bluuebunny/crossref_metadata_2025 huggingface dataset:
Halomonas venusta Coupled Operation of Nitrogen Removal and Electricity Generation under High Salt
Authors: Wang Jinfeng , Liu Weifeng , Bo Le , Zhang Linghua
Published: February 2021

In this paper, the moderately halophilic bacterium Halomonas venusta DSM 4743T was selected to optimize the N removal conditions and the electricity generation conditions in the MFC, and conduct the coupled operation of the electricity generation and denitrification of MFC high-salt wastewater. The results showed when sodium succinate was used as carbon source, C/N was 5:1, pH was 9, and NaCl was 30 g/L, 93.22% N removal rate was obtained at 168 h. The maximum output voltage of MFC is 346 mV under the conditions of 6 g/L NaAc, 50 μm riboflavin, pH=8 and 30 g/L NaCl. H. venusta DSM 4743T MFC generates electric denitrification coupled operation, with the maximum output voltage up to 224 mV and the denitrification rate of 53.5%.
Nitrogen-modified Graphene Synthesis and Modification of H2S Removal Efficiency Comparison
Authors: Xue Hanling , Wu Yehao , Lei Chao , Yan Yuting , Wan Xuening , Guo Peiqi
Published: February 2021

In this paper, multilayer graphene is used as the raw material, graphene oxide is prepared by Hummers' improved method, and Nitrogen-modified Graphene is prepared by solvothermal method. It uses SEM, XRD, XPS, Ramman to characterize the sample morphology, internal composition, internal structure and element content, analyze its chaos and functional group change trend, and get: graphene to graphene oxide to Nitrogen-modified Graphene, graphene oxide The replacement of C atoms by O atoms increases surface wrinkles and increases defects and confusion. Nitrogen-modified Graphene is reduced due to the oxygen-containing functional groups of graphene oxide, reducing functional groups and reducing interlayer materials, resulting in a clean surface and reduced defects. The layer spacing is reduced. Then through a fixed bed reactor, using graphene, graphene oxide, and Nitrogen-modified Graphene as experimental samples, the adsorption of hydrogen sulfide gas was tested and researched: the original graphene and graphene oxide had similar adsorption capacities for hydrogen sulfide gas. Nitrogen-modified Graphene is about 3 times that of the first two experimental samples.
Effect of Atmosphere and Additive on Enrichment Characteristics of Trace Elements during Fluidized Bed Coal Combustion
Authors: Ma Zhirui , Liang Cai
Published: February 2021

The enrichment characteristics of trace elements (Cr, Mn, Co, Ni, Cd, Pb, Hg, As, Se) were investigated under air and O2/CO2 atmosphere during fluidized bed coal combustion. Results showed that Co, Ni, Cd, Pb, Hg, As, Se were more volatile than Cr and Mn. The increase of temperature promoted Mn, Co, Ni, Cd and Pb to migration from bottom ash to fly ash, and contributed Hg, As and Se to vapor phase. Cr, Mn, Co, Cd, Se tended to decrease in bottom ash and increase in fly ash during oxy combustion, while 21%O2/79%CO2 atmosphere led to the emission of gaseous As and the enrichment of Ni, Pb in both bottom ash and fly ash. With the increase in O2 concentration, the relative enrichment of all the trace elements except As increased, suggesting that their volatility were inhibited. Adding limestone and mixture of limestone and kaolinite had an inhibiting effect on volatilization of trace elements (especially Mn, Cd, Pb, Hg, As, Se) and the inhibiting behavior was strengthened under the oxy atmosphere.
The Preparation of Double Layers Low Pressure Carbon Nanotubes Membrane
Authors: Liu Weiyan , Xue Xiaolei , Wang Qingshan , Wang Yu , Guo Jin
Published: February 2021

