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Atmospheric particulate matter with an aerodynamic diameter < 2.5 µm (PM2.5) is associated with adverse effects on the climate system, the human health, vegetation and the ecosystems. The World Health Organization (WHO) lowered the guideline limit for PM2.5 in autumn 2021 and this is exceeded in many regions including rural and remote areas in mainland Europe. Measurements of the chemical composition of PM2.5 is essential to assess the sources which contribute to PM2.5 mass concentrations and to further design meaningful policies to tackle sources at their origin.Here we report 6 years (2014- 2020) of PM2.5 mass and chemical speciation at five remote sites across France belonging to the EMEP network (European Monitoring and Evaluation Programme). The seasonal and spatial variability of aerosol composition and source contributions based on the proximity of sources and long-range transport are discussed. Trends in PM2.5 and the main components at the five locations were evaluated by means of random-forest modelling coupled with a de-weathering algorithm. This approach is advantageous as resulting trends are driven by changes in emission or atmospheric processes and not by changes in weather conditions and/or long-range transport patterns. Random-forest regression modelling was built using meteorological data, backtrajectory information and temporal variables at each site and quantified the most important factors that explain PM2.5 concentrations at remote rural areas in France.All sites observed statistically significant downward trends in PM2.5 at a rate of -4 to -9% year-1 for the period 2014 – 2020. The decrease in PM2.5 concentrations was mostly explained by changes in the secondary inorganic species (sulphate, nitrate and ammonium) and not by changes in primary PM2.5 emissions. The variability in trends in PM2.5 and components observed across the sites is discussed with their implications for policy makers.

Improving air quality in urban areas is essential since 97% of European cities exceed the annual PM2.5 value of the WHO guidelines (10 μg/m3). Therefore, in order to mitigate adverse health outcomes of air pollutants, it is extremely important to understand the long-term chemical compositions and organic aerosol (OA) sources in the largest European city, London. North Kensington (50.52° N, 0.21° W) is an urban background monitoring station located in a residential area of west London. A Quadrupole Aerosol Chemical Speciation Monitors, Q-ACSM (Aerodyne Research Inc., MA, USA), was deployed to continuously monitor submicron non-refractory particulate matter (NR-PM1) from March 2013 until May 2018. The knowledge of OA sources is crucial not only because OA is the main constituent of particulate matter (PM), but also because different sources of OA are known to have different toxicities. Positive matrix factorization (PMF) on the OA matrix of ACSM data remains the most common technique to conduct source apportionment (SA) analyses. By following the standardized protocol developed by Chen et al. (2022), we have retrieved high-quality SA results in these 5 years using the most advanced SA techniques (i.e., rolling PMF (Parworth et al., 2015), the ME-2 solver (Paatero, 1999), and bootstrap resampling (Erfon, 1979)). Additionally, back trajectory analysis has helped identify the geographical origin of OA sources. A variety of auxiliary measurements have been conducted on the same site, which has been used to validate our SA results. Overall, this study provided a rare opportunity to investigate the long-term trends of PM composition and OA sources in a European megacity and provided valuable information for policymakers to understand the effects of mitigation strategies and design more efficient policies.

Ammonia (NH3) is the major alkaline gas in the atmosphere and the third most abundant N-containing species, after N2 and N2O. It plays an important role in N deposition processes, responsible of several damages on ecosystems, and it is also a precursor of fine particulate matter, known to cause numerous impacts on human health. Despite this, not many countries have implemented long-term monitoring of NH3 in their air quality programs due to the lack of consensus on limit values for ambient levels and a reference method of measuring this gas. In the climate change context, governments and health organizations are increasingly concerned about NH3 and its effects. As a proof, the revision of the EU air quality directives proposes the inclusion of NH3 as a mandatory pollutant for several urban and rural supersites for all member states.Currently, there are only 12 long term programs worldwide dedicated specifically to measure NH3 or including gas-phase measurements of NH3. The longest NH3 time series come from UK and Africa, where measurements start in mid-1990. The rest of locations have started after 2000 and they have lower temporal coverage, between 5 and 22 years. The objectives pursued by these networks are to follow long term spatio-temporal trends, assess the N deposition on sensitive ecosystems, validate emission and/or chemistry transport models and help to understand the effectiveness of air pollution control and mitigation policies. Most of these networks operate using a combination of low-cost samplers with a high spatial density with few collocated sites with high time resolution instrumentation to help calibrate passive samplers and to better monitor the fine temporal variability of NH3. This combined approach has proven to be successful for most of the proposed objectives.However, there are several differences that may difficult harmonizing the information at both the technical and scientific level. At the technical level these include type and number of passive samplers per site, calibration protocol, data control and quality analysis, exposure duration and type of high time resolution sampling method. On the scientific level, increased difficulty understanding the operative parameters and scientific results may come from language barriers (non-English reports), availability of the data (whether it is public or not), and gaps on the knowledge of NH3 levels on a spatial scale due to differences in the implementation of monitoring strategies within the same country.This work aims to review synthetically the world current long-term NH3 networks and provide some insight and recommendations for other countries and supranational programs aiming to establish long term monitoring networks of NH3, based on cost-effective, technical, and operational criteria.

Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger and their families. Moreover, the guideline panel formulated considerations of the ethical implications that are associated with these procedures. Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the evidence and recommendations. In this clinical practice guideline, existing evidence and international expertise are combined to develop transparent recommendations that are easy to use to facilitate ongoing communication between health-care providers and patients with childhood, adolescent, and young adult cancer who might be at high risk for fertility impairment and their families.

Many rail services around the world continue to use diesel as the primary fuel source and enclosed railway stations have been identified as a possible hotspot for exposure to harmful diesel exhaust exposures. Little is known about the occupational exposure to air pollution for railway station workers due to their mobility around the station and variations in station design. A detailed understanding of the concentration of black carbon (BC), a diesel exhaust tracer, inside railway stations and the factors driving occupational exposures is required to minimize occupational exposure. Real-time personal exposure to BC was measured during 60 work-shifts encompassing different roles at three large enclosed railway stations of different design in London, Birmingham and Edinburgh (UK). Sampling was conducted by the train station workers over a period of 27 days between January 2017 to October 2018. Worker shift-mean BC exposures ranged 0.6–20.8 μg m−3 but 1-min peak exposures reached 773 μg m−3, with train dispatchers experiencing the highest BC exposures. Station design, job role, and frequency of diesel trains were the main drivers of occupational BC exposure. Elevated exposures for some station workers indicate that mitigation measures to reduce their exposure should be implemented to lower the risk of occupational health impacts. These could include improving ventilation and reducing engine emissions. Funding for open access charge: CRUE-Universitat Jaume I

Pontardawe in South Wales, United Kingdom (UK), consistently has the highest concentrations of nickel (Ni) in PM10 in the UK and repeatedly breaches the 20 ng m−3 annual mean EU target value. Several local industries use Ni in their processes. To assist policy makers and regulators in quantifying the relative Ni contributions of these industries and developing appropriate emission reduction approaches, the hourly concentrations of 23 elements were measured using X-ray fluorescence alongside meteorological variables and black carbon during a four-week campaign in November–December 2015. Concentrations of Ni ranged between 0 and 2480 ng m−3 as hourly means. Positive Matrix Factorization (PMF) was used to identify sources contributing to measured elements. Cluster analysis of bivariate polar plots of those factors containing Ni in their profile was further used to quantify the industrial processes contributing to ambient PM10 concentrations. Two sources were identified to contribute to Ni concentrations, stainless-steel (which contributed to 10% of the Ni burden) and the Ni refinery (contributing 90%). From the stainless-steel process, melting activities were responsible for 66% of the stainless-steel factor contribution.

Concentrations of the air pollutants (NO2 and particulate matter) were measured for several months and at multiple locations inside and outside two enclosed railway stations in the United Kingdom – Edinburgh Waverly (EDB) and London King’s Cross (KGX) – which, respectively, had at the time 59% and 18% of their train services powered by diesel engines. Average concentrations of NO2 were above the 40 μg m−3 annual limit value outside the stations and were further elevated inside, especially at EDB. Concentrations of PM2.5 inside the stations were 30–40% higher at EDB than outside and up to 20% higher at KGX. Concentrations of both NO2 and PM2.5 were highest closer to the platforms, especially those with a higher frequency of diesel services. A random-forest regression model was used to quantify the impact of numbers of different types of diesel trains on measured concentrations allowing prediction of the impact of individual diesel-powered rolling stock.

