bluuebunny/crossref_metadata_2025 huggingface dataset:
A framework for using computational fire simulations from the early phases of ship design
Authors: Kang H. J. , Choi J. , Lee D. , Jo M. C.
Published: August 2021

Despite all ships being built according to fire safety rules and regulations, ship fire accidents still occur. Currently, computational simulation tools are used to predict and mitigate fire propagation. However, fires have no reproducibility, and many types of flammable equipment and facilities cannot be considered in such simulations. Vague and varying simulation requirements can confuse ship designers. Time and budget limitation of design process also should be considered. Therefore, a framework for using computational fire simulations was explored in this study. The frame work started from the viewpoint ship designers with understanding of real ship design and building process.
Design and Performance Analysis of Vane Wheel
Authors: Seok Woo-Chan , Lee Hyoungsuk , Zorn Tobias , Shigunov Vladimir
Published: August 2021

For the analysis, a vane wheel was considered consisting of two portions, namely, a turbine portion and a propeller portion. The turbine portion was designed using Blade Element Momentum Theory (BEMT); the propeller portion, Computational Fluid Dynamics (CFD) under open-water conditions. Model tests were conducted at Hyundai Maritime Research Institute (HMRI) in their towing tank, using a Contra Rotating Propeller (CRP) dynamometer. Model tests as well as full-scale CFD calculations were performed to predict overall performance. The CFD calculations showed better performance compared to the model tests. In general, the analyzed vane wheel improved the propulsive efficiency via power reduction compared to the case without a vane wheel.
Investigation of the Cost of Future Naval Amphibious Capability
Authors: Jones Andrew J. , Armstrong Rob
Published: August 2021

Through the creation of a large number of concept designs, the cost and vessel impact of deploying and supporting amphibious operations has been investigated. The investigation has looked at capabilities such as the transportation and delivery of vehicles, landing craft, aviation and embarked troops in a number of platform types such as LPDs, LHDs and Ro-Ros. A series of trends describing the costs of the capability have been investigated to estimate the cost of individual capabilities within a design. Over the timeframe of the study, vessel manning is predicted to change and a method of predicting the crew requirement has been developed to investigate the impact of reduced manning on amphibious platform designs. This is the first of two stages of work; in the second stage the requirements for a task group will be investigated to determine the best way to deploy capability at a fleet level.
Prediction of Warship Manoeuvring Coefficients using CFD
Authors: Oldfield C. , Larmaei M. Moradi , Kendrick A. , McTaggart K.
Published: August 2021

Verification and validation has been completed for the use of computational fluid dynamics as a practical means of simulating captive manoeuvring model tests. Verification includes spatial and temporal refinement studies. Direct validation includes the comparison of individual steady drift and planar motion mechanism simulations to physical model test data. Rotating arm simulations are validated indirectly on the basis of manoeuvring derivatives developed from the PMM tests. The merits of steady and unsteady simulations are discussed.
Strongly Nonlinear Phenomena in Extreme Waves
Authors: Iafrati Alessandro , Vita Francesco , Toffoli Alessandro , Alberello Alberto
Published: August 2021

In this paper the breaking of steep free surface waves is investigated by a two-fluid numerical approach. The study is focused at providing estimates of the energy dissipation and the variations to the spectrum associated to the breaking process. The simulations make available a highly refined description of the flow in both air and water which is also important for the estimates of load in severe conditions. Two different approaches are used to produce steep waves. A first approach exploits the classical Benjamin-Feir instability which generates extreme waves through the modulational instability process. In a second application a more realistic, narrow-banded, JONSWAP spectrum is used. Results are presented in terms of free surface dynamics and energy, separated in kinetic and potential components. The changes operated by the breaking occurrence on the spectrum are also discussed.
On the Hydromechanics of Vessels and Debris Fields during Sinking Events
Authors: Kery Sean
Published: August 2021

When a vessel leaves the surface and plunges to the seabed, a lot of things can happen that will affect its orientation and position on the seabed and the creation and distribution of the debris field. Crushing and catastrophic implosion due to the rapidly increasing hydrostatic pressure has been noted on portions of many wrecks. Extensive damage due to bottom impact and subsequent motions have also been observed and documented. This paper describes the successful numerical modeling of the sinking of several historic vessels. One was in deep water and another in shallow water. In both cases it was possible for the simulation to replicate important details of the debris field. Further work is planned to help explain some of the taphonomy observed as the wreck decays over time as it is acted on by bottom currents, benthic storms and in the shallow case storm waves.
Head Sea Slamming Pressures Prediction on a Frigate Ship Hull (A Numerical Study)
Authors: Nugroho Wibowo H. , Mujahid Ahmad S.
Published: August 2021

