bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation analysis of optimization design strategy of natural lighting in office buildings
Authors: Wu Junsha
Published: February 2021

As an important indicator of building quality, natural lighting is an important way to save energy and improve visual comfort in buildings. Reasonable use of natural lighting can effectively reduce building lighting energy consumption. Taking an office building project in Wuhan as an example, the article analyzes from three aspects: overall design, deepening design, and other factors, and proposes natural lighting optimization strategies such as building orientation and form layout, atrium daylighting, daylighting openings. Through software simulation analysis, the strategy is verified, and the project design plan is optimized. Thus the optimization design strategy of natural lighting in office buildings is summarized, which provides reference for future lighting and energy saving research.
The effect of the trench layout on the loss of nitrogen production and flow from the rainfall of oblique farmland
Authors: Zhang Guangjun , Liu Shanshan , Qing Tianling , Lv Cuimei
Published: February 2021

The oblique farmland in the northern part of China is often affected by rainfall, which arises out of the loss of a large amount of nitrogen, which causes the reduction of crop yield and the nutrient-rich pollution of river basins. Evaluating the impact of the trench farming layout on the loss of nitrogen production and flow of rainfall in sloping farmland can provide a scientific basis for the prediction and effective prevention and control of nitrogen loss in sloping farmland. Taking the oblique farmland of corn as the research object, nitrogen loss of distinctive ridges and the pitch of the ditches under natural rainfall conditions were continually observed by using the field prototype field observation test. According to the local farming tradition, three kinds of ridge and furrow trends should be set up, including horizontal ridge, vertical ridge and oblique ridge. The ridge and furrow spacing of the three tillage methods should be set at three levels, 40cm, 60cm and 80cm in turn. In addition, establish a field without ridge flat for blank control. Using the method of frequency statistics, it is calculated that the trench layout with the smallest nitrogen loss in each rainfall production stream is frequency in the annual rainfall production flow, and the trench layout with the smallest nitrogen loss is found from the overall trench layout and the same trench to different ridge spacing, and the same trench spacing to the three aspects of the trench layout. The results show that the optimal ridge and furrow layout with the minimum loss of nitrate nitrogen, ammonium nitrogen and total nitrogen is 60 cm ditch spacing in a horizontal ridge direction.
Study on Influencing Factors of Carbon Emission of Civil Buildings Based on Regional Differences
Authors: Sihui Yang , Jing Liu , Mengjie Wang
Published: February 2021

China's civil building carbon emissions show different characteristics due to different regions, so we should take measures to reduce carbon emissions according to local conditions. In this paper, LMDI model is used to study the influencing factors of carbon emissions in four regions of China according to the total amount and efficiency of carbon emissions. The influencing factors are divided into economic scale effect, per capita economic effect, urbanization effect, per capita building area effect, energy consumption per unit area effect and comprehensive carbon emission factor effect, and decompose each effect, find out the key factors that affect the carbon emissions of civil buildings in each region, and provide the direction for carbon emission governance of civil buildings in China.
Design of air quality monitoring system based on light scattering sensor
Authors: Tong YU , Mei-de XU , Zi-han YU , Tian-qing ZHANG
Published: February 2021

The current air quality detector mainly detects the PM2.5, temperature and humidity of the environment at a single point, and the official website data is also a large range of regional data. The traditional cable transmission and wiring is complex, limited by the environment and high cost. In this paper, a data service air quality detection system based on light scattering sensor is proposed, which can detect PM2.5, temperature and humidity, and upload data to the Internet of things platform for real-time analysis and historical data statistics. It can also upload data to the Internet of things platform for real-time analysis and historical data statistics. The system collects three kinds of sensor modules to monitor indoor air environment in real time. Monitoring data is sent to mobile terminal equipment or PC terminal through WiFi. Its historical data can be viewed and called for data statistics through mobile phones. The system is stable and convenient to use. The paper also studies the detection characteristics and improvement methods of light scattering sensor.
Comprehensive assessment of water quality of ten rivers in Zhengzhou main urban area
Authors: Ren Wenhao , Zhang Qiying , Qian Hui
Published: February 2021

In order to clarify the water quality characteristics and provide reference for the overall control and prevention of the rivers in Zhengzhou, the comprehensive pollution index method and the Nemerow pollution index method were used to evaluate the water quality of ten rivers in Zhengzhou main urban area. The results show that the water quality of ten rivers in Zhengzhou is worse than that of Class III before February 2018. After that, the water quality was improved and basically reached Class III water quality. Suggestion: the main prevention and control work in Zhengzhou is to control the discharge of pollutants, especially chemical oxygen demand and ammonia nitrogen pollutants.
Temporal-spatial evolution characteristics of meteorological drought in Guanzhong Basin based on SPEI drought index
Authors: Zhang Qiying , Ren Wenhao , Qian Hui , Xu Panpan , Guo Meng
Published: February 2021