Double layers low pressure carbon nanotubes (CNTs) membrane was prepared by pre-depositing CNTs on the Polyethersulfone (PES) flat membrane by pressure-assisted membrane filtration technology. Ethanol and Triton X-100 (TX-100) were used as dispersant to disperse two kinds of CNTs. By filtering two kind of CNTs dispersions in sequence, double layers CNTs were distributed on the surface of a PES membrane. With the proportion of the CNTs using TX-100 as dispersant increasing, the pure water flux of the double layers CNTs membrane will decrease. Normally, a membrane’s upper layer using ethanol as CNTs’ dispersant have higher pure water flux. Overall, almost all the double layers low pressure CNTs membrane realized the higher HA removal rate than single layer. By using CNTs with a diameter of 10-20 nm and length of 10-30 μm, the membrane with upper layer of 70% CNTs using ethanol as dispersant and 30% CNTs using TX-100 as dispersant can removal over 95% HA.
Short circuit current limiting method based on VSC-HVDC current limiting strategy
Authors: Huo Qidi , Lu Yingquan , Su Qingmei , Tang Xiaojun , Ma Shiying , Li Kewen , Zhang Huiyu
Published: February 2021

In this paper, a short-circuit current suppression method based on the adjustment of low-voltage current limiting strategy is proposed, which can suppress the output current of VSC-HVDC system during the fault by adjusting the low-voltage current limiting setting value of the VSC-HVDC control system, so as to achieve the purpose of suppressing the short-circuit current level in the converter station.
Incentive strategies for responders of electric vehicle virtual energy storage based on comprehensive contribution evaluation
Authors: Li Bei , Niu Meng , Wu Hongrui , Zou Mengjiao , Zhang Yue , Liu Dunnan , Shang Shanshan , Wang Lingxiang , Zhang Tingting , Liu Mingguang
Published: February 2021

The user-side demand resources of electric vehicles are integrated by load aggregators to respond to grid dispatch, which will bring many value-added benefits to the grid and other entities in the market. This article analyzes and constructs evaluation indicators from the two aspects of power contribution and response rate contribution to analyze the contribution of electric vehicle operators and electric vehicle users. The TOPSIS-grey correlation evaluation model is established and divided into four stages: state determination, reward and punishment analysis, peak-valley combination, and incentive distribution to analyze the comprehensive contribution of electric vehicle users.This is conducive to determining the amount of electricity and the response range of response speed when electric vehicles participate in the market to obtain rewards or punishments, and then distribute the compensation value and value-added benefits obtained when electric vehicle users participate in the regulation operation.
Decrease process analysis of urban system resilience based on the extreme flood simulation
Authors: Yabo Li , Peng Wang
Published: February 2021

Urban flood is growing worldwide due to climate change, rapid urbanization and population increase. Although the concept of resilience is an effective tool to deal with urban flood, urban flood resilience remains difficult to put into practice nowadays. The attenuation process of urban flood control capacity under the influence of flood is still a challenge. And the stage damage of flood resilience is strongly linked with the recovery of urban system to floods. But current studies failed to capture the change characteristic of flood resilience in time stage. Therefore, this study made stage damage analysis based on flood simulation and modelling in Jianye and Gulou District. Results reveal that Jianye has the higher inundated area and exposed population and asset to flood. Gulou shows more resilience to urban flood with flood return periods of 100 years. Moreover, the stage damage curve benefits the comprehensive understanding of loss and recovery process. This study provides a theoretical support for effective adaptive strategy to urban flood.
Effects of construction waste on the growth of Potted Chinese Rose
Authors: Xie Tiantian , Sun Haiyan , Zhou Wangwang
Published: February 2021

In order to verify the feasibility of reclamation and utilization of construction wastes of different particle sizes in landscaping, construction wastes were screened out with 4 grain grades of 0-2mm, 2-3mm, 3-5mm and 0-6mm. According to the compound mass ratio of 10%, 20%, 30%, 40%, 50% and the soil, the effects of different particle size and proportion matrix treatment on soil bulk density and potted rose growth were studied. The results show that the bulk density of substrates decreases with the increase of the particle size and proportion of construction waste. In addition to no significant effect on leaf morphology, adding proper amount of construction waste to the soil had a significant effect on plant height, stem diameter increment, root length, root fresh weight, total flower number, chlorophyll content and nitrogen, phosphorus, potassium content in the plant of potted rose. However, excessive application of construction waste inhibited the growth of potted rose. In the comprehensive analysis, the optimal particle size was 3-5mm, followed by 2-3mm. The optimal proportion is 40%, followed by 30%. It is feasible to add construction waste as a modifier to landscaping matrix.
The design of an impedance tube and testing of sound absorption coefficient of selected materials
Authors: Ďuriš R , Labašová E
Published: February 2021