As a relatively high-speed warship a frigate has to maintain the capability to operate in rough seas. At this sea condition the ship certainly often experiences slamming since it normally has a low draft. This paper presents a numerical prediction of the slamming pressure on a frigate ship. The frigate has a typical V-shape hull form and operated at a head-sea condition which assumed to have maximum slamming load/pressure. The locations of prediction are determined for places which are prone to dynamic loads that affected the performance of warships. The locations are the tip of the bow which is usually a sonar dome, and a quarter of the area of the bow of the ship length which is the location of weapons systems, and the area aft (stern) in where a helipad , helicopter hangars, and the weapons systems are mainly placed . The main dimension of the vessel for this study is LPP = 120m, B = 15.89m, D = 9.365 m and T = 4. 83 m, with a service speed of V = 25 knots. The environmental condition of the open sea is selected as JONSWAP spectrum with a significant height Hs of 5 m, and a peak period Tp of 13,782 secs. Steps of slamming loads prediction from the procedure of Slamming Strength Assessment of the American Bureau of Shipping (ABS) Rules of 2011 is applied for this study. It starts with a Response Amplitude Operator (RAO) motion calculation of the frigate to obtain the range of peak frequencies in which the response of relative vertical motion and velocity is a maximum. Then, these frequencies are set to be the working frequencies for calculating the pressure distribution of the ship hull. These calculation results are used to obtain the design slamming pressure by applying the formula from ABS Guide for Slamming Loads and Strength Assessment for Vessels, 2011 (see references). The comparison of the result of this study to a well- known Stavovy & and Chuang method and modified data from Mariner full- scale measurement has been made and found that they agree well each other. Accordingly this information of the pressure can be used for preliminary life assessment and size determination of the structural component of the frigate.
Global FEM Strength and Fatigue Analysis of Large LNG Vessel
Authors: Wang Jia , Jin Yan , Yang Ren , Liu Jin
Published: August 2021

Due to the dangers of liquefied natural gas and the high price of a liquefied natural gas (LNG) vessel, there are high reliability and safety requirements with the structure design of large LNG vessels. Taking a large LNG Vessel designed by Hudong-Zhonghua shipbuilding group as a research object, global finite element model (FEM) strength and fatigue analysis was carried out by DLA/SFA software. Five typical load conditions, including fully loaded, ballast, one tank empty, two adjacent tanks empty and three adjacent tanks empty conditions, were considered in the global strength analysis (Dynamic Loading Approach, simplified as DLA), following the Guide for Safehull-dynamic Loading Approach for Vessels (DLA Guide). For the fatigue analysis spectral-based fatigue analysis, simplified as SFA, two typical operational load conditions, including homogeneous load condition at summer draught departure and ballast load condition arrival, were considered to achieve at least 40 years fatigue life requirement with north Atlantic wave spectrum, following Guidance Notes on Spectral-based Fatigue Analysis for Vessels (SFA Guide). Some special design details were taken to solve the local stress concentration yielding and fatigue problems. Some analysis methods and design experiences are discussed and proposed. The analysis procedure and solutions of global FEM strength and fatigue analysis in this paper for a large LNG ship can be a reference to analysis for other large vessels.
Eliminating Discharges in Oil/Sea Interfaces - a Return to Seawater Lubricated Propeller Shaft Systems for Commercial Ships
Authors: Carter Craig D.
Published: August 2021

Oil discharges from a ship’s propeller shaft system are an issue for commercial ship owners. A 2010 study by a New York Consulting firm estimated the total worldwide amount of lubricants from operational discharges from ships would be about 130 to 244 million litres annually. To add perspective, oil pollution from the Exxon Valdez tanker spill in 1989 was 41.6 million litres. Most ships use mineral oil to lubricate the propeller shaft and the oil is contained in the propeller shaftline by the aft seal – which is the oil to sea interface. According to the new U.S. Environment Protection Agency Vessel General Permit (VGP), all vessels built on or after Dec. 19, 2013 and trading in US waters must use an environmentally acceptable lubricant (EAL) in all oil to sea interfaces before their next drydocking. This paper will review: the renaissance of seawater based systems, a general description of a seawater lubricated bearing system, current commercial ship users and results, lower operating costs with “free” seawater and no aft seal, conversions of existing ships and resistance of shipyards to change standard designs from oil to seawater. The paper will also review new Classification rules from LR, CCS and BV for seawater lubricated propeller shaft systems, allowing the shaft to remain in place if monitoring conditions are met - which removes a major obstacle that ship owners had with seawater-based propeller shaft bearing systems.
Design Considerations for Operation of Coast Guard Cutters and Combatants in the Arctic
Authors: DeBord Frank , McAllister Timothy , Cleary Christopher , Dolny John , Kawamoto Robin
Published: August 2021

The United States Coast Guard is responsible for completing all of its statutory missions in U.S. waters surrounding Alaska. In the past, patrols in these waters have been limited to areas outside of the seasonal sea ice boundary, plus one or two icebreaker patrols per year. Recently, due to reduced sea ice areal coverage and the associated increases in commercial activity, demands for a Coast Guard presence in the Alaskan Arctic have increased significantly. In addition to ongoing efforts to increase the size of the icebreaker fleet, these demands have caused the U.S. Coast Guard to operate non-ice-strengthened cutters in areas where sea ice could be encountered, and to evaluate the capabilities of these cutters to operate in ice. This paper presents results of engineering studies completed over the past several years to evaluate the capabilities of current and future cutters for operations in ice and cold temperatures. These studies, which are also applicable to naval combatants, include: (1) definition of sea ice characteristics variations with season and geographic location; (2) evaluation of the ice-transiting capabilities of non-ice-strengthened hull structures; (3) analysis of potential increases in safe operating areas for different levels of ice strengthening; (4) evaluation of the capabilities of existing rudders, propellers, struts and shafting to withstand ice impacts; (5) assessment of possible cold temperature operating issues for deck equipment; and (6) analysis of the capabilities of HVAC, electrical and seawater systems to operate in cold air and water temperatures. Findings for each of these studies are discussed and results are presented. In addition, lessons learned from actual operations are included where appropriate. Finally, recommendations are offered for future class-specific engineering evaluations and operating considerations when non-ice-strengthened vessels are assigned to operating areas where sea-ice and cold temperatures may be encountered.
Experimental Evaluation of Ageing Marine Structures
Authors: Garbatov Yordan , Soares Carlos Guedes
Published: August 2021