As the main agricultural area of Shaanxi Province, the Guanzhong Basin has a fragile ecology and frequent droughts. This study focuses on the intensity, duration, and frequency of meteorological droughts in Guanzhong Basin, from 1955 to 2015, and the temporal-spatial characteristics of meteorological drought were evaluated based on the standardized precipitation evapotranspiration index (SPEI). Our results show that the four SPEI values all show a decreasing trend with time, which indicates that the frequency of droughts is gradually increasing. Moreover, the frequency of meteorological droughts does not exceed 40%, with a decreasing order of light drought > moderate drought > heavy drought > extreme drought. The mild drought, moderate drought, severe drought, and extreme drought mainly occur in the eastern, west, south, and north parts of the Guanzhong Basin, respectively.
An Investigation of the Membrane Fouling Behaviors in Constant Flux Mode
Authors: Yin Shuang , Song Peng , Chen Yujie , Du Xinpei , Liu Xuguo , Zhang Hu , Wang Zhan , Wang Xi
Published: February 2021

Studying the effect of different operation conditions (bovine serum albumin (BSA) concentration, flux and stirring speed) on the membrane fouling behaviors (the variation of transmembrane pressure (TMP), cake resistance (Rc), pore blocking resistance (Rc
) and available membrane area ratio (A/A0
) is of paramount importance in the membrane bioreactor (MBR) process. The constant flux filtration experiment was conducted to investigate the fouling behaviors of BSA solution, which provides a guidance for controlling the membrane fouling. The intermediate blocking-cake combined model was established and it was described mathematically with good results. The results showed that the influence sequence of operating conditions on the TMP was obtained as flux > concentration > stirring speed. Meanwhile, Rc
decreased with the increase of stirring speed, and the A/A0
decreased with the increase of BSA concentration and the flux.
A study on heating of residential buildings in the Yangtze River Valley of China
Authors: Dong Xujuan , Yan Zengfeng , Shi Xiaofeng
Published: February 2021

Yangtze River is China's densely populated and the most economically prosperous region. It’s hot and humid in summer and cold in winter in this region. This area is considered as a non-heating region in winter, The residential building design usually does not consider the building heating requirements. The building envelope thermal performance is poor, and the indoor thermal environment quality is worse in the residential building in this region. In recent years, local experts and residents in the area have expressed strong willingness to building heating in winter. Consequently, on the basis of field investigation and field test, this paper has analyzed the choice of building heating mode from the aspects of local meteorological conditions, indoor environment status, local residents' living habits and residents' heating demand. Based on the results of the technological economic comparison of preliminary studies, suggestions on the suitable building heating mode were given in the Yangtze River Valley of China.
A Preliminary Study of Slow Traffic System to Activate the Vitality of Historic Districts Take Wuhan Tanhualin Historic District as an example
Authors: Zhang Naiwen
Published: February 2021

Human activity is a prerequisite for a neighborhood to be full of vitality. As the embodiment of the image of the city, the historical districts need to rely on human behavior. Slow traffic can promote people's communication to a certain extent, so the slow traffic system has a certain significance in activating the vitality of historic districts. This article summarizes the Tan Hualin historic district by investigating the current situation of residents’ traffic in Tan Hualin Combining with the existing examples and based on the slow traffic system, this paper proposes measures to improve the existing problems in the Tanhualin Historic District in Wuhan, and explores how the slow traffic system can stimulate the vitality of the historic district.
The Study of Fouling Behavior for the Model Binary Mixture
Authors: Gao Shujuan , Liu Xinsen , Zhang Hu , Liu Xuguo , Wang Zhan , Wang Xi
Published: February 2021

This study systematically investigated the fouling behavior and mechanism of PAN Microfiltration (MF) membrane fouled with the model binary mixture (bovine serum albumin (BSA) and sodium alginate (SA)) of extracellular polymer substance (EPS) solution under different concentration and transmembrane pressure (TMP). The result showed that the fouling mechanism of the model binary mixture was the pore blocking and cake formation. Moreover, the SA plays a dominant role in the model binary mixture (BSA/SA). The higher SA concentration could cause the more serious membrane fouling (both the flux (J) and the available membrane area (A/A0
) decreased), and the total resistance increased and caused the fouling mechanism changing from combined complete blocking and cake filtration into individual cake filtration appeared earlier. In addition, increasing of the TMP can also aggravate membrane fouling and it could be accurately described by the cake-complete model. This studied offered insight into the model binary mixture in the fouling behavior and mechanism, which can be used as guidance for practical application.
Application of water ecological restoration guided by microbial activation in landscape water
Authors: Yuan Yihui , Zhao Fengbin , Feng Yibing
Published: February 2021