Aims: Survival after cancer diagnosed during childhood or adolescence continues to improve with new treatments and supportive therapies. Optimal long-term care requires that risks to vulnerable organs are clearly defined and translated into guidelines that are implemented into practice. PanCareLIFE is a pan-European consortium that addresses survivorship issues comprising fertility, hearing impairment and quality of life. This article describes the scientific basis of PanCareLIFE's studies.Methods: PanCareLIFE involves 17 partner institutions from eight European countries, with additional 11 data providers from five other countries. Study designs and methods include molecular genetic, cohort and case-control studies, a longitudinal study and an intervention study. Ethics and data protection issues have been taken into account from the beginning.Results: PanCareLIFE will investigate the way that treatment impairs female fertility, by evaluating anti-Mullerian hormone levels and the underlying genetic susceptibility to loss of fertility. For our fertility studies, more than 6000 survivors have completed questionnaires, more than 1500 provided serum samples and more than 400 case-control triads have been identified. Fertility preservation guidelines for boys and girls will be developed. More than 2000 survivors have contributed audiograms for the ototoxicity study. Almost 1000 samples were sent for genetic analysis related to ototoxicity and gonadal reserve. The SF-36 questionnaire will measure quality of life in more than 10,000 survivors.Conclusions: The large number of subjects enrolled in PanCareLIFE and the detailed information accumulated will allow in-depth evaluation of important outcomes. Fertility preservation guidelines will help patients and their families make informed decisions and contribute to their long-term well-being. (C) 2018 Elsevier Ltd. All rights reserved.

Background: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. Methods: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. Results: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. Conclusion: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families. (C) 2020 The Authors. Published by Elsevier Ltd.

Measuring the chemical composition of airborne particulate matter (PM) can provide valuable information on the concentration of regulated toxic metals, support modelling approaches for source detection and assist in the identification and validation of abatement techniques. Undertaking these at a high time resolution (1 h or less) enables receptor modelling techniques to be more robustly linked to emission processes. This study describes a comprehensive laboratory and field evaluation of a high time resolution x-ray fluorescence (XRF) instrument (CES XACT 625) for a range of elements (As, Ba, Ca, Cd, Ce, Cl, Cr, Cu, Fe, K, Mn, Mo, Ni, Pb, Pt, S, Sb, Se, Si, Sr, Ti, V and Zn) against alternative techniques: high time resolution mass measurements, high time resolution ion chromatography, aerosol mass spectrometry, and established filter-based, laboratory analysis using inductively coupled plasma mass spectrometry (ICP-MS). Laboratory evaluation was carried out using a novel mass-based calibration technique to independently assess the accuracy of the XRF against laboratory generated aerosols, which resulted in slopes that were not significantly different from unity. This demonstrated that generated particles can serve as an alternative calibration method for this instrument.The XACT was evaluated in three contrasting field deployments; a heavily trafficked roadside site (PM10 and PM2.5), an industrial location downwind of a nickel refinery (PM10) and an urban background location influenced by nearby industries and motorways (PM10). The XRF technique agreed well with the ICP-MS measurements of daily filter samples in all cases with a median R2 of 0.93 and a median slope of 1.07 for the elements As, Ba, Ca, Cr, Cu, Fe, K, Mn, Ni, Pb, Se, Sr, Ti, V and Zn. Differences in the results were attributed to a combination of inlet location and sampling temperature, variable blank levels in filter paper and recovery rates from acid digestion. The XRF technique also agreed well with the other high time resolution measurements but showed a clear positive difference (slopes between 1.41 and 4.6), probably due to differences in the size selection methodology, volatility and water solubility of the PM in aerosol mass spectrometry (SO4) and ion chromatography (Ca, Cl, K and SO4), respectively.A novel filter analysis technique using the XACT showed promising initial results: filters analysed off-line with the XACT compared well to in situ XACT measurements with a median R2 of 0.96 and median slope of 1.07. The resulting range of slopes was comparable to slopes produced in the ICP-MS comparison. This technique provides an opportunity to use the XACT when it is not deployed in the field; thus expanding the potential use of this instrument in future studies.

Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs. Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effective interventions for fertility preservation across institutions. As part of the PanCareLIFE Consortium, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in female patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. This clinical practice guideline leverages existing evidence and international expertise to develop transparent recommendations that are easy to use to facilitate the care of female patients with childhood, adolescent, and young adult cancer who are at high risk for fertility impairment. A complete review of the existing evidence, including a quality assessment, transparent reporting of the guideline panel's decisions, and achievement of global interdisciplinary consensus, is an important result of this intensive collaboration.