The paper describes a design, building and testing a low-cost impedance tube for measuring the acoustic parameters of small testing samples. The measurement of sound absorption coefficient is based on transfer function and the two microphone method in accordance with ISO 10534-2 and ASTM E 1050 standards. With small configuration updates and after installation of additional microphones on measuring apparatus testing of complex acoustic material properties can be performed. The impedance tube has been used also as a teaching tool.
Study of bovine serum albumin interaction with zinc oxide surfaces by force field simulations
Authors: Hematian H , Rezek B
Published: February 2021

We studied the interactions of bovine serum albumin (BSA) molecule with ZnO surfaces by force field simulations. The different orientations of BSA over the two main nonpolar wurtzite ZnO surfaces (10

1

¯

0) and (11

1

¯

0) have been investigated. These surfaces contain both Zn and O atoms. We compare the results also with polar Zn-face (0001) surface. The results demonstrate tendency of BSA molecule for being adsorbed on the ZnO surface in specific orientations. This happens either by bonding between a hydrogen atom of BSA molecule to an oxygen atom of the ZnO surface or by physical attraction inducing ZnO atoms displacement in some cases.
Origami-kirigami approach to materials structures modelling
Authors: Markechová I , Stúpalová H
Published: February 2021

Additive manufacturing and origami/kirigami principles fit together like a coffee cup and saucer. Recently derived translational surface with an elliptic curve (not an ellipse), as the governing one, led to constructing origami-like object. Set of eight surfaces, each with a square-shaped orthogonal projection, turned out to be enchantingly similar to heaven-and-hell-origami. In presented work engaged starting translational surface (STS) is originally subjected to the selected linear and nonlinear transformations, in two ways. The first one is dedicated to spacial placement of STS replicas. Shape STS variations represent the second approach. Square-shape of STS orthogonal projection is preserved during all the mappings, it does not change. On the other hand, especially in this point, the similarity with origami/kirigami structures is broken; generally, square-shaped sheet of paper changes via folding. In our paper, preserved orthogonal projection offers suitable opportunities to illustrate a structure of the hypothetical material. Explicit and parametric equations of geometrical elements, transformational matrices and MATLAB application MuPAD serve as the useful mathematical and computational tools for formal and graphical representation of the modeled structures.
Examination of crystal plasticity in cold drawn tube forming using FEM and Voronoi tessellation
Authors: Necpal M , Martinkovič M , Kuruc M
Published: February 2021

The analyses of the tube drawing process can be divided into two basics parts of investigations - macro-scale and micro-scale. Macro-scale analyses involve investigation of dimensional accuracy of the formed specimen, drawing forces, strain, stress, etc. The analyses of the tube drawing process in the macro-scale have been studied experimentally or theoretically using numerical methods for many years. For the final product of drawing process is also important to know the surface quality for example. For this purpose, it is important to know micro-scale material properties (spatial distribution of grain neighbourhood orientation etc.), and examine the context of micro forming material. There has been a trend in the last decade to make a link between macro-scale forming and micro-scale material properties and name it Multi-scale modelling. This research illustrates the possibility to use Voronoi tessellation grain microstructure model in DEFORM FEM software to predict grain plasticity. The result obtained from numerical simulation is compared with direct reconstruction, derivation of Voronoi tessellation, and measurement using the line and also with analytical theoretical method of strain distribution in tube draw process throw the die.
Analysis of the validity of the mathematical assumptions of electrical impedance tomography for human head tissues
Authors: Williams Toby , Bouazza-Marouf Kaddour , Zecca Massimiliano , Green Alexander L
Published: February 2021