Water eutrophication is one of the difficulties in urban landscape water. In the past period of time, people have been exploring the prevention and control of eutrophication of landscape water. At present, submerged plant restoration, chemical control of algae and physical equipment filtration technology are becoming more and more mature. Among them, submerged macrophyte restoration has become the mainstream technology, but the restoration of submerged macrophytes is faced with the problem of lack of transparency, which leads to the failure of engineering construction. Indigenous microbial activation(IMA) technology has become an effective method to solve this problem. The technology focuses on the water microbial community as the research object. By adding an activator with a suitable concentration gradient to the experimental landscape water, the indigenous microbial community is activated landscape water. The paper analyzed the current landscape water eutrophication technology, summarized the relationship between bacteria and algae, algae and submerged plants, and proposed IMA microbial activation technology. In addition, we share a project case to better illustrate this technology.In the case, IMA equipment was added to the experimental landscape water to study the water environment quality changes before and after the implementation of the project, so as to evaluate the feasibility and technical advantages of IMA technology, and provide technical ideas and data support for landscape water treatment.
Achievements of green economic development in China from the perspective of environmental governance modernization
Authors: Zhong Xianzhe
Published: February 2021

President Xi Jinping's concept of green development contains prosperous concepts of economic development and environmental governance modernization. It is an important guideline for the coordination between economic development and energy development. The concept of green development adheres to the two main lines including high-quality economic development and environmental protection, helping the construction of ecological civilization and the harmonious development of economy in China. This paper analyzes the new achievements of China's economic green development in the process of ecological civilization construction. It uses the regional development index method to analyze the comprehensive development index of Beijing and neighboring Tianjin municipality and Hebei province, showing the breakthrough of China's economic green development. It also helps further understand the characteristics and theoretical contributions of Xi Jinping's ecological civilization thought, which will effectively promote an in-depth development of China's ecological civilization strategy. Meanwhile, it provides China's plan and wisdom for promoting world economic development, global ecological governance and building a community of shared future for mankind.
Predicting the impact of urban rail transit construction on employment attractiveness based on the GM(1,1) model: A case study of Guangzhou
Authors: Ge Yingxi , Wang Beibei
Published: February 2021

Taking Guangzhou, one of the four largest first-tier cities in China, as an example, this paper analyzes the impact of urban rail transit construction on the level of urban employment attraction. Through the establishment of grey model, the relationship between the number of employees in the subway and the whole society is established, and the development trend of Guangzhou's employment attraction in the next five years is predicted. The conclusion is that the number of employees in Guangzhou will reach 10371290 in 2023.
Reference XPS spectra of amino acids
Authors: Artemenko A , Shchukarev A , Štenclová P , Wågberg T , Segervald J , Jia X , Kromka A
Published: February 2021

In this report we present XPS data for five amino acids (AAs) (tryptophan, methionine, glutamine, glutamic acid, and arginine) with different side chain groups measured in solid state (powder form). The theoretically and experimentally obtained chemical structure of AAs are compared. Here, we analyse and discuss C 1 s, N 1 s, O 1s and S 2p core level binding energies, FWHMs, atomic concentrations of the functional groups in AAs. The experimentally obtained and theoretically calculated ratio of atomic concentrations are compared. The zwitterionic nature of methionine and glutamine in solid state was determined from protonated amino groups in N 1s peak and deprotonated carboxylic groups in the C 1s spectrum. The obtained XPS results for AAs well correspond with previously reported data.
Optical emission spectroscopy of radio frequency inductively coupled plasma for cold hydrogenation of nanoparticles
Authors: Remes Z , Kromka A , Micova J , Rezek B , Poruba A , Hsu Hua-Shu
Published: February 2021

The radio frequency inductively coupled plasma (ICP) offers an alternative “cold” way to affect the size, composition, structure, and surface functionality of nanoparticles (NPs), such as metal oxide NPs, providing further adjustment of their physical and chemical properties. The ICP was monitored in-situ by optical emission spectroscopy (OES). In particular, hydrogen, oxygen, argon, and nitrogen plasma was studied. OES data show that despite the decrease of the optical emission intensity with increasing gas pressure, the concentration of atomic hydrogen increases with pressure and radio frequency power.
Bactericidal effect of zinc oxide nanoparticles on Grampositive and Gram-negative strains in reverse spin bioreactor
Authors: Rutherford D , Jíra J , Kolářová K , Remeš Z , Rezek B
Published: February 2021

