bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Comprehensive Evaluation of Water Ecological Environment in Small Basin
Authors: Gao Hua , Chu Rui
Published: February 2021

In order to evaluate the water ecological environment quality of small basin and realize scientific management and control of small basin, 15 sampling spots were set up on the small basin of Nanhe River of Qionglai city, 11 indexes were selected from three aspects of water environmental quality, aquatic ecology and aquatic habitat for each sampling spot, and the grey relational analysis (GRA) was used to comprehensively evaluate the water ecological environment quality in the small watershed of Nanhe River of Qionglai city. The results show that it is feasible to use GRA to comprehensively evaluate the regional water ecological environment. The water ecological environment of wenjing River, Baimo River and Dengjiang River is in good condition, and their control standards should be relatively improved. The water ecological environment of the five reaches of Xiaonan River, Shitou River, Pujiang River, Inclined River and the lower reaches of Nanhe River is in poor condition, which requires priority control. Pollution prevention and control measures should be considered comprehensively in combination with the ecological environmental pressure borne by the reach.
Exhaust emission analysis of expressway toll station based on PEMS data
Authors: Liang Tianwen
Published: February 2021

The complex operation characteristics of vehicles at tollbooths on expressway lead to the increase of vehicle emission intensity. In order to reduce energy emissions at toll stations on highways, the toll stations on highways have been replaced with ETC charging mode. In order to effectively evaluate the environmental and energy efficiency after the abolition of toll stations, it is necessary to analyze the correlation between ETC charging mode and lane emission under manual charging mode. Using PEMS data, this paper analyzes in detail the correlation between vehicle operating characteristics and emissions in ETC lane and toll lane. The results show that ETC lane can increase the vehicle traffic efficiency and effectively reduce the exhaust emissions at the toll station. The results of this study will provide a basis for evaluating the energy efficiency of expressway tollbooths after their removal.
Effects of sea reclamation project on heavy metal concentrations in seawater- a case study in Qixingtu
Authors: Hao Zhe , Xu Hengtao
Published: February 2021

Sea reclamation will pollute the environment and reduce the quality of marine water. In order to discuss the impact of reclamation on seawater, 4 heavy metals (Cu, Pb, Zm, Cd) in seawater near Qixingtu were analysized for three time periods: 2007(before the reclamation), 2016(not long after the reclamation) and 2018 (after the reclamation). As a result, concentrations of all the 4 heavy metal met the standard requirements in surrounding seawater of Qixingtu, which indicated a good sea water quality in this area. Except for Cd, all the other heavy metals showed a trend of increasing first and then decreasing. Sea reclamation could indeed aggravate the heavy metal pollution in the surrounding seawater but the impact would recover through reasonable treatment and protection.
Comparative Analysis of Gender Differences in Environmental Values of Chinese People
Authors: Wu Ningning , Wang Shuai , Liang Xiao , Tong Zepeng , Sun Yan
Published: February 2021

This study investigated the differences of environmental values of Chinese people across the country and between men and women. Questionnaire survey method was adopted, T test and variance analysis were used to obtain the results. Result shows that: the overall score of the male NEP scale was significantly lower than that of the female. From the mean value of the five dimensions of environmental values, environmental education should be carried out continuously, with special emphasis on men.
Automated system for cleaning solar panels based on a linear actuator
Authors: Zatsarinnaya Yu N , Amirov D I
Published: February 2021

High volatility in the hydrocarbon market in tandem with an increase in anthropogenic impact on the environment has become one of the main reasons for the accelerated transformation of the global energy industry. Today we have witnessed a gradual increase in the share of renewable energy sources (RES) in the energy industry structure of leading economically developed countries. Solar energy is a promising area of renewable energy for most economies because of its availability and ease of use. Not only for commercial companies but also for the private sector. Pollution of a front surface of a module has become a pressing problem of generating electrical energy by using photovoltaic panels (PVP). For a solution to the problem of timely panels cleaning developers proposed several options of systems none of which were widely used. We started the development of the panel cleaning system which is based on the linear actuator operation principle. The system is planned to be controlled by using the Arduino UNO R3 microcontroller which will allow us to minimize the share of human participation in the cleaning of PVP.
The use of optimization in new design of tribometer specimen clamping system
Authors: Hajdu Š
Published: February 2021