Although pain is one of the most prevalent and bothersome symptoms children with cancer experience, evidence-based guidance regarding assessment and management is lacking. With 44 international, multidisciplinary healthcare professionals and nine patient representatives, we aimed to develop a clinical practice guideline (following GRADE methodology), addressing assessment and pharmacological, psychological, and physical management of tumor-, treatment-, and procedure-related pain in children with cancer. In this paper, we present our thorough methodology for this development, including the challenges we faced and how we approached these. This lays the foundation for our clinical practice guideline, for which there is a high clinical demand.

Paris and London are Europe's two megacities and both experience poor air quality with systemic breaches of the NO2 limit value. Policy initiatives have been taken to address this: some European-wide (e.g. Euro emission standards); others local (e.g. Low Emission Zone, LEZ). Trends in NOX, NO2 and particulate matter (PM10, PM2.5) for 2005–2016 in background and roadside locations; and trends in traffic increments were calculated in both cities to address their impact. Trends in traffic counts and the distribution in Euro standards for diesel vehicles were also evaluated. Linear-mixed effect models were built to determine the main determinants of traffic concentrations. There was an overall increase in roadside NO2 in 2005–2009 in both cities followed by a decrease of ∼5% year−1 from 2010. Downward trends were associated with the introduction of Euro V heavy vehicles. Despite NO2 decreasing, at current rates, roads will need 20 (Paris) and 193 years (London) to achieve the European Limit Value (40 μg m−3 annual mean). Euro 5 light diesel vehicles were associated with the decrease in roadside PM10. An increase in motorcycles in London since 2010 contributed to the lack of significant trend in PM2.5 roadside increment in 2010–16.

BACKGROUNDFertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations.METHODSA systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations.RESULTSA total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores 60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer.CONCLUSIONSOnly approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors. Cancer 2016;122:2216-23. (c) 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.Only approximately one-third of the identified clinical practice guidelines for fertility preservation in children, adolescents, and young adults with cancer were found to be of sufficient quality, and among these, the recommendations varied substantially. This finding supports the need for well-developed and transparent harmonized clinical practice guidelines for children and young adults diagnosed with cancer who are at risk of fertility impairment.

BackgroundLow emission zones (LEZ) are an increasingly common, but unevaluated, intervention aimed at improving urban air quality and public health. We investigated the impact of London's LEZ on air quality and children's respiratory health.MethodsWe did a sequential annual cross-sectional study of 2164 children aged 8–9 years attending primary schools between 2009–10 and 2013–14 in central London, UK, following the introduction of London's LEZ in February, 2008. We examined the association between modelled pollutant exposures of nitrogen oxides (including nitrogen dioxide [NO2]) and particulate matter with a diameter of less than 2·5 μm (PM2·5) and less than 10 μm (PM10) and lung function: postbronchodilator forced expiratory volume in 1 s (FEV1, primary outcome), forced vital capacity (FVC), and respiratory or allergic symptoms. We assigned annual exposures by each child's home and school address, as well as spatially resolved estimates for the 3 h (0600–0900 h), 24 h, and 7 days before each child's assessment, to isolate long-term from short-term effects.FindingsThe percentage of children living at addresses exceeding the EU limit value for annual NO2 (40 μg/m3) fell from 99% (444/450) in 2009 to 34% (150/441) in 2013. Over this period, we identified a reduction in NO2 at both roadside (median −1·35 μg/m3 per year; 95% CI −2·09 to −0·61; p=0·0004) and background locations (−0·97; −1·56 to −0·38; p=0·0013), but not for PM10. The effect on PM2·5 was equivocal. We found no association between postbronchodilator FEV1 and annual residential pollutant attributions. By contrast, FVC was inversely correlated with annual NO2 (−0·0023 L/μg per m3; −0·0044 to −0·0002; p=0·033) and PM10 (−0·0090 L/μg per m3; −0·0175 to −0·0005; p=0·038).InterpretationWithin London's LEZ, a smaller lung volume in children was associated with higher annual air pollutant exposures. We found no evidence of a reduction in the proportion of children with small lungs over this period, despite small improvements in air quality in highly polluted urban areas during the implementation of London's LEZ. Interventions that deliver larger reductions in emissions might yield improvements in children's health.FundingNational Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, NHS Hackney, Lee Him donation, and Felicity Wilde Charitable Trust.