We present an experimental study investigating the efficacy of zinc oxide nanoparticle use for bacterial decontamination of water using reverse spin technology. The number of viable bacteria reduced with treatment time and the rate of inactivation was dependent on zinc oxide concentration. Gram-positive S. aureus bacteria were more resistant to zinc oxide nanoparticles compared to Gram-negative E. coli, however both strains were completely eradicated after 4 hours using a concentration of 10 μg/mL. Nanoparticles did not inhibit growth of bacteria when added to an agar surface, neither when in liquid before bacteria inoculation nor when loaded onto filter paper disks after bacteria inoculation. These results emphasise the importance of efficient reactor mixing to enhance interaction capability for ZnO use in water decontamination.
Mobile application to optimize care for ST-segment elevation myocardial infarction patients in a large healthcare system, STEMIcathAID: rationale and design
Authors: Krishnamoorthy Parasuram , Vengrenyuk Andriy , Wasielewski Brian , Barman Nitin , Bander Jeffrey , Sweeny Joseph , Baber Usman , Dangas George , Gidwani Umesh , Syros Georgios , Singh Manjit , Vengrenyuk Yuliya , Ezenkwele Ugo , Tamis-Holland Jacqueline , Chu Kenny , Warshaw Abraham , Kukar Atul , Bai Matthew , Darrow Bruce , Garcia Haydee , Oliver Beth , Sharma Samin K , Kini Annapoorna S
Published: February 2021

Aims

Technological advancements have transformed healthcare. System delays in transferring patients with ST-segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) centre are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication, and coordination between the STEMI care teams to reduce ischaemia time and improve patient outcomes.

Methods and results

The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the electrocardiogram and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer centre. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPAA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge, important data elements have to be entered to close the case.

Conclusion

We developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.
Double Counting of Investment
Authors: Barro Robert J
Published: February 2021

The national-income accounts double-count investment, which enters once when it occurs and again in present value as rental income on added capital. The double counting implies that GDP and national income overstate sustainable consumption. An alternative measure, ‘permanent income’, equals consumption in the steady state but deviates from consumption outside of the steady state because expensing of gross investment applies to the long-run flow, not the current value. The permanent-income perspective substantially affects measured factor-income shares. When computed in relation to permanent income, the US labour-income share has been reasonably stable, in contrast to the declining share based on GDP.
Physical Activity, Sedentary Behavior, and Cancer
Authors: Friedenreich Christine M. , Stone Chelsea R. , McNeil Jessica
Published: February 2021

This chapter reviews the epidemiologic evidence for the associations between physical activity, sedentary time, and cancer incidence. There is consistent evidence that regular physical activity participation decreases the risk of breast, colorectal, prostate, lung, endometrial, ovarian, and pancreatic cancers and that higher levels of sedentary time increase the risk of colorectal, endometrial, and lung cancers, independently of physical activity participation. There is emerging evidence suggesting a protective effect of resistance exercise and cardiorespiratory fitness on cancer risk. Several plausible biologic mechanisms now exist to explain how physical activity and sedentary behaviors are associated with cancer risk. In addition, common barriers and facilitators to physical activity behavior change are reviewed that should be considered in future intervention trials. The chapter also provides estimates of the population attributable risks for cancer incidence associated with physical inactivity and sedentary behavior and an update on physical activity guidelines aimed at reducing cancer risk.
Sun Exposure and Cancer Risk
Authors: Dobbinson Suzanne J. , Girgis Afaf , Armstrong Bruce K. , Cust Anne E.
Published: February 2021

This chapter covers epidemiologic evidence for the association of ultraviolet (UV) radiation with cancer, psychosocial and behavioral research on sun exposure and sun protection, and mixed messages regarding the role of vitamin D in influencing cancer risk. The focus is primarily on sun exposure, but indoor tanning is also covered. The evidence is convincing for a causal relationship between UV radiation and skin cancer, but there appears to be a protective association of UV radiation with some internal cancers, namely colorectal, prostate, and breast cancers and non-Hodgkin lymphoma. This association may or may not be mediated by cutaneous vitamin D production. Predictors of sun exposure and sun protection behaviors and recommendations for UV protection are reviewed. A summary of psychosocial and behavioral skin cancer prevention interventions and approaches for different target groups is presented and linked to theoretical models that help to explain behavior change.
Skin Cancer Screening
Authors: Hay Jennifer L. , Christian Stephanie N.
Published: February 2021