The article deals with the innovation of the clamping part of the tribometer, where the tested specimens are clamped. The new clamping system was designed in the CAD system CATIA V5. The advantages of the new clamping system are compared with the original clamping system of specimens on the tribometer type A30. The new clamping design is evaluated from technical, technological and marginally also from economical point of view. The new clamping design ensures easy handling and exchange of specimens. Easy handling is ensured by the conical collet, which is released by the fixation nut, and subsequently the specimen can be pulled out and replaced with a new one without disassembly the device. The content of the article is also the strength analysis of the conical clamping collet and subsequent optimization. In the strength analysis, the conical collet is pushed into the conical cavity of the tribometer rotor by an outer fixation nut. The result is a numerical simulation of the new designed clamping system which will consist of the rotor, the conical collet, fixation nut and the tested specimen. The von Misses stresses, deformations and reaction forces acting on the collet will be determined by the numerical analysis. Subsequent optimization consisting of defining the target function, boundary conditions and type of optimization will be found. The minimum necessary fixation force which will be obtained from the fixation nut to ensure the transmission of torque to the clamped specimen without slip.
Dynamic Analysis of Cone Waveguide for Ultrasonic Assisted Technological Processes
Authors: Naď M , Šimon Š , Bucha P
Published: February 2021

Research and development of new materials (ceramics and composites) with advanced mechanical properties also leads to the development and application of new so-called hybrid technological processes, which are based on a combination of conventional technological processes with ultrasonic tool vibrations. The fundamental condition for the optimal realization of technological process is the vibration of ultrasonic waveguide in the resonant state. Therefore, the ultrasonic waveguide must have the required modal properties, which depend on the distribution of its mass and stiffness properties. Design and analysis of dynamic properties of ultrasonic cone waveguide with adaptive modification of modal properties is presented in this paper. Modification of modal properties is performed using an embedded core, which changes the distribution of spatial properties of the waveguide structure. The effect of geometric parameters and material properties of the inserted core on the ultrasonic waveguide modal properties (mode shapes, natural frequency, amplification factor) is presented.
Comparison of microstructures and mechanical properties of Al-Ti weld joints prepared by different welding technologies
Authors: Nagy M , Behúlová M , Vrtiel Š
Published: February 2021

This study deals with the evaluation of butt welded-brazed joints of two plates with the thickness of 2 mm from EN AW5083-H111 alloy and titanium Grade 2 prepared by two different welding technologies: laser beam welding-brazing (LBWB) and gas tungsten arc welding (GTAW). ER4047 and ER4043 welding wires with the diameter of 1.2 mm were used as filler materials. The macrostructures, microstructures and mechanical properties of experimental weld joints were analysed and compared. In general, the strength of joints produced by LBWB was higher than the strength of GTAW samples. The highest tensile strength at the level of 245 MPa was measured for the experimental joint made by LBWB using following welding parameters: the laser power of 1800 W, the welding speed of 30 mm.s−1, the laser beam offset to Al-sheet of 400 µm and the wire feed rate of 2.4 m.min−1.
Anchor rods position assesment for connection of manipulating equipment to the transported structure
Authors: Vrtiel Š , Naď M , Behúlová M
Published: February 2021

The manipulation and transport of baskets in which goods or components of various shapes are inserted is very often complicated due to manufacturing tolerances and deformations of the basket. Prediction of the connectivity of the basket and the transport device in the gripping points is very important from the point of view of safe transport of the basket. The methodology and procedure for determining the connectivity of the gripping elements of the transported device with the anchor holes of the basket columns is presented. In the analysis and evaluation of the connectivity of the basket with the transport device, the production tolerances of the basket and the transport device are taken into account and as well as the changes of important dimensions of the basket caused by different loading conditions.
Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer
Authors: Merluzzi Thomas V , Philip Errol J , Gomer Brenna , Heitzmann Ruhf Carolyn A , Kim Dahyeon
Published: February 2021

Background

Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress.

Purpose

The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD).

Methods

Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress.

Results

Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type.

Conclusions

Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.
Sexual dichromatism, size dimorphism, and microscale anatomy of white wing stripe in blue tits
Authors: Janas Katarzyna , Gaweł Paulina , Łatkiewicz Anna , Lutyk Dorota , Gustafsson Lars , Cichoń Mariusz , Drobniak Szymon M
Published: February 2021

Achromatic patches are a common element of plumage patterns in many bird species and there is growing body of evidence that in many avian taxa they can play a signaling role in mate choice. Although the blue tit Cyanistes caeruleus is a well-established model species in the studies on coloration, its white wing patch has never been examined in the context of sex-specific trait expression. In this exploratory study, we examined sexual size dimorphism and dichromatism of greater covert’s dots creating white wing patch and analyzed its correlations with current body condition and crown coloration—a trait with established role in sexual selection. Further, we qualitatively analyzed microstructural barb morphology underlying covert’s coloration. We found significant sexual dimorphism in the dot size independent of covert size and sexual dichromatism in both white dot and blue outer covert’s vane spectral characteristics. Internal structure of covert barbs within the white dot was similar to the one found in barbs from the blue part that is, with a medullary area consisting of dead keratinocytes containing channel-type ß-keratin spongy nanostructure and centrally located air cavities. However, it lacked melanosomes which was the main observed difference. Importantly, UV chroma of covert’s blue vane was positively correlated with crown UV chroma and current condition (the latter only in males), which should be a premise for further research on the signal function of the wing stripe.
An Empirical Evaluation of the Impact of Collaboration on the Pace and Scale of National Forest Management in Idaho
Authors: McIver Chelsea Pennick , Becker Dennis R
Published: February 2021