Large swarms of simple autonomous robots can be employed to find objects clustered at random locations, and transport them to a central depot. This solution offers system parallelisation through concurrent environment exploration and object collection by several robots, but it also introduces the challenge of robot coordination. Inspired by ants’ foraging behaviour, we successfully tackle robot swarm coordination through indirect stigmergic communication in the form of virtual pheromone trails. We design and implement a robot swarm composed of up to 100 Kilobots using the recent technology Augmented Reality for Kilobots (ARK). Using pheromone trails, our memoryless robots rediscover object sources that have been located previously. The emerging collective dynamics show a throughput inversely proportional to the source distance. We assume environments with multiple sources, each providing objects of different qualities, and we investigate how the robot swarm balances the quality-distance trade-off by using quality-sensitive pheromone trails. To our knowledge this work represents the largest robotic experiment in stigmergic foraging, and is the first complete demonstration of ARK, showcasing the set of unique functionalities it provides.

Este artículo contiene 12 páginas, 1 tabla, 5 figuras., In order to improve the understanding of the carbon cycle in the Pyrenean region, two atmospheric monitoring mountain stations were set up within the Long-Term Ecological Research node of Aigüestortes i Estany de Sant Maurici at Central Pyrenees, Spain. The atmospheric concentration of carbon dioxide (CO2) was measured over 2008–2014 and 2010–2014 at Estany Llong (ELL) site and Centre de Recerca d’Alta Muntanya (CRAM), respectively. Measurements were carried out fortnightly off-line with high precision instrumentation at ELL and every minute online with a lower precision sensor at CRAM in conjunction with meteorological variables. The two datasets were analyzed in this study, quantifying whenever possible annual growth rates (AGR), seasonal variability, and diurnal amplitudes. Results were also compared with the NOAA Marine Boundary Layer (MBL) reference product and CO2 data from other background monitoring stations. Four-harmonics adjusted CO2 data from ELL showed a high correlation with the NOAA MBL reference product for the same latitude (Spearman’s rho ρ = 0.96). In addition, AGRs of CO2 at ELL correlated well with those observed at Mace Head (MHD) station (ρ = 0.94), suggesting that ELL can be considered a background station. Winter CRAM CO2 data was not statistically different from ELL data, while in summer, it was 5.5 ppm lower on average, suggesting a higher photosynthesis uptake. The amplitude of the CO2 diurnal cycle at CRAM was found to be exponentially related to the local mean daily temperature and dependent on forthcoming wind sector (N-NW or E-SE-S-SW).An increase in CRAM CO2 concentrations was observed under N-NW winds during daytime, which could be related to traffic emissions. This study demonstrates that the use of CO2 sensors with low precision but continuously corrected and periodically calibrated can be used for the study of local and regional CO2 sources and sinks., This work has been mainly funded by own resources of the LAO-Climadat Lab at IC3 and by the Fluxpyr project (POCTEFA Program EFA 34/08 - Interreg IV-A). Data is available through virtual access provided and funded in the frame of eLTER H2020 - European Long-Term Ecosystem and Socio-Ecological Research Infrastructure (EC project GA: 654359; INFRAIA; 2015– 2019).

Focusing on trends rather than compliance can lead to more effective policies

Objective Self-reported data show differences in social outcomes (not being married/having a registered partnership; not living independently; using social benefits) for childhood cancer survivors compared with their peers. We aimed to determine differences in these social outcomes between survivors and the general population using national register data and explored associated risk factors. Methods We performed medical record linkage between a single-centre cohort of 1768 ≥ 5-year survivors of childhood cancer (diagnosed 1966–2001) and two national registers (1999–2011) and obtained a random reference sample matched on gender and year of birth per survivor. We used multivariable logistic regression to calculate in adult survivors of childhood cancer (born before 1990) the odds of the specified social outcomes at the end of follow-up in both groups. Within the survivors, we analysed risk factors for the social outcomes. Results We retrieved data from 1283 adult childhood cancer survivors and 25 082 reference persons. Survivors had higher odds (odds ratio; 95% confidence interval) of not being married (1.2; 1.07–1.42), not living independently (1.7; 1.41–2.00) and using social benefits (2.3; 1.98–2.69) compared with reference persons. Radiotherapy to head and/or neck, and an original central nervous system tumour diagnosis negatively influenced all social outcomes examined in childhood cancer survivors. Conclusions National register data show differences between social outcomes in childhood cancer survivors and the general population, especially for survivors treated with radiotherapy to head and/or neck and those originally diagnosed with central nervous system tumours. Development and implementation of effective targeted support strategies to improve social outcomes of childhood cancer survivors needs consideration. Copyright © 2015 John Wiley & Sons, Ltd.