The objective of this work is to present a review of recently performed experimental tests of large and small scale steel corroded specimens. Four types of tests are discussed here: corrosion deterioration, ultimate strength, tensile strength and fatigue strength material properties. Two large scale specimens, in the form of box girders simulating the midship section of tanker ship where corroded in a natural open sea condition. The corrosion degradation and its distribution around the structural components of the box girders are presented and discussed. The effect of the severity of corrosion degradation on the strength of the corroded steel specimens is experimentally evaluated, where the box girders are tested under four-point loading, producing a constant bending moment along the box girder until collapse. The experimental results of fatigue strength tests of small scale corroded steel specimens, cut from the same corroded box girders, are also presented. Finally, the experimental tensile strength tests are performed using small-scale corroded specimens, cut from the corroded box girders after the ultimate strength test was completed. The test identifies the effect of the degree of degradation to the mechanical properties of the specimens, namely modulus of elasticity, yield stress, tensile strength and total uniform elongation are also presented. The results of the experimental tests, presented here, are highly important and need to be accounted for when linear or nonlinear structural analyses are performed to evaluate the structural capacity of ageing marine structure.
A study of the response to sway motions of free surface anti-roll tanks
Authors: Carette Nicolas
Published: August 2021

Free surface anti-roll tanks are commonly used to reduce the rolling of ships. These devices have been studied quite extensively in the past, both analytically and experimentally. Most of these studies focused on the tank response to roll motions; in some work the effects of roll induced sway were addressed by varying the vertical position of the tank with respect to the rotation point. To obtain a more definite answer on the effects of sway in the response of anti-roll tanks, the present work investigated their response under arbitrary combinations of roll and sway motions. Using a 6 degrees of freedom hexapod table, harmonic and irregular forced motion tests were performed in roll, heave and sway, both independently and combined.
Experiments and CFD for ONRT Course Keeping and Turning Circle Maneuvering in Regular Waves
Authors: Sadat-Hosseini Hamid , Sanada Yugo , Stern Frederick
Published: August 2021

CFD computations are validated for course keeping and maneuvering of ONRT ship hull advancing at Froude number 0.2 in regular waves. The course keeping computations are conducted for various wave headings (0, 45, 90, 135, 180 deg) with λ/L=1.0 and H/λ=0.02. The maneuvering computation is performed for a turning maneuver with 35 deg rudder deflection for the ship located initially in head waves with λ/L=1.0 and H/λ=0.02. The 6DOF motions/velocities and wave elevation are validated against available experimental data. For course keeping, the validation study focuses on the 0th, 1st and 2nd harmonic amplitude of motions/velocities. The effective and propeller power are also investigated using CFD results. For the turning maneuver, the validation study focuses on the characteristics of turning trajectory in waves and low and high frequency of motions/velocities. For course keeping, the 0th and 2nd harmonic of motions show an average error of 30%DR whereas 1st harmonic amplitude predictions show a smaller error with an average value of 12%DR over all the wave headings. For all harmonics, the largest error value was for the stern quartering wave and the smallest value was often for the head wave conditions. The study on the propeller performance in course keeping showed that the effective power required for the ship was largest in head waves, about 30% more than the power required in calm water. The effective power decreased by increasing the wave heading such that the values were close to the effective power in calm water for wave heading > 90 deg. The propeller efficiency was found to be higher in waves. The increase of the propeller efficiency was largest for wave heading of 45 deg, about 10% increase compared to calm water. For the turning maneuver, the trajectory was well predicted with E=2.9%D and 3.7%D for the advance distance and tactical diameter, respectively. The drift distance was under predicted by 9%D and the drift angle is predicted 87 deg whereas the experimental data shows 55 deg. The comparison of course keeping and turning showed the low frequency values are significantly affected by turning. The low frequency values of the experimental heave and pitch showed the wave is distorted by the ship motion for the second and third turning cycles. The high frequency values of turning and course keeping are similar for the heave and pitch motions and different for other motions/velocities. CFD shows good agreement for the high frequency values of heave, pitch and roll motions and low frequency values of most motions/velocities excluding heave and pitch.
Inspection and Maintenance Platform for Enhanced Ship Safety
Authors: Lazakis Iraklis , Dikis Konstantinos , Theotokatos Gerasimos
Published: August 2021

The research work presented in this paper addresses issues related to ship inspection and maintenance through the development of a novel platform as part of the INCASS (Inspection Capabilities for Enhanced Ship Safety) project. INCASS addresses ship safety including structural and machinery monitoring, data gathering, reliability analysis and decision support. As part of the above, a case study on the machinery monitoring will be presented in this paper. The analysis involves ship’s main engine, lubrication and starting sub-systems and various components and failure modes. The case study presents the working state reliability performance on system, sub-system and components levels.
A Method to Quantify Mitigation Characteristics of Shock Isolation Seats Before Installation in a High-Speed Planing Craft
Authors: Riley Michael R. , Coats Timothy W. , Murphy Heidi P. , Ganey Neil
Published: August 2021