It has been posited that US national forest administration is undergoing a governance transition characterized by an increase in the involvement and influence of non-state actors. One example of this new form of national forest governance is the use of multi-stakeholder collaborative efforts for planning and implementing projects. This has raised normative and positive questions about the value and effectiveness of such efforts and how they compare with more traditional public involvement and planning processes. This study attempts to address the latter questions by analyzing project-level planning and implementation data while comparing collaborative and traditional projects on a suite of metrics related to pace, scale, complexity, and legal outcomes. We used administrative data from the USDA Forest Service to conduct a quantitative analysis of projects over a 14-year period. We found that collaboratively developed projects were larger and more complex than traditional projects and were associated with greater planning efficiency. This analysis responds to the need to systematically assess the impact of collaborative governance and contributes to existing theories of governance, organizational learning, and policy implementation.
Association Between Combined Lifestyle Factors and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study
Authors: Zhou Yan-Feng , Song Xing-Yue , Pan Xiong-Fei , Feng Lei , Luo Nan , Yuan Jian-Min , Pan An , Koh Woon-Puay
Published: February 2021

Background

The aim of the study was to examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese adults.

Method

We included 14 159 participants aged 45–74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0–5 scale) was calculated at baseline (1993–1998) and updated at the second follow-up visit (2006–2010) on the basis of optimal body mass index (18.5–22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 h/wk of moderate activity or ≥0.5 h/wk of strenuous activity), nonsmoking (never smoking), and low-to-moderate alcohol drinking (>0 to ≤14 drinks/wk for men and >0 to ≤7 drinks/wk for women). Healthy ageing was assessed at the third follow-up visit (2014–2016) and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain.

Results

About 20.0% (2834) of the participants met the criteria of healthy ageing after a median follow-up of 20 years. Each 1-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%–30%) and 24% (18%–29%), respectively. The population-attributable risk percent of adherence to 4–5 protective lifestyle factors was 34.3% (95% CI: 25.3%–42.3%) at baseline and 31.3% (23.0%–38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12%–1.24%) for each increment in protective lifestyle score.

Conclusions

Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.
Theory of Irrational Politics: Classical Realist Lessons on Foreign Policy Analysis
Authors: Edinger Harald
Published: February 2021

This article argues that efforts to strengthen the theoretical foundations for foreign policy analysis (FPA) should take as a vantage point the smallest social unit—the human being. It advocates far-reaching engagement with psychology and the life sciences for insights on the individual in the social context. Research on emotion, as a general human phenomenon and one that has been extensively researched across disciplines, is thought to offer a particularly promising conceptual lens on foreign policy. For cues on how to incorporate scientific findings with historical analysis and situate resulting hypotheses in relation to prevailing theoretical paradigms, the article draws on classical realism. Especially mid-twentieth century realists such as Hans Morgenthau expressed a nuanced conception of human agency and the interplay between emotion and cognition. Substantial aspects of their theories, based largely on experience and intuition, have been corroborated by recent scientific research. This review is structured around four central issues. These have been both the loci of much criticism levelled at classical realism and remain a challenge to IR as a whole: the levels of analysis problem, the “scaling up” of emotion, the classification and choice of emotion(s), and the accessibility of the political world to scientific method.
Improving performance of finishing pigs with added valine, isoleucine, and tryptophan: validating a meta-analysis model
Authors: Kerkaert Hayden R , Cemin Henrique S , Woodworth Jason C , DeRouchey Joel M , Dritz Steve S , Tokach Mike D , Goodband Robert D , Haydon Keith D , Hastad Chad W , Post Zach B
Published: February 2021