Skin cancers are exceedingly common malignancies in the United States and include keratinocyte cancers, which have low mortality rates but are costly to treat, and melanomas, which can be deadly if diagnosed at later stages. Skin cancer screening for the general population has not received recommendation by the United States Preventive Services Task Force, given the paucity of clinical trial data documenting utility, yet there are sound arguments for the utility of risk-based screening, based on increased skin cancer risk. Such risk factors include skin type, high mole number, genetic susceptibility, and family or personal history of skin cancers. Screening can involve an inspection of the entire skin surface performed by a dermatologist or other health care provider, or self-screening, whereby individuals conduct an examination of their skin surface at home, which can be facilitated through the use of a mirror, as well as a family member or friend to facilitate skin inspection. Rates of physician screening as well as skin self-examination are low in the United States. This chapter reviews the current evidence and recommendations for skin cancer screening in the United States. It also reviews the current rates of screening, both overall and in higher-risk subgroups. The chapter discusses the recent evidence for the use of interventions to enhance skin cancer screening. It also presents some innovative use of new technology to increase skin cancer screening as well as future directions for this research.
Colorectal Cancer
Authors: Miles Anne , Redeker Claudia
Published: February 2021

Psychological issues around colorectal cancer (CRC) can emerge from the point CRC is suspected, through treatment, to living with or beyond cancer. One-third of patients report high levels of anxiety while undergoing investigations for suspected cancer, and emotional difficulties, particularly anxiety and fear of recurrence, can persist for years following a confirmed diagnosis. Treatments for CRC can result in problems with bowel, urinary, or sexual function and issues with body image following major surgery and/or the presence of a stoma. Such problems can impact both the patient’s social life and ability to work, and result in financial difficulties. Fatigue and difficulty sleeping remain common problems among patients with chronic cancer. Evidence suggests that patients with screen-detected disease experience better quality of life and are more satisfied with their cancer care. Enhancing screening provision and uptake is probably the most effective way of reducing the psychological impact of a CRC diagnosis. However, there are marked differences across countries in screening provision. A substantial proportion of patients living with cancer, and of people cancer-free following curative treatment, report unmet needs around living with anxiety, uncertainty, and fear of dying as well as the need for medical support and information. Interventions to reduce unmet needs in cancer patients have had little success to date, and more effective interventions are required to help CRC patients with the challenges they face before and after a cancer diagnosis.
Prostate Cancer and Genitourinary Malignancies
Authors: Roth Andrew J. , Gonzalez-Restrepo Alejandro
Published: February 2021

This chapter on prostate and genitourinary (GU) cancers focuses on advances in the science of treating prostate, bladder, testicular, kidney, and penile cancers. These cancers are common and are becoming more successfully treated yet can cause significant worry about both longevity and quality of life. Psycho-oncologists can help patients manage the challenges of potential sexual and intimacy issues as well as disruption to one’s body image, distress about treatment decisions, living with active surveillance and with the potential of cancer recurrence, pain and fatigue related to cancer treatments or bony metastases, and end-of-life issues. Men with prostate cancer deal with erectile and urinary dysfunction and attempt to avoid it at all costs in primary treatment decisions. Men with testicular cancer face a life-threatening situation that can interfere with early relationships, career, and body image. People with bladder cancer face the possibility of needing an external apparatus to deal with a heretofore natural bodily function. Even with improved treatments for kidney cancer, patients still cope with significant mortality prediction. Those men with penile cancers deal with very direct invasion of the body image and sexuality. Psycho-oncologists must keep abreast of breakthroughs in new diagnostic tests, which may facilitate more options for active surveillance, as well as new cancer treatments that patients must consider, and the side effects they might encounter. Advocates for improved symptom control including pain management and fatigue improvement are especially important with prostate and GU cancers because patients and families can feel unwarranted shame and embarrassment because of the location of the cancer.
Cancer-Related Pain
Authors: Garrett Key R. , Liebling Dustin , Malhotra Vivek T. , Passik Steven D. , Moryl Natalie , Breitbart William S.
Published: February 2021

Pain is prevalent in cancer patients, and the number of people diagnosed and living with cancer is expected to increase in the future. The need for experts in cancer pain management will grow as treatment complexity and survival increase. Cancer clinicians need to understand the pharmacologic, surgical/interventional, and psychological approaches to cancer-related pain. This chapter reviews the prevalence of pain in cancer, cancer pain syndromes, pain assessment and treatment, and pain-related recommendations of the National Comprehensive Cancer Network (NCCN). Psychiatric and psychological interventions in the treatment of cancer pain are an integral part of a comprehensive approach to pain management and are highlighted.
Sexual Problems and Cancer
Authors: Carter Jeanne , Arkema Ashley , Roth Andrew J. , Saban Sally , Nelson Christian J.
Published: February 2021