This paper presents a new approach for quantifying the mitigation achieved by a passive marine shock isolation seat. A brief historical perspective is summarized to explain why common myths have evolved that has led to seats being integrated into craft only to find out during subsequent seakeeping trials that the seats provide little to no mitigation or that they actually amplify wave impact loads. Acceleration data is presented to demonstrate use of the new computational method and the lessons learned are explained in terms that support development of a standard for laboratory seat testing.
Comparative Performance of Optimum High Speed SWATH and Semi-SWATH in Calm Water and in Waves
Authors: Brizzolara S. , Vernengo G. , Bonfiglio L. , Bruzzone D.
Published: August 2021

The hydrodynamic performance of unconventional SWATH and Semi-SWATH for high speed applications are analyzed and compared in this paper. Bare hull resistance in calm water is estimated by an inviscid boundary element method with viscous corrections and verified by a fully turbulent, multiphase unsteady RANSE solver. Motions response in head waves, calculated by a frequency domain 3D panel method with forward speed effects are also evaluated and compared. Both considered hulls are the best designs coming from full parametric hull form optimization procedures, based on CFD solvers for the estimation of their hydrodynamic performance and driven by evolutionary minimization algorithms. The SWATH has twin parabolic struts and an unconventional underwater shape, the semi-SWATH has a slender triangular waterline, a bulbous shape in the entrance body which gradually morph into a U-section with a shallow transom in the run body. In general, as expected, the Semi-SWATH hull shows a lower drag at high speeds while the single strut SWATH is superior at lower speeds. As regards seakeeping, the SWATH shows unbeatable lower pitch and heave motions in shorter waves, where the Semi-SWATH evidences a double peaked RAO. More detailed analysis and conclusion are drawn in the paper.
Cold-Ironing in Anchorage Area of Rotterdam Port using Renewable Energy Sources
Authors: Gemenetzis Petros , Vranakis Emmanouil , Xydis Konstantinos , Sfakianos Nikolaos , Selas Spyridon , Sakaguchi Tsuyoki
Published: August 2021

In an attempt to address the growing need for greener shipping, the potential of cold ironing technology, has been considered as one of the most effective methods to control the atmospheric emissions generated by marine industry. The present study focuses on the reduction of emissions occurred in anchorage areas of one of the busiest ports in Europe. For this purpose, an innovative design was produced by combining the method of cold ironing and the use of renewable energy sources such as wind farms, located close to the anchorage areas of Rotterdam Port. Electrical power produced by the windfarms will be stored in an offshore platform, distributed in a subsea station located outside the anchorage area and then to the vessels with the use of four calm buoys.
The Design, Building and Testing of a Trans-Atlantic Autonomous Sailboat
Authors: Douglas Satchel B. , Conway Nolan R. , Weklar Matthew B.
Published: August 2021

The use of autonomous vehicles is growing in all industries. However, there are no open-source autonomous surface vehicles available in the marine industry. This paper details the design decisions made, construction methods used, and testing performed on a low-cost, open-source vessel. The vessel was designed to cross the Atlantic Ocean as a means of proving its ability to survive the harsh marine environment. A trimaran hull form and free rotating wing sail were used because the combination provided good righting characteristics, durability and low power consumption. The vessel has been shown to navigate autonomously. Total costs were less than $4000 dollars, excluding labor. Vessels of this type could be used for long duration missions recording data in the open ocean at extremely low cost.
A teoria da degeneração e suas implicações no Hospital de Doenças Nervosas e Mentais. Recife, PE /1920
Authors: Miranda Carlos Alberto Cunha
Published: August 2021

Neste artigo, inicialmente apresentaremos o conceito de degeneração desenvolvido por Benedict-Augustin Morel, Valentin Magnan e Emil Kraepelin, bem como suas repercussões na psiquiatria brasileira nos primeiros anos do século XX. Com base nesses pressupostos, discorreremos sobre a trajetória de vida de pessoas consideradas portadoras de transtornos mentais e do saber psiquiátrico no Hospital de Doenças Nervosas e Mentais do Recife, através da análise de alguns prontuários dos anos de 1920 com pacientes diagnosticados como portadores de Episódio Delirante de Degeneração. O suporte desta pesquisa está no trabalho desenvolvido no acervo do Hospital Ulysses Pernambucano, em que foi realizado o resgate da documentação, a catalogação e a edição de um inventário de todos os livros entre os anos de 1926 a 1970, no total de 1013 volumes, cada um com cinquenta prontuários. A análise dessas importantes fontes, juntamente com o aporte teórico, permitiu a elaboração desse artigo.
Palavras-chave: Hospital; psiquiatria; degenerados; eugenia.
Recurso de la acción de tutela por derecho a la salud mental en la jurisprudencia colombiana, 2000-2019
Authors: Gutiérrez Avendaño Jairo , Herazo Edwin
Published: August 2021