Based on results of a recent meta-analysis, we hypothesized that increased dietary Val, Ile, or Trp could correct possible amino acid interactions because of excess Leu in diets containing high levels of corn protein, namely dried distiller’s grains with solubles (DDGS). A total of 1,200 pigs (PIC TR4 × (Fast LW × PIC L02); initially 33.6 ± 0.6 kg) were used in a 103-d study. The 6 dietary treatments were corn–soybean meal (SBM)-DDGS-based as follows: (1) high SBM and low level of l-Lys HCl (HSBM), (2) high l-Lys HCl and moderate Ile, Val, Trp (AA above NRC 2012 estimates; NC), (3) moderate l-Lys HCl and high Ile, Val, and Trp (PC), and PC with either increased (4) L-Val (PC+Val), (5) L-Ile (PC+Ile), or (6) L-Trp (PC+Trp). Pigs fed the NC diet were predicted to have the poorest average daily gain (ADG), the PC diet to be intermediate, and pigs fed the HSBM, PC+Val, PC+Ile, and PC+Trp have the same and highest predicted ADG. In the grower period (34 to 90 kg), ADG was greater (Ρ < 0.05) for the pigs fed HSBM and PC+Val diets than the NC with pigs fed other diets intermediate. Pigs fed HSBM were more (Ρ < 0.05) efficient (G:F) than the NC and PC with pigs fed other diets intermediate. In the finisher period (90 to 136 kg), ADG was greater (Ρ < 0.05) for pigs fed PC+Ile than that of the NC with pigs fed other diets intermediate. Pigs fed PC+Val had greater (Ρ < 0.05) average daily feed intake (ADFI) than the NC with pigs fed other diets intermediate. However, PC+Ile pigs were more (Ρ < 0.05) efficient than PC+Val with pigs fed other diets intermediate. Overall, ADG was greater (Ρ < 0.05) for pigs fed HSBM, PC+Val, and PC+Ile diets than the NC with pigs fed other diets intermediate. Pigs fed the PC+Val diet had greater (Ρ < 0.05) ADFI than the NC with pigs fed other diets intermediate. No differences were detected between treatments for overall G:F or other carcass characteristics. In conclusion, increasing Val or Ile in high l-Lys-HCl-DDGS-based diets improved growth performance compared with pigs fed diets containing high levels of l-Lys HCl without added Val and Ile. These results present evidence that the recently developed meta-analysis can predict the relative differences in overall ADG for pigs fed the NC, PC, PC+Val, and PC+Ile diets; however, the predicted G:F was less accurate. The data demonstrate that the negative effects of high Leu concentrations in corn-DDGS-based diets can be reversed by increasing the ratios of Val and Ile relative to Lys.
Diet and Cancer
Authors: Fitzgibbon Marian L. , Tussing-Humphreys Lisa , Kong Angela , Bains Alexis
Published: February 2021

Diet contributes to the development of 30% to 35% of cancers. Shifts in the food landscape have contributed to changes in dietary intake, energy balance, and the development of obesity. Obesity, defined as a body mass index (BMI) greater than or equal to 30 kg/m², is associated with several cancers. The World Cancer Research Fund (WCRF), the American Institute for Cancer Research (AICR), the American Cancer Society (ACS), and several large U.S.-based randomized trials are studying the relationship between diet, dietary patterns, lifestyle risk factors, obesity, and cancer. Prior research reported an association between individual nutrients and cancer risk. This research, however, did not fully investigate the complexity of diet and interactions between specific dietary components. Overall, according to data reported by the WCRF and the AICR, primary prevention of many cancers is possible through modifiable lifestyle changes. Identifying and intervening on barriers to lifestyle modifications remains a challenge, but it is increasingly apparent that there is a relationship between diet, lifestyle risk factors, and cancer development and that many cancers can be prevented.
Psychosocial Issues in Genetic Testing for Hereditary Colorectal Cancer
Authors: Makhnoon Sukh , Peterson Susan K.
Published: February 2021

Psychosocial factors influence colorectal cancer (CRC) genetic testing decisions and risk management strategies. Psychosocial research on hereditary CRC has focused on understanding individuals’ motivations and decisions regarding genetic testing, the psychological impact of genetic risk notification, the effects on family and interpersonal relationships, and factors influencing the uptake of risk reduction options (e.g., screening, risk-reducing surgery, or chemoprevention). Overall, the literature on psychosocial aspects of hereditary CRC suggest that despite initial fears, negative psychological impacts of genetic testing are often absent or modest, and adverse impacts, if observed, are short-lived. Due to the shared familial nature of genetic information, patients utilizing CRC genetic testing also experience novel psychosocial challenges in terms of family communication and childbearing. Positive psychosocial benefits such as relief from uncertainty and satisfaction of curiosity have been less frequently examined. Psychosocial outcomes vary across types of genetic testing, test results, gene penetrance and associated cancer risks, and various clinical and personal factors. For example, the psychosocial outcomes in response to an uncertain test result from a moderate-penetrance CRC-related gene may be different from a negative test result in a high-penetrance gene. This suggests that generalizing psychosocial outcomes from the various areas of scholarship may be unwise. Psychosocial aspects of genetic testing deserve attention by researchers and clinicians to design and deliver tailored genetic and psychological counseling support services geared to the ongoing needs of patients and their relatives who face genetic risk for colorectal cancer.
Assessment, Screening, and Case Finding for Depression and Anxiety in People with Cancer
Authors: Donovan Kristine A. , Jacobsen Paul B.
Published: February 2021