Objective: To determine the validity of the key mathematical assumptions used in electrical impedance tomography for human head tissues. Approach:Conductivity and permittivity data collected from available literature for each tissue within the human head have been evaluated and critiqued. The most relevant dielectric tissue data for each tissue was then used to assess the validity of the mathematical assumptions of electrical impedance tomography in terms of their suitability for human head imaging in order to estimate related errors. Main Results:For induced currents with frequencies greater than 200 Hz the internal current source density is negligible. The assumption that magnetic effects are negligible is valid to an error of 1.7% for human head tissues for frequencies below 1 MHz. The capacitive effects are negligible for CSF, dura mater, blood, bone (cortical), and deep tissue skin for frequencies less than 3.2 MHz, 320 kHz, 25 kHz, 3.2 kHz, and 130 Hz respectively. However, the capacitive effects are not negligible for brain tissues, as the minimum error for brain tissues across the frequency range of 10 Hz to 100 GHz is 6.2% at 800 Hz, and the maximum error is 410% at 20 GHz. Significance:It is often assumed that the mathematical reduction of the base equations is valid for human head tissues over a broad frequency range; this study shows that these assumptions are not true for all tissues at all frequencies. False assumptions will result in greater errors and local distortions within tomographic images of the human head using electrical impedance tomography. This study provides the relationships between injected current frequency and the validity of the mathematical assumptions for each individual tissue, providing greater awareness of the magnitude of possible distortions.
Breach of the agreement to arbitrate due to third party conduct
Authors: Katsikis Dimitrios
Published: February 2021

It is widely accepted, especially in common law jurisdictions, that foreign proceedings may give rise to a breach of the agreement to arbitrate, entitling the aggrieved party to damages and specific performance. In the vast majority of cases, foreign proceedings amounting to a breach of the agreement to arbitrate are initiated by a party bound by that agreement. This article explores whether foreign proceedings are in breach of the agreement to arbitrate even when these are commenced by a person not party to that agreement (a ‘third party’), a question that has received little to no direct treatment to date. The article proposes that the conduct of a third party can, and in certain circumstances should, be treated as giving rise to a breach of the agreement, entitling the aggrieved party to remedies. The article then explores what these circumstances are, and considers what legal bases the aggrieved party may be able to rely on as routes to a remedy.
Refractory constrictive pericarditis caused by an immune checkpoint inhibitor properly managed with infliximab: a case report
Authors: Moriyama Shohei , Fukata Mitsuhiro , Tatsumoto Ryoma , Kono Mihoko
Published: February 2021

Background

Immune checkpoint inhibitors (ICIs) can cause cardiac immune-related adverse events (irAEs), including pericarditis. Cardiovascular events related to pericardial irAE are less frequent, but fulminant forms can be fatal. However, the diagnosis and treatment strategies for pericardial irAE have not established.

Case summary

A 58-year-old man was diagnosed with advanced non-small-cell lung cancer and nivolumab was administered as 5th-line therapy. Eighteen months after the initiation of nivolumab, the patient developed limb oedema and increased body weight. Although a favourable response of the cancer was observed, pericardial thickening and effusion were newly detected. He was diagnosed with irAE pericarditis after excluding other causes of pericarditis. Nivolumab was suspended and a high-dose corticosteroid was initiated. However, right heart failure (RHF) symptoms were exacerbated during the tapering of corticosteroid because acute pericarditis developed to steroid-refractory constrictive pericarditis. To suppress sustained inflammation of the pericardium, infliximab, a tumour necrosis factor-alfa inhibitor, was initiated. After the initiation of infliximab, the corticosteroid dose was tapered without deterioration of RHF. Exacerbation of lung cancer by irAE treatment including infliximab was not observed.

Discussion

IrAE should be considered when pericarditis develops after the administration of ICI even after a long period from its initiation. Infliximab rescue therapy may be considered as a 2nd-line therapy for steroid-refractory irAE pericarditis even with constrictive physiology.
On an Extension of Hoffmann’s Separation Theorem for Quadratic Forms
Authors: Scully Stephen
Published: February 2021