Objetivo: analizar la eficacia de la acción de tutela por derecho a la salud mental en la jurisprudencia colombiana, 2000-2019. Metodología: estudio cualitativo de enfoque hermenéutico, mediante análisis descriptivo - retrospectivo de 85 sentencias de tutela revisadas y falladas en segunda instancia por la Corte Constitucional de Colombia. Conclusiones: se evidencia que la tendencia ha sido la de conceder el amparo solicitado y que los demandantes hacen parte de la población con más vulnerabilidad. Se destaca la reiteración de jurisprudencia por un mismo problema jurídico; en particular, el acceso a la prestación de servicios excluidos del Plan obligatorio de Salud (POS). Este mecanismo tutelar, además de ayudar a garantizar la atención de los usuarios, es un indicador de la eficacia y eficiencia del servicio, que ha sentado precedentes en la jurisprudencia para revisar, confirmar y derogar actuaciones administrativas y técnicas que limitan o vulneran los derechos a la salud, la vida digna y la seguridad social.
Palabras clave: Acción de tutela; Salud mental; Vida digna; Seguridad social; Discapacidad mental.
Understanding Attitudes and Roles of Oncology Advanced Practitioners in the Setting of Cancer Clinical Trials: A Pilot Study
Authors: Braun-Inglis, MS, APRN-Rx, FNP-BC, AOCNP Christa , B. Shvetsov, PhD Yurii , Springer, MSN, APRN-Rx, AGPCNP-BC Ashley , Ferguson, MSN, APRN-Rx, FNP-C, AOCNP Valerie , Workman, MS, APRN-Rx, AGPCNS-BC Tyler , Omatsu, MS, APRN-Rx, PNP-BC, CPON Dee Ann , Conde, PhD, APRN-Rx, AOCNP, FAAN Francisco , O'Carroll Bantum, PhD Erin
Published: August 2021

Purpose: Oncology advanced practitioners (APs), including nurse practitioners, physician assistants, clinical nurse specialists, and pharmacists, are skilled health-care providers who contribute significantly to quality cancer care. However, little is known about how APs function within the clinical trials arena. With low rates of clinical trial enrollment among the adult oncology patient population, APs could play an important role in improving clinical trial enrollment. Methods: A descriptive cross-sectional study was conducted based on a 57-item survey of oncology APs’ attitudes, beliefs, and roles in relation to cancer clinical trials. Results: To assess validity and internal consistency of the survey, a pilot data collection was completed on 14 respondents from Hawaii. The survey’s internal consistency across the subscales was moderate to very high, with Cronbach’s alpha ranging between 0.55 and 0.86. The majority of oncology APs were interested in being more involved in the clinical trials process, and many are registered as investigators through the National Cancer Institute (NCI). However, few respondents reported being involved in recruitment, consenting, protocol development, or being actively involved with a research base. Conclusions: This survey was found to be a valid tool to measure APs’ attitudes and roles in regards to clinical trials. This survey is just the beginning of data collection in regards to clinical trials among this group of health-care professionals. Recommendations: To gain further insight into oncology APs and their roles in clinical trials, it is recommended that this survey be implemented on a national level as a first step in moving this issue forward.
Transitioning From Thrombopoietin Agonists to the Novel SYK Inhibitor Fostamatinib: A Multicenter, Real-World Case Series
Authors: M. Hughes, PharmD, BCOP David , Toste, DNP, APN Charina , Nelson, ACNP-BC Christopher , Escalon, ANP Juliet , Blevins, PA-C Frances , Shah, RPh, BCOP Bhavesh
Published: August 2021

Fostamatinib is an oral spleen tyrosine kinase (SYK) inhibitor used for the treatment of adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to a previous treatment. Clinical and operational barriers may exist that warrant bridging or switching from thrombopoietin receptor agonists (TPO-RAs), such as volatility or unpredictability of platelets, adverse events, and quality of life or patient preference. While fostamatinib demonstrated durable platelet responses, the safety and efficacy in combination, bridging, and/or switching with TPO-RAs is not well documented. The objective of this article is to provide guidance from real-world case studies for a safe and effective strategy for the transitioning of patients from TPO-RAs to fostamatinib, with some degree of overlap between the two agents. Currently, the evidence does not exist to guide the safe and effective use of combination therapy or transition between therapies in ITP. This case series highlights the importance to further understand the complexities of managing this disease, as well as successfully combining, bridging, and/or switching patients over to fostamatinib without the need for rescue therapy or increase in adverse events. The need for real-world evidence that guides providers on the safety and efficacy of short- and long-term combination therapy of fostamatinib and TPO-RAs is crucial. The rationale for combination therapy is to target different pathways, platelet destruction, and production without added toxicities. Additionally, gradual tapering off of TPO-RAs may provide a more favorable clinical outcome when switching to fostamatinib. The need for additional data is necessary to provide clinicians with guidance when managing patients with ITP.
Mental Health and Chemical Dependency Services at US Cancer Centers
Authors: Niazi Shehzad K. , Spaulding Aaron , Brennan Emily , Meier Sarah K. , Crook Julia E. , Cornell Lauren F. , Ailawadhi Sikander , Clark Matthew M. , Rummans Teresa A.
Published: August 2021