BACKGROUND Current treatment strategies in pediatric oncology are intensive and lead to high survival rates but also to treatment-related complications. Therefore, supportive care plays an increasingly important role. This study was designed to evaluate variations in supportive care practice in children with cancer in the Netherlands and adherence to selected existing international guidelines through an in-depth review of local guidelines and protocols at all 6 Dutch pediatric cancer centers. METHODS Based on shared expert opinion, a questionnaire regarding current supportive care practice was compiled. For each center, the required information was extracted from local supportive care guidelines, and the list was sent to a pediatric oncologist of that center to verify its correspondence with local daily practice. Subsequently, it was determined whether clinical practice was concordant (same in ≥ 5 of 6 centers), partly concordant (highly overlapping in ≥ 5 of 6 centers), or discordant (same in

Childhood cancer survivors (CCS) experience higher hospitalization rates compared to the general population for neoplasms, circulatory diseases, endocrine/nutritional/metabolic diseases and eye disorders. We studied trends in hospitalization rates and associated patient and treatment‐specific risk factors for diagnosis subgroups among these four diseases. We performed medical record linkage of a ≥5‐year CCS cohort with national registers, and obtained a random reference sample matched on age, gender and calendar year per CCS. For each diagnosis subgroup we compared hospitalization rates and trends over time in CCS and the reference population. Further, we analyzed risk factors for hospitalizations within the four CCS diagnosis groups. We used multivariate Poisson regression for all models. We retrieved hospitalization data from 1382 CCS and 26,583 reference persons. CCS had increased hospitalization rates for almost all diagnosis subgroups examined. Hospitalization rates for endocrine/nutritional/metabolic diseases appeared to increase with longer time since primary cancer diagnosis up to 30 years after primary cancer diagnosis. Survivors initially treated with radiotherapy had increased hospitalization rates for neoplasms (P

Purpose Intensive therapies in pediatric malignancies increased survival rates but also occurrence of treatment-related morbidities. Therefore, supportive care fulfills an increasingly important role. In planning development of guidelines with incorporation of shared decision making, we noticed that little is known about the needs and preferences of patients and their parents. Our goals were therefore to investigate (1) which supportive care topics patients and parents regard as most important and (2) the preferred role they wish to fulfill in decision making. Methods This qualitative study consisted of three focus groups (two traditional, one online) with patients and parents of two Dutch pediatric oncology centers. Data were transcribed as simple verbatim and analyzed using thematic analysis. Results Eleven adolescent patients and 18 parents shared detailed views on various aspects of supportive care. Themes of major importance were communication between patient and physician (commitment, accessibility, proactive attitude of physicians), well-timed provision of information, and the suitability and accessibility of psychosocial care. In contrast to prioritized supportive care topics by medical professionals, somatic issues (e.g., febrile neutropenia) were infrequently addressed. Patients and parents preferred to be actively involved in decision making in selected topics, such as choice of analgesics and anti-emetics, but not in, e.g., choice of antibiotics. Conclusions Children with cancer and parents were provided a valuable insight into their views regarding supportive care and shared decision making. These results have important implications towards improving supportive care, both in selecting topics for guideline development and incorporating preferences of patients and parents herein. Electronic supplementary material The online version of this article (doi:10.1007/s00520-017-3723-7) contains supplementary material, which is available to authorized users.

Road widening schemes in urban areas are often proposed as a solution to traffic congestion and as a means of stimulating economic growth. There is however clear evidence that new or expanded roads rapidly fill with either displaced or induced traffic, offsetting any short-term gains in eased traffic flows. What has not been addressed in any great detail is the impact of such schemes on air quality, with modelled impact predictions seldom validated by measurements after the expansion of road capacity. In this study we made use of a road widening project in London to investigate the impact on ambient air quality (particulate matter, NOX, NO2) during and after the completion of the road works. PM10 increased during the construction period up to 15 μg m(-3) during working hours compared to concentrations before the road works. A box modelling approach was used to determine a median emission factor of 0.0022 kg PM10 m(-2) month(-1), three times larger than that used in the UK emission inventory (0.0007 kg PM10 m(-2) month(-1)). Peaks of activity released 0.0130 kg PM10 m(-2) month(-1), three and eight times smaller than the peak values used in the European and US inventories. After the completion of the widening there was an increase in all pollutants from the road during rush hour: 2-4 μg m(-3) for PM10; 1 μg m(-3) for PM2.5; 40 and 8 μg m(-3) for NOX and NO2, respectively. NO2 EU Limit Value was breached after the road development illustrating a notable deterioration in residential air quality. Additionally, PM10, but not PM2.5, glutathione dependent oxidative potential increased after the road was widened consistent with an increase in pro-oxidant components in the coarse particle mode, related to vehicle abrasion processes. These increased air pollution indices were associated with an increase in the number of cars, taxis and LGVs.