Let $p$ and $q$ be anisotropic non-degenerate quadratic forms of dimension $\geq 2$ over an arbitrary field $F$, let $s$ be the unique non-negative integer for which $2^s<{\textrm{dim}( p)} \leq 2^{s+1}$, and let $k$ be the dimension of the anisotropic part of $q$ after extension to $F(p)$. A recent conjecture of the author then asserts that ${\textrm{dim}( q)}$ must lie within $k$ of an integer multiple of $2^{s+1}$. This statement, which holds trivially if $k \geq 2^s -1$, represents a natural generalization of the well-known separation theorem of Hoffmann, bridging a gap between it and certain classical results on the Witt kernels of function fields of quadrics. In the present article, we prove the conjecture in the case where $\textrm{char}(F) \neq 2$ and ${\textrm{dim}( p)}> 2k - 2^{s-1}$. This implies, in particular, that the conjecture holds if $\textrm{char}(F) \neq 2$ and either $k \leq 2^{s-1} + 2^{s-2}$ or ${\textrm{dim}( p)} \geq 2^s + 2^{s-1} - 4$.
Refusing to Cooperate with Armed GroupsCivilian Agency and Civilian Noncooperation in Armed Conflicts
Authors: Masullo Juan
Published: February 2021

Conflict scholars have increasingly stressed the importance of taking civilian agency seriously for understanding how conflicts operate on the ground and the social legacies they leave behind. Among the different expressions of civilian agency that this scholarship has studied, instances in which civilians refuse to collaborate with armed groups have captured particular attention. While this development is to be praised, the proliferation of neighboring terms (e.g., “voice,” “autonomy,” “civil action,” “oppositional agency,” “resilience,” and “resistance”) menaces the further progression of this intellectually stimulating and policy relevant field of inquiry. In dialogue with the growing literature on civilian agency, and drawing on an established literature on concept formation, I propose civilian noncooperation as the root concept to capture these instances and specify its meaning by identifying both necessary and accompanying attributes. I discuss the advantages of this concept and assess it vis á vis alternative terms and conceptualizations. Finally, I illustrate how these conceptual foundations provide a more solid basis for empirical research by introducing a descriptive typology and a database of civilian noncooperation campaigns in the Colombian civil war. Research on noncooperation holds great potential to improving existing theories of conflict, as well as to inform crucial policy debates, including the protection of civilians, peace-building, and post-conflict reconstruction. Conceptual rigor is central to fulfilling this potential.
Psychosocial Factors
Authors: Heymann Anika von , Johansen Christoffer
Published: February 2021

Interest in psychosocial risk factors for cancer is and has been large among patients, health care professionals, and researchers for many years. Because of this great interest and the potential implications of personal guilt and blame for patients with cancer of the notion of psychosocial cancer causation, it is paramount that the research field adhere to stringent criteria for assessing causality. However, many conclusions drawn about psychosocial risk factors have been based on studies that cannot address strict criteria for causality. This chapter therefore begins by summarizing the standards necessary to provide evidence for causality, and then covers studies that make use of stringent methods to assess the effects of major life events and stress, depression and depressive mood, and personality on cancer incidence. Where available, evidence on cancer prognosis and mechanisms is likewise included. In general, studies in which the data on exposure and outcome are collected independently from each other and from the hypothesis investigated often fail to find an effect of life events or stress on cancer incidence. Likewise, most studies of depression and personality also do not find convincing associations with cancer incidence. Overall, the evidence summarized in this chapter conveys the reassuring message that cancer patients need not blame their personality, prior depression, or stressful life experiences for their disease. Still, the subject remains controversial and a field of intense debate.
Prostate Cancer Screening
Authors: Diefenbach Michael A. , Nethala Daniel , Schwartz Michael , Hall Simon J.
Published: February 2021

This chapter introduces the controversy of prostate cancer screening that has emerged over the past two decades, starting with the widespread use of the prostate-specific antigen (PSA) test in 1994. The PSA test revolutionized prostate cancer detection as it is the first biomarker available to physicians to identify prostate cancers that could not be detected by a digital rectal exam. However, unrestricted utilization of the PSA test in asymptomatic men led to an increase in overdiagnosis and treatment-related morbidity. When reviewing evidence relating prostate cancer screening to prostate cancer–related morbidity and mortality, the US Preventative Services Task Force (USPSTF) issued a recommendation in 2012 that screening among asymptomatic men for prostate cancer produces more harm than benefit. These recommendations were updated in 2018 to offer screening selectively for men between the ages of 55 and 69 years. Both recommendations called for physicians to engage patients in shared decision making regarding screening. Consequences of these recommendations on shared decision making, health communication, and efforts to address disparities in screening among underserved and at-risk populations are discussed.
Screening and Assessment for Distress
Authors: Mitchell Alex J.
Published: February 2021