In this chapter, published systematic reviews and meta-analyses were used to identify English-language instruments commonly used to evaluate depression and anxiety in people with cancer. Research evidence regarding the relative merits of these instruments, particularly with respect to assessment, screening, and case finding, is summarized. Clinical practice guidelines and consensus statements regarding the use of these instruments in everyday clinical practice are also summarized. The Center for Epidemiologic Studies Depression Scale and the Hospital Anxiety and Depression Scale are highlighted as the instruments with the strongest evidence for their use. Nevertheless, no single instrument can be recommended for all possible applications; clinicians and researchers alike must choose based on the specific circumstances for which they intend to use an instrument.
Cancer-Related Fatigue
Authors: McFarland Daniel C. , Bjerre-Real Christian , Alici Yesne , Breitbart William S.
Published: February 2021

Cancer-related fatigue (CRF) is abundantly represented in most cancer populations and is highly distressing, causing significant psychological and functional morbidity. It does not receive enough attention from cancer clinicians as a certain amount of fatigue is expected from cancer and treatments. However, CRF is a distinct entity and category of fatigue that does not respond to usual restorative measures. This chapter reviews its definition, prevalence, pathophysiology, and assessment including unique contributory causes and distinguishing CRF from other symptoms such as depression and pain. Measurement tools are discussed. Strategies for the management of CRF including pharmacologic and nonpharmacologic interventions are reviewed and tips are provided. Evidence is presented for the use of psychostimulants and other drug therapy as well as exercise, psychotherapies, and mind-body interventions (e.g., yoga, acupuncture). CRF is a distinct entity with significant consequences for patients. Its assessment should be thorough and treatment directed toward underlying causes.
Depressive Disorders in Cancer
Authors: Schulz-Quach Christian , Li Madeline , Miller Kimberley , Rodin Gary
Published: February 2021

The prevalence, clinical features, pathophysiology, and diagnostic and treatment approaches for the spectrum of depressive disorders in cancer patients are reviewed here. At the more severe end of the continuum, major depression is a serious comorbidity with a prevalence of 8–24% in cancer patients and associated with significant impairment in quality of life and engagement in cancer treatment. Subthreshold depressive disorders are even more common and can be associated with substantial functional impairment. The distinction among these disorders can be difficult to make but has important implications for treatment. Milder depressive symptoms, such as those associated with an adjustment disorder or subthreshold depression, may not be responsive to antidepressant medication, while moderate to severe major depression often does respond. Biological factors contributing to depression should be addressed and psychological interventions may be beneficial across the spectrum of depression. Psychotherapeutic and pharmacologic interventions have been shown to be effective in cancer, and collaborative care models may enhance their delivery. Future research is needed to better define the phenomenology of subthreshold depression in cancer patients and to strengthen the evidence base for both the pharmacotherapy and psychotherapy of depression in cancer.
Psychiatric Toxicities of Cancer Therapies
Authors: McFarland Daniel C. , Sharma Mehak , Alici Yesne
Published: February 2021

The psychiatric effects of cancer treatments should receive renewed interest based on cancer treatment–related paradigm shifts and the ever-changing parade of new and improving cancer treatments. Precision medicine in oncology relies on personal molecular analysis and is touching patients in profound ways by providing prognostic information to guide treatment decisions. Due to enhancements in molecular sciences as well as data collection and management, the development of new treatments has accelerated in the field of oncology in particular. While there are many advantages to increasing the speed of drug development, ensuring that the psychiatric and psychological outcomes of these treatments are well understood remains a largely undeveloped area. This chapter introduces immunotherapies and targeted drug therapies, their mechanisms of action, and what is known about their psychiatric toxicity profiles. The chapter focuses on outlining the scientific rationale behind newer treatments such as immunotherapy and targeted therapies so that psychiatric consequences, perhaps yet to be discovered, may be further understood. Increased attention to patient-reported outcomes will hopefully enhance the identification of psychiatric consequences of immunotherapy and targeted therapies in oncology.
Delivering Integrated Psychosocial Oncology Care
Authors: Fann Jesse R. , Ruark Julia , Sharpe Michael
Published: February 2021