Cancer survivors face a unique set of treatment-related issues impacting sexual function and quality of life. While some treatment-related sexual adverse effects are temporary, many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement. Treatment modalities including surgery, chemotherapy, radiation therapy, and endocrine therapy present with persistent changes in tissue quality and sexual response. Common changes in sexual function for cancer survivors include decreased libido or sexual interest and pain with penetration in women and erectile dysfunction in men. As cancer survivorship improves, it is increasingly important for medical professionals to inquire about the sexual health of their patients. Health promotion strategies such as vulvovaginal moisturizers and dilator therapy for women or prescription medication for men can be recommended to counteract sexual side effects during and after treatment. Additionally, sexual counseling can enhance communication among distressed couples coping with cancer. While sexual side effects are prevalent, they often go unacknowledged in busy clinical settings. Screening tools can be utilized to identify treatment-related complications including lymphedema, fatigue, insomnia, and pain. Standardized measures validated in cancer populations are recommended to clinicians assessing sexual dysfunction in oncologic settings. Educational resources and sexual health referral networks can provide additional support to help patients manage distressing symptoms.
Neuropsychological Impact of Cancer and Cancer Treatments
Authors: Gaynor Alexandra M. , Root James C. , Ahles Tim A.
Published: February 2021

Survivors of primary central nervous system (CNS) cancers and non-CNS cancers often report cognitive deficits, thought to result from surgery, radiation, chemotherapy, and the presence of cancer itself, and which significantly impact quality of life in survivorship. To develop the most effective methods of remediation and rehabilitation for cognitive dysfunction in a growing population of cancer survivors, it is necessary to understand the disease- and treatment-related factors that contribute to cancer-associated cognitive dysfunction, the strengths and limitations of current methods of neurocognitive assessment, the relationship between self-reported cognitive difficulties and objective measures of neuropsychological function, and the treatment and management options available to those suffering from cognitive impairment following treatment. The current chapter reviews the etiology, types of neurocognitive assessment, and treatment and management methods, and includes suggestions for future research to better understand the complex nature of cancer-associated cognitive dysfunction.
Adjustment Disorders in Cancer
Authors: de Vries Froukje , Hales Sarah , Rodin Gary , Li Madeline
Published: February 2021

Adjustment disorder (AD) refers to a condition in which an individual reacts to an identifiable stressor with disproportionate symptoms and behaviors. It is now considered as a stress-related disorder in both the DSM-5 and ICD-11 and is the most commonly diagnosed psychiatric disorder in cancer patients. Nevertheless, this diagnosis remains problematic in terms of its conceptualization and evidence base. The specificity of the diagnostic criteria has been questioned and concern has been expressed that it medicalizes distress and increases the likelihood of unnecessary psychopharmacological interventions. However, evidence suggests that categorizing distress as AD may actually lead to appropriate interventions aimed at prevention or treatment. This chapter focuses on the validity and utility of the concept of and diagnostic criteria for AD and reviews the available evidence base regarding treatment of this disorder in cancer patients.
Delirium
Authors: Alici Yesne , Breitbart William S.
Published: February 2021

Delirium is one of the most common and often serious neuropsychiatric complications in the management of cancer patients that is characterized by abrupt-onset, fluctuating disturbance in awareness, attention, cognition, and perception. Delirium is associated with increased morbidity and mortality, causing distress in patients, family members, and staff. Delirium is a medical emergency, a sign of significant physiologic disturbance, usually involving multiple medical etiologies, that needs to be prevented, identified, and treated vigorously. Unfortunately, delirium is often underrecognized or misdiagnosed and inappropriately treated or untreated in the medical setting. Psycho-oncologists who care for patients with cancer must be able to diagnose delirium accurately, undertake appropriate assessment of etiologies, and understand the benefits and risks of pharmacologic and nonpharmacologic interventions currently available. This chapter presents a comprehensive overview of the epidemiology, pathophysiology, clinical features, assessment, and management of delirium in cancer patients.
Posttraumatic Stress Disorder Associated with Cancer Diagnosis and Treatment
Authors: Doolittle Matthew , DuHamel Katherine N.
Published: February 2021