Screening for distress is a vital component of healthcare that has an important place in psychosocial oncology. Over the last 10 years the evidence base for screening has strengthened significantly, but important unanswered questions remain. Successful development and validation of numerous instruments have occurred, followed by the large-scale implementation of frontline screening in a number of cancer centers. These studies have shown in which circumstances screening is successful and when it is unsuccessful. New evidence from large-scale studies has confirmed that screening for distress does not universally improve patient-reported outcomes without uptake by frontline clinicians, simple interpretation of scores, and adequate healthcare resources to ensure that timely interventions and adequate follow-up are offered in all cases with unmet needs. Further attention should also be given to an important subgroup of patients who are identified as distressed but nevertheless decline professional help. Without all key components of high quality of care in place, routine screening is perceived as an unnecessary burden by patients and staff. Yet when integrated into a holistic high-quality healthcare model, screening for distress has the potential to improve the well-being of patients and caregivers.
Melanoma
Authors: Kasparian Nadine A. , Bartula Iris
Published: February 2021

Comprehensive psychological care of people with melanoma spans all phases of the disease trajectory, including risk assessment, diagnosis, treatment, recovery, and survivorship, as well as the transition from curative to palliative care, death, and bereavement. At least one-third of people with melanoma report levels of psychological distress indicative of a need for clinical intervention, and over 70% report high levels of fear of cancer recurrence or progression. Many patients experience the period of diagnostic uncertainty between detection of a suspicious lesion and receipt of biopsy results as particularly stressful. High psychological distress is associated with reduced participation in cancer screening, treatment and risk management recommendations, delays in seeking medical advice, lower satisfaction with clinical care, higher health care costs, poorer social functioning, greater morbidity and mortality, and poorer overall quality of life. Screening for distress in people with melanoma is strongly recommended as part of routine, multidisciplinary care, followed by a stepped approach to psychological support and treatment, based on patient risk and resilience factors, needs, values, and preferences. A range of psychotherapeutic and psychoeducational interventions, delivered via a variety of modalities, are effective in reducing psychological distress in people with melanoma in the short and longer term. Cutting-edge research is focused on harnessing technology to bring effective interventions to scale.
Breast Cancer
Authors: Knobf M. Tish , Hwang Youri
Published: February 2021

There are more than 3 million breast cancer survivors, with an estimated 268,600 new cases of invasive cancer in the United States in 2019. A significant mortality disparity exists between white and black women diagnosed with breast cancer, especially for young black women. Advances in the understanding of the biology of breast cancer and newer therapeutic approaches have increased the complexity of the experience for all women. Anxiety, uncertainty, and inadequate information can result in significant distress during the decision-making process for primary treatment (breast conservation surgery with radiotherapy, mastectomy with or without reconstruction, prophylactic mastectomy), adjuvant therapy, and metastatic disease. Predictors of psychological distress include younger age, prior psychological problems, chemotherapy, non-Caucasian ethnicity, limited social support, lower socioeconomic status, increase in the subtype of triple-negative breast cancer, and moderate to severe physical symptom distress. Some level of psychological distress occurs in all women and permeates time spent in treatment as well as the transition to survivorship, when women attempt to integrate the entire breast cancer experience into their life. As providers personalize therapies based on biologic characteristics, we need to personalize psychosocial interventions based on the unique psychosocial experience of the individual woman.
Body Image—An Important Dimension in Cancer Care
Authors: Esplen Mary Jane , Fingeret Michelle Cororve
Published: February 2021

Body image is a critical psychosocial issue for patients with cancer due to the profound effects the disease and its treatment can have on appearance and bodily functioning. A rapidly growing body of scientific research demonstrates adverse psychological effects of body image changes associated with cancer, which can include debilitating levels of anxiety, social avoidance, depression, problems with intimacy and sexuality, and feelings of shame/inadequacy. In this chapter, a broad overview of seminal research on body image and cancer with the ultimate goal of helping readers better identify, evaluate, and treat psychosocial difficulties stemming from body image concerns in the oncology setting is provided. Attention is given to defining the construct of body image and reviewing emerging theoretical frameworks related to body image and cancer. A brief summary of what is known about the risk factors of body image disturbance across cancer types is presented. Finally, current approaches to assessment, along with a review of treatment interventions with clinical implications, are discussed.
Suicide and Medical Aid in Dying
Authors: Pessin Hayley , Isenberg-Grzeda Elie , Jaiswal Reena , James Monique
Published: February 2021