This chapter describes how the collaborative care model can be used to integrate psychosocial care into cancer care. It also describes the evolution of, and evidence for, the collaborative care approach in cancer services. Collaborative care consists of systematic identification of need, integrated delivery of psychosocial care by care managers with specialist supervision, and the stepping up of care based on the systematic measurement of outcomes. Trials of this approach for the management of depression and pain in patients with cancer have found it to be feasible to deliver, effective in improving outcomes, and cost-effective. The chapter describes how to overcome patient, provider, and institutional challenges in providing psychosocial care in diverse oncology settings. It concludes by proposing practical steps for implementing and sustaining an integrated psychosocial oncology service based on the principles of collaborative care.
Acceptance and Commitment Therapy (ACT) for Cancer Patients
Authors: Hulbert-Williams Nicholas J. , Owen Ray , Nelson Christian J.
Published: February 2021

Acceptance and commitment therapy (ACT) is often described as one of the newer “third wave” cognitive behavioral therapies. ACT is transdiagnostic and functions by increasing psychological flexibility and training skills in appropriate behavioral responses to distressing cognitions and emotions. ACT emphasizes the importance of values-based living to give meaning and purpose to life. Although the evidence base for ACT in cancer settings is growing, more methodologically robust and powered trials are needed for definitive evidence. This chapter outlines how ACT can be used to help people during cancer treatment and survivorship, with a focus on managing troubling thoughts and coping with treatment side effects, demoralization, grief, and avoidance of valued activities.
Integrative Oncology
Authors: Narayanan Santhosshi , Lopez Gabriel , Mao Jun J. , Liu Wenli , Cohen Lorenzo
Published: February 2021

Patients with cancer often seek an integrative approach to their care in hope of a cure or symptom management. The integrative care plan requires a patient-centered approach that involves attention to their concerns and developing a comprehensive plan involving physical, mind-body, and social modalities in collaboration with the patient’s main oncology team and colleagues in palliative care, pain management, psychiatry, and rehabilitation. A personalized symptom management strategy utilizing an evidence-based application of conventional and nonconventional therapies can help improve quality of life and optimize treatment outcomes. Recommendation of modalities such as acupuncture, massage, and mind-body practices, as well as open communication and discussion on herbs and supplements, their safety, and interactions with cancer and chemotherapy, is critical to achieve optimal clinical outcomes.
e-Health Interventions for Cancer Prevention and Control
Authors: Shaffer Kelly M. , Coups Elliot J. , Ritterband Lee M.
Published: February 2021

Many terms have been used to describe technology-delivered behavioral and psychological treatments, including web-based treatments, online treatments, e-therapy, digital health interventions, cybertherapy, computer-mediated interventions, and eHealth/mHealth, among others. Attempts have been made to standardize terminology and definitions, although terms are continuously gaining and losing favor across the literature. This chapter provides an overview of eHealth in cancer prevention and control. Types of eHealth intervention methodologies are reviewed along with examples within the context of cancer prevention and control, such as sun safety behaviors and cancer screening. Future research directions, including issues related to the development and implementation of eHealth interventions, are addressed.
Cancer, Culture, and Health Disparities
Authors: Kagawa-Singer Marjorie , Valdez-Dadia Annalyn
Published: February 2021

Culture is the core, dynamic, responsive, adaptive, and organizing system of life that (1) ensures the survival and well-being of its members, (2) provides a shared way to find meaning and purpose throughout one’s life, (3) creates culturally identifiable ways to communicate caring, and (4) defines characteristics that identify a “good” person. Thus, a cultural system is composed of a shared set of beliefs, values, and lifestyles that enables its members to successfully adapt within a biotic and abiotic geographic niche, using available technology and economic resources, that ensures the survival of its members and provides meaning in and for life within this worldview. Culture also provides its members a purpose for living, especially in times of trial, such as the receipt of a cancer diagnosis. This chapter provides a more comprehensive and integrating concept of culture to guide clinicians to better understand how culture defines a “good person” and desired modes of emotional, physical, and spiritual support. Following these guidelines, clinicians might feel more comfortable learning from their patients in cross-cultural encounters and likely enrich their ability to work collaboratively with patients from diverse backgrounds to provide them the information and support they desire and need when faced with cancer and its myriad questions, choices, and fears.
The Experience of Cancer as an Immigrant
Authors: Gany Francesca M. , Leng Jennifer
Published: February 2021