Background.Research to date on health effects associated with incineration has found limited evidence of health risks, but many previous studies have been constrained by poor exposure assessment. This paper provides a comparative assessment of atmospheric dispersion modelling and distance from source (a commonly used proxy for exposure) as exposure assessment methods for pollutants released from incinerators.Methods.Distance from source and the atmospheric dispersion model ADMS-Urban were used to characterise ambient exposures to particulates from two municipal solid waste incinerators (MSWIs) in the UK. Additionally an exploration of the sensitivity of the dispersion model simulations to input parameters was performed.Results.The model output indicated extremely low ground level concentrations of PM10, with maximum concentrations of μg/m3. Proximity and modelled PM10concentrations for both MSWIs at postcode level were highly correlated when using continuous measures (Spearman correlation coefficients ~ 0.7) but showed poor agreement for categorical measures (deciles or quintiles, Cohen’s kappa coefficients ≤ 0.5).Conclusion.To provide the most appropriate estimate of ambient exposure from MSWIs, it is essential that incinerator characteristics, magnitude of emissions, and surrounding meteorological and topographical conditions are considered. Reducing exposure misclassification is particularly important in environmental epidemiology to aid detection of low-level risks.

As cure rates in pediatric oncology have improved substantially over the last decades, supportive care has become increasingly important to reduce morbidity and mortality and improve quality of life in children with cancer. Currently, large variations exist in pediatric oncology supportive care practice, which might negatively influence care. This plea underlines the importance of development and implementation of trustworthy supportive care clinical practice guidelines, which we believe is the essential next step towards better supportive care practice, and thus a higher quality of care. To facilitate international development and endorsement, the International Pediatric Oncology Guidelines in Supportive Care Network has been established.

Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (P

A large number of policy initiatives are being taken at the European level, across the United Kingdom and in London to improve air quality and reduce population exposure to harmful pollutants from traffic emissions. Trends in roadside increments of nitrogen oxides (NO

Resumen Objetivo Evaluar la eficacia de una intervencion educativa de enfermeria preoperatoria mediante entrega de material grafico para la gestion del dolor agudo post-operatorio en los pacientes intervenidos de hernias en una unidad de cirugia mayor ambulatoria (UCMA). Metodo Estudio cuasi experimental (no aleatorizado). Grupo control, pacientes intervenidos de hernia entre julio de 2006 y junio de 2007 y grupo intervencion, pacientes intervenidos entre julio de 2007 y junio de 2008. Ambos grupos recibieron la misma accion formativa para la preparacion quirurgica y recomendaciones para el post-operatorio en la consulta de enfermeria. Al grupo intervencion se reforzo la informacion con la entrega de material grafico. La recogida de datos se realizo mediante cuestionario al ingreso y llamada telefonica a las 24 h post-operatorias. La medicion del dolor se realizo con la escala visual analogica/escala verbal numerica (EVA/EVN). Resultados Se incluyeron 205 pacientes en el grupo control y 292 en el grupo intervencion. En el analisis bivariado el porcentaje de pacientes con EVA > 3 fue del 23,9% para el grupo control y del 15,1% para el grupo intervencion. En el analisis multivariante las variables asociadas al dolor post-operatorio fueron la edad joven, genero femenino, problemas para movilizarse y caminar, y falta de conocimiento de los cuidados a seguir en casa. Conclusiones Una intervencion educativa de enfermeria con la entrega de material grafico sugiere que puede reducir la percepcion individual del dolor agudo post-operatorio asi como disminuir el porcentaje de pacientes con problemas para caminar, movilizarse y mejorar el cumplimiento y adhesion al tratamiento.