Identification, assessment, and the clinical management of individuals at risk for suicide continue to be vital topics for clinicians working with cancer patients, as patients with cancer are at increased risk for suicidal ideation and behavior when compared to the general population and other medically ill populations. This chapter will describe suicidality in cancer, its prevalence rates, and risk factors, and will provide best practices and clinical guidelines for screening, assessment, and intervention with patients who express suicidal ideation or a desire for hastened death. The related constructs of medical assistance in dying (MAID), physician-assisted death (PAD), and euthanasia will be defined and discussed as well.
Substance Use Disorders
Authors: Hassamal Sameer , Rzetelny Adam , Passik Steven D.
Published: February 2021

Substance use disorders (SUDs) are a major leading cause of disability in the United States. Emerging literature suggests that patients with cancer are not immune from the burden of SUDs; substance use rates range from 2% to 35% across the cancer continuum. Substance use may predate cancer or develop during and after cancer treatment commonly in the context of pain and symptom burden management. In the setting of cancer, substance use presents a complex set of challenges for both the patient and the treatment team. Ongoing substance use reduces treatment compliance, is associated with worse health-related quality of life, complicates cancer treatment, and obstructs pain and symptom management. Unfortunately, many psycho-oncology practitioners lack knowledge about SUDs. To address this gap, this chapter broadly discusses the epidemiology, identification, and clinical management of substance use disorders within the context of cancer populations. It provides recommendations for the evaluation and treatment of cancer patients with a history of SUDs.
Mindfulness-Based Interventions
Authors: Carlson Linda E.
Published: February 2021

Mindfulness-based interventions (MBIs) train participants in mindfulness skills thorough the practice of regular meditation and gentle yoga. This chapter describes the characteristics of MBIs and discusses their suitability for cancer patients and survivors, then summarizes the literature supporting their efficacy. Dozens of randomized controlled trials (RCTs) now show sustained benefits for cancer survivors across a range of outcomes including distress, anxiety, stress, depression, fatigue, cognitive function, fear of cancer recurrence, sleep, and pain. Online and app-based MBIs also show promise. The bulk of the research, however, comes from women with breast cancer; more studies with other types of cancer survivors, as well as people with advanced cancer, is warranted.
Psychosocial Interventions for Couples and Families Coping with Cancer
Authors: Zaider Talia I. , Kissane David W.
Published: February 2021

Couple therapy in cancer care delivers improvements in anxiety, depression, and marital satisfaction, with gains in communication and relational functioning. Women with breast cancer gain considerable benefit, whether through individual or group approaches to couple therapy. For men with prostate cancer, altered sexual functioning from prostate cancer treatment creates a more deleterious effect on couples. Psychoeducation, cognitive, and coping models of therapy (interventions with multiple components) deliver reliable effects, including in the setting of lung cancer. Use of telephone and web-based interventions is increasing. In advanced cancer, integrating a couple approach into the model of palliative care has benefits. Family-centered care can also increase knowledge of illness, caregiving, and coping and deliver small gains in relational functioning. Family therapy is worthwhile when a parent of dependent children is dying from cancer, in childhood and adolescent cancers, and when dysfunctional relationships add risk to bereavement outcome. Continuity of family-centered care from the palliative phase into bereavement has been shown to prevent prolonged grief disorder. Future research is needed to enhance approaches to family-centered care.
Meaning-Centered Psychotherapy
Authors: Duva Melissa Masterson , Lichtenthal Wendy G. , Applebaum Allison J. , Breitbart William S.
Published: February 2021

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.
e-Health Interventions for Tobacco Cessation
Authors: Kotsen Chris , Ostroff Jamie , Carter-Harris Lisa
Published: February 2021