Immigrants, refugees, and asylum seekers make up approximately 13.6% of the U.S. population (44.4 million people). They have experienced diverse healthcare systems in their sending countries, with varied cancer care options and attitudes toward cancer (e.g., stigmatization). Immigration status and other socioeconomic factors have a deterministic influence on immigrants’ cancer experience, impacting access to treatment and psychosocial resources, and compel the development of linguistically and culturally responsive interventions. Several interventions and programs have been developed to address the socioeconomic and psychosocial factors contributing to cancer health disparities among immigrants. Healthcare access must be greatly improved, and culturally and linguistically responsive evidence-based interventions must be broadly implemented to improve the immigrant experience of cancer.
Fear of Cancer Recurrence
Authors: Smith Allan B. , Fardell Joanna E. , Butow Phyllis N.
Published: February 2021

Fear of cancer recurrence (FCR) is broadly defined as “fear, worry or concern relating to the possibility that cancer will come back or progress.” Some degree of FCR is almost universal among cancer survivors, and management of FCR is frequently reported as an unmet need. Conceptualization and measurement of FCR remain challenging, as consensus regarding its multidimensional nature and clinical presentation is yet to be established. Accordingly, estimated prevalence rates of “clinical FCR” vary widely. Research suggests that if left untreated FCR remains stable over time, and that those who are younger, have greater symptom burden, and experience greater psychological distress are likely to experience more FCR. In contrast, medical (diagnosis staging, treatment, etc.) and other demographic variables do not appear to be strongly associated with FCR levels, making identification of FCR in clinical practice difficult. Brief FCR screening measures have been developed, but further work validating clinical cut-offs is needed. Those who experience a high level of FCR have poorer quality of life and experience difficulties moving on with their life after cancer diagnosis and treatment. A growing number of interventions have demonstrated efficacy in addressing FCR in recent years, with those using contemporary cognitive-behavioral therapy approaches focused on how patients relate to their thoughts, rather than on changing the contents of thoughts, shown to be most effective. Priorities for future research include development of treatment models, such as stepped care, that address the varying levels of FCR in cancer survivors and use interventions of varying intensity to efficiently address FCR.
Occupational Stress in Oncology Staff
Authors: Hlubocky Fay J. , McFarland Daniel C.
Published: February 2021

Oncology clinicians witness challenging situations involving seriously ill cancer patients and distressed families across the cancer trajectory. These experiences coupled with the complexity of cancer and end-of-life care can be onerous, causing disengagement and poor work performance. Oncology clinicians deliver complex interdisciplinary care in an ever-evolving field that increasingly cures but creates complex side effects while most patients still ultimately succumb to cancer. This is often meaningful work, but an oncology service can also be one of the most demanding and stressful areas of medicine. Oncology clinicians face myriad issues that take a toll on clinician mental health. The healthcare system is currently evolving and frustratingly can create inadvertent obstacles in care delivery. Oncology also brings up existential worry for most clinicians who are faced with patients suffering at every stage of the cancer trajectory in and out of crisis states. Many oncology clinicians encounter their own distress, depression, and professional burnout. In the last several years, attention to burnout has skyrocketed across medical disciplines. This chapter focuses on burnout in oncology, its subtypes, implications, and antidotes in mental health restoration.
New Method and Intercultural Awakening
Authors: Breilh Jaime
Published: February 2021

A groundbreaking set of potent ideas, concepts, and methodological tools—developed over years of research and advocacy—are discussed in this chapter. The chapter provides an integral in-depth analysis of health paradigms, explaining the conceptual and technical limitations of conventional epidemiology and public health. It describes and illustrates the main theoretical and methodological ruptures and new categories needed to go beyond the Cartesian logic and its knowledge illusions. It analyzes five central breaks with the cognitive pillars of empirical epidemiology: lineal causality, external conjunction, empirical quantitative and qualitative analysis, empirical socio-epidemiological stratification, and Cartesian health geography. Examples are provided to facilitate useful reflections about research, postgraduate teaching, and health agency. The chapter also highlights some key elements for working toward a new framework for practice and ethos—one necessary to transform the notions of health prevention and promotion, to move beyond conventional conceptions, to leave our institutional comfort zones, and to reaffirm a critical scientific philosophy and rescue potent concepts of the wisdom of ‘others,” moving from passive vertical bureaucratic surveillance to active, community-based critical health monitoring.
Rigid Bronchoscopy and Surgical Airway Procedures, Foreign Body Aspiration, and Gastric Content Aspiration Management
Authors: Webber Audra , Faria John
Published: February 2021

