact and social conversations with peers over the course of the intervention. No significant changes in social problem solving were noted. Conclusions This pilot study is the first to report improvements related to group social skills intervention at the level of observed social performance over the course of intervention. The lack of change in social problem solving suggests that survivors may possess the social knowledge required for social situations but have difficulty enacting social behaviors. Copyright © 2013 John Wiley & Sons, Ltd.

Pediatric central nervous system (CNS) tumor survivors are at high risk for numerous late effects including decreased health-related quality of life (HRQOL). Our objective was to summarize studies describing HRQOL in pediatric CNS tumor survivors and compare HRQOL outcomes in studies that included a comparison group.EMBASE, MEDLINE, and PsychINFO were used to identify relevant articles published until August, 2016. Eligible studies reported outcomes for pediatric CNS tumor survivors diagnosed before age 21, at least 5 years from diagnosis and/or 2 years off therapy and used a standardized measure of HRQOL. All data were abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0.Of 1,912 unique articles identified, 74 were included in this review. Papers described 29 different HRQOL tools. Meta-analyses compared pediatric CNS tumor survivors to healthy comparisons and other pediatric cancer survivors separately. HRQOL was significantly lower for CNS (n = 797) than healthy comparisons (n = 1,397) (mean difference = -0.54, 95% confidence interval [CI] = -0.72 to -0.35, P0.001, IPediatric CNS tumor survivors experience worse HRQOL than healthy comparisons and non-CNS cancer survivors. Future HRQOL work should be longitudinal, and/or multisite studies that examine HRQOL by diagnosis and treatment modalities.

Background To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS). Methods We conducted a randomized control trial in which PBTS (8-16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2-hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self-reported, proxy-reported (caregiver), and teacher-reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow-up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis. Results Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow-up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect. Conclusions Participating in group social skills intervention can improve self-reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence.

To review the literature investigating the social competence outcomes of child and adolescent survivors of brain tumors.Twenty articles published between 2000 and 2009 were accessed using PsycInfo and PubMed and reviewed for their findings related to three hypothesized levels of social competence (i.e., social adjustment, social performance, social skills).Current evidence indicates that childhood brain tumor survivors experience decreased social adjustment following treatment. Inconsistencies among studies continue to be an obstacle for advancing the field. The operationalization of social competence requires greater attention to facilitate comparability between studies (e.g., social adjustment, social performance, social skills). The effects of child, familial, and treatment factors and their relationships are still not well understood. There is a lack of theory driven research.Many childhood brain tumor survivors experience deficits in social competence at the level of social adjustment. These deficits worsen with time. Little is known about more rudimentary levels of social competence such as social skills or social performance. This information is needed to guide the development of social intervention programs.