Background: It is standard of care and an accreditation requirement to screen for and address distress and psychosocial needs in patients with cancer. This study assessed the availability of mental health (MH) and chemical dependency (CD) services at US cancer centers. Methods: The 2017–2018 American Hospital Association (AHA) survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases were used to assess availability of services and associations with hospital-level and health services area (HSA)–level characteristics. Results: Of 1,144 cancer centers surveyed, 85.4% offered MH services and 45.5% offered CD services; only 44.1% provided both. Factors associated with increased adjusted odds of offering MH services were teaching status (odds ratio [OR], 1.76; 95% CI, 1.18–2.62), being a member of a hospital system (OR, 2.00; 95% CI, 1.31–3.07), and having more beds (OR, 1.04 per 10-bed increase; 95% CI, 1.02–1.05). Higher population estimate (OR, 0.98; 95% CI, 0.97–0.99), higher percentage uninsured (OR, 0.90; 95% CI, 0.86–0.95), and higher Mental Health Professional Shortage Area level in the HSA (OR, 0.99; 95% CI, 0.98–1.00) were associated with decreased odds of offering MH services. Government-run (OR, 2.85; 95% CI, 1.30–6.22) and nonprofit centers (OR, 3.48; 95% CI, 1.78–6.79) showed increased odds of offering CD services compared with for-profit centers. Those that were members of hospital systems (OR, 1.61; 95% CI, 1.14–2.29) and had more beds (OR, 1.02; 95% CI, 1.01–1.03) also showed increased odds of offering these services. A higher percentage of uninsured patients in the HSA (OR, 0.92; 95% CI, 0.88–0.97) was associated with decreased odds of offering CD services. Conclusions: Patients’ ability to pay, membership in a hospital system, and organization size may be drivers of decisions to co-locate services within cancer centers. Larger organizations may be better able to financially support offering these services despite poor reimbursement rates. Innovations in specialty payment models highlight opportunities to drive transformation in delivering MH and CD services for high-need patients with cancer.
Sociodemographic Factors Associated With Rapid Relapse in Triple-Negative Breast Cancer: A Multi-Institution Study
Authors: Asad Sarah , Barcenas Carlos H. , Bleicher Richard J. , Cohen Adam L. , Javid Sara H. , Levine Ellis G. , Lin Nancy U. , Moy Beverly , Niland Joyce , Wolff Antonio C. , Hassett Michael J. , Stover Daniel G.
Published: August 2021

Background:Triple-negative breast cancer (TNBC) accounts for disproportionately poor outcomes in breast cancer, driven by a subset of rapid-relapse TNBC (rrTNBC) with marked chemoresistance, rapid metastatic spread, and poor survival. Our objective was to evaluate clinicopathologic and sociodemographic features associated with rrTNBC.Methods:We included patients diagnosed with stage I–III TNBC in 1996 through 2012 who received chemotherapy at 1 of 10 academic cancer centers. rrTNBC was defined as a distant metastatic recurrence event or death ≤24 months after diagnosis. Features associated with rrTNBC were included in a multivariable logistic model upon which backward elimination was performed with aP<.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts.Results:Among all patients with breast cancer treated at these centers, 3,016 fit the inclusion criteria. Training cohort (n=2,112) bivariable analyses identified disease stage, insurance type, age, body mass index, race, and income as being associated with rrTNBC (P<.10). In the final multivariable model, rrTNBC was significantly associated with higher disease stage (adjusted odds ratio for stage III vs I, 16.0; 95% CI, 9.8–26.2;P<.0001), Medicaid/indigent insurance, lower income (by 2000 US Census tract), and younger age at diagnosis. Model performance was consistent between the training and validation cohorts. In sensitivity analyses, insurance type, low income, and young age were associated with rrTNBC among patients with stage I/II but not stage III disease. When comparing rrTNBC versus late relapse (>24 months), we found that insurance type and young age remained significant.Conclusions:Timing of relapse in TNBC is associated with stage of disease and distinct sociodemographic features, including insurance type, income, and age at diagnosis.
Race- and Age-Related Disparities in Cervical Cancer Mortality
Authors: Alimena Stephanie , Pachigolla Suvidya Lakshmi , Feldman Sarah , Yang David , Orio Peter F. , Lee Larissa , King Martin
Published: August 2021