Posttraumatic stress disorder (PTSD) is a set of maladaptive responses to intensely fearful or life-threatening events. Unlike other traumas, the trauma of cancer is not generally a single catastrophic event, but is instead an ongoing series of fearful and painful experiences associated with the threat of death. Unlike the DSM-IV, the DSM-5 defines medical trauma in objective terms as an identifiable catastrophic event, and this complicates the applicability of the model to cancer. Nonetheless, maladaptive stress responses can clearly result in increased distress in cancer patients, and in a subset of highly symptomatic people they may interfere with adherence to necessary or even life-saving medical treatments. The heterogeneity of studies and methodologies does not yet allow clear estimation of the prevalence of such responses. However, rates of posttraumatic stress symptoms among patients diagnosed with cancer are consistently higher than those in the general population. Risk factors are not clearly defined in the general population and are less well described in the cancer population, but it is likely that patients with pre-existing psychiatric diagnoses and especially patients with prior trauma are at elevated risk. Diagnosis and treatment of PTSD in the cancer setting are currently analogous to that in the noncancer setting, although research on nonpharmacological interventions is developing, and research on medications is almost nonexistent. For psycho-oncologists, the task is to devise more effective and methodical ways of identifying at-risk or symptomatic populations, and to develop treatments that may improve the quality of life and improve adherence in these vulnerable patients.
The Role of Implementation Science in Advancing Psychosocial Cancer Care
Authors: Jacobsen Paul B. , Norton Wynne E.
Published: February 2021

Despite considerable evidence that psychosocial care can effectively reduce distress in patients with cancer, many individuals who could benefit from these services do not receive them. This situation reflects, in part, the general lack of studies informed by implementation science that are designed specifically to promote the adoption of evidence-based models of psychosocial care as part of routine clinical practice. Thus, part of the solution involves expanding the scope of research in psychosocial oncology to include designing and conducting pragmatic clinical trials and using hybrid designs to simultaneously evaluate clinical effectiveness and barriers and facilitators of implementation. Use of these approaches holds considerable potential for promoting more widespread adoption of evidence-based models of care and providing stronger support for standards and policies related to the psychosocial care of people with cancer.
Supportive Psychotherapy in Cancer
Authors: Caruso Rosangela , Nanni Maria Giulia , Grassi Luigi
Published: February 2021

Cancer patients are confronted with several issues, potentially interfering with quality of life at many levels. For this reason, psychological support is recognized as an essential component of comprehensive cancer care. Supportive psychotherapy (SP) can be a valid tool in the psychological care of cancer patients. The role of SP is to facilitate patients’ adjustment, to sustain engagement with life, to regulate affects, and to alleviate anxiety and confusion derived from trauma. The therapists work with the aim to strengthen patients’ sense of self-efficacy, confidence, and hope, without challenging their positive defenses. SP can be delivered both continuously and intermittently to cancer patients, in integration with other therapeutic approaches and according to the level of psychological suffering. The circumstances when a supportive intervention may be particularly indicated are represented by the “tipping” or critical points in the illness trajectory, namely at the time of diagnosis; during therapy, posttherapy, progression, and palliative care; and in any phase when distress or psychological needs emerge. Psychological needs can be significantly different for patients at the early stages of illness and those at an advanced or terminal stage. Supportive psychotherapists must consequently be flexible and adjust their approach to patients’ conditions and difficulties. Moving SP toward an era of high-quality research and manualization is necessary, with the aim of adapting SP to different phases of the disease, as well as different psychosocial conditions and needs of patients, according to a personalized approach to cancer care. Therefore, training in SP needs to be part of the curriculum of diverse professionals in oncology settings to increase the availability of more evidence-based interventions across the cancer continuum.
Metacognitive Approaches
Authors: Sharpe Louise , Curran Leah
Published: February 2021

This chapter presents the theory underpinning metacognitive therapy (MCT) and evidence for the efficacy of MCT in psychological disorders generally and its application in addressing anxiety and mood disorders in psycho-oncology specifically. MCT is a third-wave therapy that targets the processes that maintain psychopathology, such as worry, rumination, and suppression, and the beliefs about how one should respond to intrusive and unwanted thoughts (metacognitions) that drive those responses. Because MCT does not target the content of thoughts or worries but rather the content of metacognitions and interrupts the process of worrying that often follows, it is particularly useful in the psycho-oncology context. Emerging evidence suggests that MCT may be an acceptable and effective treatment for cancer-related anxiety and fear of cancer recurrence.
Physical Activity and Exercise Interventions in Cancer Survivors
Authors: Grimmett Chloe , Beeken Rebecca J. , Fisher Abigail
Published: February 2021