In this study the differences in the measured atmospheric CO2 mixing ratio at three aircraft profiling sites in NE Spain separated by 60 km are analyzed in regard to the variability of the surface fluxes in the regional surface influence area. First, the Regional Potential Surface Influence (RPSI) for fifty-one days in 2006 is calculated to assess the vertical, horizontal and temporal extent of the surface influence for the three sites at the regional scale (104 km2) at different altitudes of the profile (600, 1200, 2500 and 4000 meters above the sea level, m a.s.l.). Second, three flights carried out in 2006 (7 February, 24 August and 29 November) following the Crown Atmospheric Sampling (CAS) design are presented to study the relation between the measured CO2 variability and the Potential Surface Influence (PSI) and RPSI concepts. At 600 and 1200 m a.s.l. the regional signal is confined up to 50 h before the measurements whereas at higher altitudes (2500 and 4000 m a.s.l.) the regional surface influence is only recovered during spring and summer months. The RPSI from sites separated by 60 km overlap by up to 70% of the regional surface influence at 600 and 1200 m a.s.l., while the overlap decreases to 10–40% at higher altitudes (2500 and 4000 m a.s.l.). The scale of the RPSI area is suitable to understand the differences in the measured CO2 concentration in the three vertices of the CAS, as CO2 differences are attributed to local surrounding fluxes (February) or to the variability of regional surface influence as for the August and November flights. For these two flights, the variability in the regional scale influences the variability measured in the local scale. The CAS sampling design for aircraft measurements appears to be a suitable method to cope with the variability of a typical grid for inversion models as measurements are intensified within the PBL and the background concentration is measured every ~102 km.

Introduction The number of Municipal Waste Incinerator (MWI) facilities in the UK are increasing due to European Union (EU) restrictions on landfill use; however, there is public concern over possi...

Current treatment strategies in pediatric oncology are intensive and lead to high survival rates but also to treatment-related complications. Therefore, supportive care plays an increasingly important role. This study was designed to evaluate variations in supportive care practice in children with cancer in the Netherlands and adherence to selected existing international guidelines through an in-depth review of local guidelines and protocols at all 6 Dutch pediatric cancer centers.Based on shared expert opinion, a questionnaire regarding current supportive care practice was compiled. For each center, the required information was extracted from local supportive care guidelines, and the list was sent to a pediatric oncologist of that center to verify its correspondence with local daily practice. Subsequently, it was determined whether clinical practice was concordant (same in ≥ 5 of 6 centers), partly concordant (highly overlapping in ≥ 5 of 6 centers), or discordant (same in 5 of 6 centers). Local practices were compared with strong recommendations from high-quality, evidence-based guidelines.The questionnaire comprised 67 questions regarding supportive care practice. Concordance was observed for 11 of 67 practice items (16%), partial concordance was observed for 6 of 67 practice items (9%), and discordance was observed for 50 of 67 practice items (75%). Adherence to strong recommendations of 4 high-quality, evidence-based guidelines varied but was generally low.Large variations exist in pediatric oncology supportive care practice, and this could negatively influence care. Adherence to existing evidence-based guidelines and the development and implementation of new clinical practice guidelines have the potential of standardizing supportive care practice and thereby improving outcomes for children with cancer.

Self-reported data show differences in social outcomes (not being married/having a registered partnership; not living independently; using social benefits) for childhood cancer survivors compared with their peers. We aimed to determine differences in these social outcomes between survivors and the general population using national register data and explored associated risk factors.We performed medical record linkage between a single-centre cohort of 1768 ≥ 5-year survivors of childhood cancer (diagnosed 1966-2001) and two national registers (1999-2011) and obtained a random reference sample matched on gender and year of birth per survivor. We used multivariable logistic regression to calculate in adult survivors of childhood cancer (born before 1990) the odds of the specified social outcomes at the end of follow-up in both groups. Within the survivors, we analysed risk factors for the social outcomes.We retrieved data from 1283 adult childhood cancer survivors and 25 082 reference persons. Survivors had higher odds (odds ratio; 95% confidence interval) of not being married (1.2; 1.07-1.42), not living independently (1.7; 1.41-2.00) and using social benefits (2.3; 1.98-2.69) compared with reference persons. Radiotherapy to head and/or neck, and an original central nervous system tumour diagnosis negatively influenced all social outcomes examined in childhood cancer survivors.National register data show differences between social outcomes in childhood cancer survivors and the general population, especially for survivors treated with radiotherapy to head and/or neck and those originally diagnosed with central nervous system tumours. Development and implementation of effective targeted support strategies to improve social outcomes of childhood cancer survivors needs consideration. Copyright © 2015 John WileySons, Ltd.