Background: Although the incidence of cervical cancer among younger Black women is now equivalent to that of White women, it is unknown whether the reduced incidence has affected survival rates among younger Black women. The goal of this study was to assess differences in survival by age and race. Patients and Methods: A retrospective cohort study was performed using the National Cancer Database to analyze women with nonmetastatic cervical cancer diagnosed between 2004 and 2014. Women with unknown survival data and those who died within 3 months of diagnosis were excluded. Multivariable logistic regression models evaluated interactions between age and race (Black vs non-Black) for presentation with stage I disease and receipt of optimal treatment. A multivariable Cox regression model was used to evaluate survival differences by age and race. Results: Of 55,659 women included, 16.4% were Black. Compared with their non-Black counterparts, fewer Black women presented with stage I disease (37.8% vs 47.8%; P<.01) and received optimal treatment (46.2% vs 58.3%; P<.01). Fewer Black women had private insurance if they were aged <65 years (39.6% vs 55.7%; P<.01), but not if they were aged ≥65 years (11.7% vs 12.4%; P=.43). According to multivariable logistic regression, Black women aged ≤39 years were less likely to present with stage I disease, with a significant interaction term between age and race (P<.01 for interaction). Disparities in overall survival by race were greatest for Black women aged ≤39 years (adjusted hazard ratio, 1.32; 95% CI, 1.20–1.46; P<.01) but decreased with increasing age interval until no disparity was noted for women aged ≥65 years (P<.01 for interaction). Conclusions: Younger Black women with cervical cancer are at risk for presenting with higher-stage disease and having worse overall survival. These findings may be related to insurance-related disparities and inadequate follow-up for abnormal Papanicolaou test results. Younger Black women with cervical cancer may be a particularly vulnerable population.
Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology
Authors: Shah Manisha H. , Goldner Whitney S. , Benson Al B. , Bergsland Emily , Blaszkowsky Lawrence S. , Brock Pamela , Chan Jennifer , Das Satya , Dickson Paxton V. , Fanta Paul , Giordano Thomas , Halfdanarson Thorvardur R. , Halperin Daniel , He Jin , Heaney Anthony , Heslin Martin J. , Kandeel Fouad , Kardan Arash , Khan Sajid A. , Kuvshinoff Boris W. , Lieu Christopher , Miller Kimberly , Pillarisetty Venu G. , Reidy Diane , Salgado Sarimar Agosto , Shaheen Shagufta , Soares Heloisa P. , Soulen Michael C. , Strosberg Jonathan R. , Sussman Craig R. , Trikalinos Nikolaos A. , Uboha Nataliya A. , Vijayvergia Namrata , Wong Terence , Lynn Beth , Hochstetler Cindy
Published: August 2021

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Neuroendocrine and Adrenal Gland Tumors focus on the diagnosis, treatment, and management of patients with neuroendocrine tumors (NETs), adrenal tumors, pheochromocytomas, paragangliomas, and multiple endocrine neoplasia. NETs are generally subclassified by site of origin, stage, and histologic characteristics. Appropriate diagnosis and treatment of NETs often involves collaboration between specialists in multiple disciplines, using specific biochemical, radiologic, and surgical methods. Specialists include pathologists, endocrinologists, radiologists (including nuclear medicine specialists), and medical, radiation, and surgical oncologists. These guidelines discuss the diagnosis and management of both sporadic and hereditary neuroendocrine and adrenal tumors and are intended to assist with clinical decision-making. This article is focused on the 2021 NCCN Guidelines principles of genetic risk assessment and counseling and recommendations for well-differentiated grade 3 NETs, poorly differentiated neuroendocrine carcinomas, adrenal tumors, pheochromocytomas, and paragangliomas.
NCCN Guidelines® Insights: Palliative Care, Version 2.2021
Authors: Dans Maria , Kutner Jean S. , Agarwal Rajiv , Baker Justin N. , Bauman Jessica R. , Beck Anna C. , Campbell Toby C. , Carey Elise C. , Case Amy A. , Dalal Shalini , Doberman Danielle J. , Epstein Andrew S. , Fecher Leslie , Jones Joshua , Kapo Jennifer , Lee Richard T. , Loggers Elizabeth T. , McCammon Susan , Mitchell William , Ogunseitan Adeboye B. , Portman Diane G. , Ramchandran Kavitha , Sutton Linda , Temel Jennifer , Teply Melissa L. , Terauchi Stephanie Y. , Thomas Jane , Walling Anne M. , Zachariah Finly , Bergman Mary Anne , Ogba Ndiya , Campbell Mallory
Published: August 2021

Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members’ clinical expertise and emerging scientific data. These NCCN Guidelines Insights summarize the panel’s recent discussions and highlights updates on the importance of fostering adaptive coping strategies for patients and families, and on the role of pharmacologic and nonpharmacologic interventions to optimize symptom management.
Larotrectinib in a Patient With Advanced Pleomorphic Liposarcoma of the Uterus
Authors: Valenciaga Anisley , Iwenofu O. Hans , Tinoco Gabriel
Published: August 2021

Pleomorphic liposarcoma of the uterus (PLU) is an extremely rare disease with poor prognosis. Limited treatment options exist for these patients, and disease recurrence usually occurs rapidly within months of initial diagnosis. Few case reports of metastatic PLU are available in the literature. We describe a 70-year-old woman who presented with a large uterus and ovarian mass on imaging and negative serum tumor markers and endometrial biopsy. Staging revealed localized disease. Surgical resection revealed PLU on pathology. Immunohistochemistry was negative for smooth muscle actin (SMA), S100, and MDM2, and positive for CD10 and cyclin-D1. She was treated with adjuvant therapy and experienced disease recurrence in the liver at 15 months from surgery. Genetic testing of the metastasis showed IQGAP-NTRK3 gene fusion. She was given entrectinib but continued to show progression in the liver. Right partial hepatectomy was performed, showing positivity for CD10, BCL-1, MDM2, and SMA on tumor staining. Treatment was switched to pazopanib with disease progression in the neck. She was treated with larotrectinib last, showing no disease progression and adequate tolerance of therapy after 18 months of this treatment. This is the first case in the literature of metastatic PLU with NRTK3 fusion treated with sequential first-generation NRTK inhibitors. More case reports are needed to identify commonalities and therapeutic options. Genetic testing in all PLU cases is needed for targeted therapy approaches.
Infancia, adolescencia y participación ciudadana en los municipios. La mirada de figuras técnicas y cargos electos
Authors: Melero Héctor S. , Sánchez-Lissen Encarnación , Esteban Marta , Martínez Miquel
Published: August 2021