The field of exercise oncology has developed such that it is clear that people affected by cancer should be encouraged to be physically active from the point of diagnosis; indeed, this is now a key component of the survivorship care package in many countries. However, there are still gaps in the evidence. The majority of evidence for the benefits of exercise after cancer comes from breast, prostate, and colorectal cancer patients, usually without metastatic disease. Trials have usually been rated as low to moderate in quality, and although double-blinding will always be an issue in behavioral trials, there is a need to approach exercise studies with the rigor applied to drug trials if it is to be considered an adjuvant cancer therapy. Additionally, there are still gaps around the most appropriate types of exercise for specific cancer sites and how best to implement exercise as part of cancer care, balancing interventions that are likely to reach a large number of patients (e.g., remote, digital) versus those that may have greater benefit (e.g., supervised, face to face). Finally, while observational data are strongly supportive of higher self-reported postdiagnosis physical activity being associated with lower all-cause and cancer-specific mortality, and possibly recurrence, definitive trial data does not yet exist (although a number of trials are underway). Until survival data are generated, caution should be used in how the benefits of exercise are presented to cancer patients, with a focus on the large number of outcomes that have been robustly demonstrated to improve in response to intervention.
Financial Toxicity in Cancer Treatment
Authors: Blinder Victoria , Gany Francesca M.
Published: February 2021

Financial toxicity is a preventable cancer treatment side effect, encompassing the subjective financial distress and objective financial burden that result from increased spending and decreased earning after diagnosis. The prevalence of financial toxicity has increased with new expensive cancer treatments and insurers gradually shifting costs to patients. Patients with financial toxicity experience increased symptom burden, treatment nonadherence, and cancer-related death. The patients at highest risk are young, female, and nonwhite. For low-income patients, the indirect costs of cancer care can be especially burdensome and include child/elder care, transportation, unpaid work absences or job loss, cancer-related comorbidity treatment costs, and fulfilling dietary requirements. Psychosocial impacts include depression, emotional distress, and reduced quality of life. Patients in palliative care have rated financial distress as more severe than physical, familial, and emotional distress. Interventions and policy changes are needed to ameliorate the effects of financial toxicity, especially for the most vulnerable groups.
Depression, Inflammation, and Cancer
Authors: McFarland Daniel C. , Walsh Leah E. , Miller Andrew H.
Published: February 2021

Depression in cancer is common, often unrecognized and untreated, and has a significant impact on quality of life and morbidity and mortality. Increasing understanding of the impact of the immune system and inflammation on the brain has revealed that cancer patients are at an especially increased risk for inflammation-induced depression by virtue of the many sources of inflammation to which they are exposed. Treatments including surgery, radiation, chemotherapy, and immunotherapy as well as cancer itself are associated with increased inflammation that can drive brain changes and depression. This chapter will review the relationship between depression and inflammation in cancer patients with special attention paid to the data that support increased inflammatory markers in cancer patients with depression, the neurobiological mechanisms by which inflammation can impact neurotransmitters and neurocircuits in the brain, and the data addressing interventions that reduce inflammation and depression in cancer patients. Finally, the chapter addresses future directions regarding the translational implications of this work.
The Older Cancer Patient
Authors: Given Barbara A. , Given Charles W.
Published: February 2021

Approximately one-third of all persons reaching the age of 70 will receive a cancer diagnosis. By 2022, there will be 18 million cancer survivors in the United States, and approximately 63% will be 65 or older. Among the population 65 and older, cancer is the second leading cause of death. These increasing incidence rates combined with longer survival will place new demands on the cancer delivery system. The single largest payers for healthcare, Medicare and Medicaid, will experience increased stress as immunologic and other costly therapies become the standards of care. It is important to understand how to manage care for older persons with cancer, many of whom may already be dealing with other chronic health problems. Factors beyond chronological age must be considered when care decisions are made. Given the increased life expectancy resulting from improved treatment of cancer, as well as management of other chronic diseases, cancer and aging are important areas of concern for the future of healthcare. Older patients, even those with few or no comorbid conditions, are less likely to receive treatment with a curative intent. Older cancer patients face the challenge of finding individualized, patient-centered cancer care that considers how physiological, social, psychological, and, more recently, economic parameters interact with treatment options to attain outcomes that manage the disease while preserving quality of life. This chapter discusses these parameters as they pertain to cancer and cancer treatment in the older individual.
Communicating with the Older Adult Cancer Patient
Authors: Parker Patricia A. , Banerjee Smita C. , Korc-Grodzicki Beatriz
Published: February 2021

The older adult population continues to increase. Among all known risk factors for developing cancer, the most important is growing old. Thus, caring for older adults with cancer is of increasing importance. This chapter describes important considerations involved in communicating with cancer patients including sensory impairment, cognitive impairment, multiple morbidity, polypharmacy, and psychological distress. It also describes how stereotyping and ageism affect communication with older adults with cancer. Finally, the chapter discusses ways to facilitate communication with older adult cancer patients and their families and provides an example of a training program that was created specifically to enhance communication between healthcare providers and older adult cancer patients and their families.