The difficult airway in pediatric patients is most frequently anticipated because of anatomic anomalies from craniofacial pathology. With the increasing population of surviving premature infants who require prolonged intubation perinatally, chronic issues such as subglottic stenosis are also becoming more common. When dealing with the difficult pediatric airway, preparation and communication are key. It is essential to have a continuous dialogue between the otolaryngologist and the anesthesiologist throughout the perioperative course. When involved with a patient who is likely to have a difficult airway, it is best to involve or consult the pediatric otolaryngologist as early in the process as possible. This chapter outlines the most common invasive techniques for management of the pediatric non-normal difficult airway: rigid bronchoscopy and tracheostomy. This chapter will also review the management of an airway foreign body and aspirated gastric contents.
Spinal Anesthesia
Authors: Lazar Alina
Published: February 2021

Spinal anesthesia is the injection of local anesthetics and additives into the subarachnoid space, providing analgesia by creating a sensory block and providing suitable surgical conditions by creating a motor block. In the pediatric population, spinal “intrathecal” anesthesia can be used as an alternative to general anesthesia for lower extremity and abdominal surgery in high-risk patients (e.g., premature or former premature infants, teenagers with malignant hyperthermia susceptibility or chronic respiratory disease). Preservative-free morphine injected into the intrathecal space can also be used for postoperative pain control, for example, after scoliosis repair.
Neonatal Resuscitation
Authors: Nizamuddin Sarah
Published: February 2021

After birth, the neonate must be immediately examined to evaluate the need for further resuscitation. Presence of an adequate respiratory effort and heart rate is vital, in addition to adequate tone and temperature. Warm, dry, and closely monitor the infant immediately after birth. Give positive pressure ventilation if there are any signs of respiratory distress or bradycardia. Low heart rate in a neonate is almost always due to hypoxia, so establish adequate ventilation as soon as possible in these cases. In cases of continued bradycardia, chest compressions and medication (epinephrine) may be necessary. Following resuscitation, transfer the neonate to an appropriate unit for continued monitoring.
Local Anesthetic Systemic Toxicity Treatment
Authors: Clebone Anna
Published: February 2021

Local anesthetic systemic toxicity is a systemic adverse reaction to the administration of a local anesthetic. Children are at particular risk for local anesthetic systemic toxicity given their smaller body weight. In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation may be indicated because cardiac toxicity may last for several hours. Under general anesthesia, some of the early central nervous system signs of local anesthetic systemic toxicity, such as altered consciousness and seizures, may be masked, and the first indicator of local anesthetic systemic toxicity may be hemodynamic instability or cardiac arrest. Nevertheless, in a multicenter database of more than 100,000 consecutive pediatric regional anesthetics, local anesthetic systemic toxicity did not occur more often in pediatric patients undergoing regional anesthesia under general anesthesia compared with patients undergoing regional anesthesia awake or under sedation, and was overall very rare (2.2/10,000 and 15.2/10,000, respectively). In cases of cardiac arrest from local anesthetic systemic toxicity, prolonged chest compressions or extracardiac membrane oxygenation (ECMO) may be required because toxicity may last for several hours or more. Aggressive resuscitation and early administration of intralipid are the most important steps.
Antibiotics for Preterm Premature Rupture of Membranes
Authors: Kohari Katherine S. , Pettker Christian M.
Published: February 2021

Antibiotics for preterm prelabor rupture of membranes (PPROM) have been shown to prolong the length of pregnancy as well as improve neonatal outcomes as demonstrated by the landmark article by Mercer et al. PPROM complicates 3% of all pregnancies, and approximately one-half of patients will deliver within 1 week of membrane rupture. Infection is thought to play a role in both the etiology of PPROM and subsequent maternal and neonatal complications. Premature birth further complicates neonatal outcomes, therefore prolongation of pregnancy after PPROM is essential for risk reduction. Administration of broad spectrum antibiotics have been associated with prolonged latency in women with PPROM at less than 32 weeks and 0 days of gestation as well as improved neonatal outcomes.
Management of Post-Term Pregnancy
Authors: Benson Ashley E. , Einerson Brett D.
Published: February 2021

This article provides a summary of a landmark study in the field of obstetrics. Should patients with post-term pregnancies undergo induction of labor or be managed with serial antenatal monitoring? The article describes the basics of the study, including funding, study location, who was studied, how many patients, study design, endpoints, results, and criticism and limitations. The article also reviews other relevant studies and implications and concludes with a clinical case for application.
Induction of Labor Versus Expectant Management for Prelabor Rupture of Membranes
Authors: Kern-Goldberger Adina , Goffman Dena
Published: February 2021

The article highlights a landmark paper from 1992 addressing the management of women with prelabor rupture of membranes at term. The article reviews the paper in detail, highlights similar and relevant subsequent studies, and addresses up-to-date guidelines. The study compared the outcomes of 5041 with prelabor rupture of membranes at term. Women were either induced with oxytocin or vaginal prostaglandin or expectant management with subsequent induction as indicated. In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.