En el ámbito municipal, los niños, niñas y adolescentes (NNA) tienen voz para construir, interpretar y también proyectar un modelo de ciudadanía activa e inclusiva y para desarrollar su derecho a la participación, sin embargo, cada municipio, colabora en mayor o menor intensidad. Este artículo, que muestra los resultados parciales de una investigación más extensa en torno a la participación de la infancia y la adolescencia en el municipio, estudia cómo es la mirada o la representación social de los técnicos municipales (figuras técnicas, FT) y de los cargos electos (CE) en torno a esta participación. Se analizan cuatro indicadores: primero, las razones por las que se impulsa la participación de NNA para cada uno de los sectores participantes, en segundo lugar, cómo caracterizan los CE la participación en las políticas municipales, tercero, cómo consideran las FT la participación por parte de la administración y, finalmente se muestran, a juicio de las FT, convergencias y divergencias entre la participación ciudadana y la participación de NNA. Como instrumento se ha utilizado un cuestionario que ha sido contestado por 191 FT y 88 CE, de 179 municipios españoles y, entre las conclusiones cabe destacar, por un lado, el valor que todas las personas que integran el estudio conceden a la participación de los NNA en sus municipios, la fortaleza de alcanzar una dinámica inclusiva, pero a la vez, las dificultades que tienen determinados modelos, excesivamente adultocéntricos, para alcanzar los objetivos deseados.
Pratiques de contextualisation en brevet de technicien supérieur en Guadeloupe : quelles articulations entre contexte local et programmes nationaux ?
Authors: Odacre Elisabeth , Delcroix Antoine , Issaieva Elisabeth
Published: August 2021

L’étude porte sur les représentations et les pratiques déclarées de professeur·e·s en sciences de gestion du brevet de technicien supérieur. Ce diplôme de l’enseignement supérieur court français vise une insertion professionnelle rapide à priori dans l’environnement de la formation. Une série d’entretiens semi-directifs montre une prise en compte pragmatique du contexte de la formation. Les professeur·e·s, conscient·e·s du rôle joué par la contextualisation pédagogique dans la motivation des étudiant·e·s, se déclarent néanmoins contraint·e·s dans leurs pratiques par l’évaluation nationale du diplôme. Ainsi se trouve posée la question de la cohérence entre la formation délivrée et l’objectif d’intégration professionnelle locale.
Les caractéristiques comportementales jouent-elles un rôle modérateur sur les interactions en classe perçues par les élèves et leur sentiment d’efficacité personnelle ?
Authors: Beaudoin Manon , Nadeau Marie-France , Lessard Anne
Published: August 2021

Fondée sur la théorie sociale cognitive (Bandura, 1986), cette étude a examiné les liens entre les interactions en classe perçues par les élèves et leur sentiment d’efficacité personnelle à l’égard du travail scolaire en considérant le rôle modérateur de leurs caractéristiques comportementales. Les données ont été recueillies auprès de 574 élèves du primaire, en classe ordinaire, au Québec. Des analyses de comparaison de moyenne indiquent que le sentiment d’efficacité personnelle est plus faible chez les élèves manifestant des difficultés comportementales extériorisées comparativement aux élèves tout venant. Selon une régression linéaire multiple, l’organisation de la classe et le soutien à l’apprentissage expliquent une partie de la variance du sentiment d’efficacité personnelle des élèves. Les caractéristiques comportementales jouent un rôle modérateur sur les relations entre les domaines des interactions en classe (soutien émotionnel, organisation de la classe, soutien à l’apprentissage) et sur le sentiment d’efficacité personnelle des élèves. Les interactions en classe n’influencent donc pas le sentiment d’efficacité personnelle de la même manière pour tou·te·s les élèves.
Mobilization readiness to respiratory disasters: how to increase financial and economic availability of mechanical ventilation equipment
Authors: Ragozin Andrei Vasil'evich , Itselev Aleksandr Aleksandrovich , Glazunova Svetlana Aleksandrovna
Published: August 2021

The COVID-19 pandemic demonstrated the critical vulnerability of modern society to the risk of respiratory disasters – situations of mass destruction of people by biological, chemical or radioactive agents with the development of respiratory failure that requires mechanical ventilation. This is substantiated by extremely high cost of conventional mechanical ventilation technology, which currently has no alternative, and implies “anti-physiological” (dangerous to health) pressure-targeted ventilation. Due to high cost of such equipment, no country is currently able to provide substantial mobilization reserves of ventilators, which in case of respiratory disasters, entails high mortality rate among population. The solution of this problem, the authors see the “catching-up” development of inexpensive, easy to use, and relatively safe method of mechanical ventilation with negative pressure ( the so-called tank ventilator or “iron lungs”), which encloses most of a person's body, and varies the air pressure in the enclosed space, to stimulate breathing. Due to the lower price, safety and ease of use of this method, the authors consider it essential in the instance of mass victims with respiratory failure caused by infectious, chemical or radiation agents. The conclusion is made on the importance of advancement of the mechanical ventilation technology based on the method of negative pressure for ensuring mobilization readiness of the Russian Federation to respiratory disaster, as well as the current need of the healthcare system.