E-health interventions for tobacco cessation have evolved and proliferated over the last decade. These treatments for tobacco dependence include internet/website; texting/mHealth; apps and serious video games; social media; Quitlines and telephonic, interactive voice response (IVR); and telehealth/telemedicine/video conferencing counseling formats. This chapter discusses the reach, acceptability, and efficacy for each of these digital cessation treatments. Strengths and limitations of studies and systematic reviews are highlighted, in particular, regarding tobacco dependence treatments involving patients who have already been diagnosed with cancer. Most of the latest e-health interventions that rely on evidence-based guidelines are showing solid acceptability and reach, and at least some short-term effectiveness. It is concluded that many of these interventions may be conceptualized as treatment extenders that may have the most efficacy when combined with more intensive tobacco treatments that allow for complex clinical tailoring of treatment, particularly with patients who present with comorbidities.
Psychological and Psychiatric Aspects of Palliative and End-of-Life Care
Authors: Irwin Scott A. , Fairman Nathan , Samsel Chase , Hirst Jeremy M. , Webb Jason A. , Trachsel Manuel
Published: February 2021

This chapter provides an overview of broad areas of overlap and potential synergy between the fields of psycho-oncology and palliative care. Content is aimed primarily at psycho-oncology providers—in particular, new learners or practitioners, who may have little familiarity with the field of palliative care. The chapter provides definitions that describe the two fields, highlights conceptual and practical areas of commonality, and reviews several psychological and psychiatric considerations that are particularly pertinent to taking care of patients in palliative care settings. As palliative care integration increasingly becomes the norm in oncologic care, there will be growing opportunities for palliative care and psycho-oncology providers to explore and develop models of collaboration and partnership that enhance the care of shared patients.
Prognostic Understanding in Advanced Cancer Patients
Authors: Polacek Laura C. , Walsh Leah E. , Applebaum Allison J. , Rosenfeld Barry
Published: February 2021

This chapter provides an overview of prognostic understanding in patients with advanced cancer. It reviews how the construct has been defined and measured historically, including current research on the multidimensional nature of prognostic understanding. It further highlights the importance of prognostic understanding for patients and their loved ones. Specifically, this chapter reviews the relationship between prognostic understanding and psychosocial outcomes, as well as the role of prognostic understanding in patient health information preferences, patient-provider communication, and healthcare decision-making at the end of life. It provides information on current communication practices and recent interventions to improve disclosure of prognostic information. Lastly, cultural variations in health information preferences and prognostic understanding are discussed, along with future directions for research and clinical practice.
Implementing the Survivorship Care Plan
Authors: Hahn Erin E. , Ganz Patricia A.
Published: February 2021

There are many challenges associated with ensuring quality care for cancer survivors. Cancer patients often require treatment by multiple specialists (surgeons, radiation oncologists, medical oncologists) due to the use of multimodal therapies. After treatment has ended, cancer patients may be at risk for serious long-term and late effects of their disease and treatment. Unfortunately, the oncology care system often fails to provide education and guidance to patients at the end of active cancer treatment, in contrast to the more standardized communication at the time of diagnosis and initial treatment planning. Delivering high-quality, coordinated care during the posttreatment phase is critical to ensure the best possible patient outcomes. One of the proposed first steps in accomplishing this is the widespread implementation of cancer treatment summaries and survivorship care planning, a key recommendation of the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. This has been embraced by a number of leading organizations, including the American Society of Clinical Oncology (ASCO) and the Commission on Cancer. Survivorship care has also become an international priority, with organizations such as the U.K. National Cancer Survivorship Initiative and Organization of European Cancer Institutes championing the importance of survivorship care. This chapter provides an overview of the development and use of treatment summaries and survivorship care planning and briefly reviews research on care plans and the health policy impact of survivorship care plans as they relate to quality improvement activities that are underway.
Distress, the Sixth Vital Sign
Authors: Bultz Barry D. , Loscalzo Matthew J. , Mitchell Alex J. , Holland Jimmie C.
Published: February 2021

Multiple studies have demonstrated that cancer patients are likely to encounter complex biopsychosocial distress at time of diagnosis and during treatment, recurrence, and end-of life care. Since the branding of distress as the sixth vital sign, there has been widespread attention to seeing comprehensive biopsychosocial screening and monitoring patient distress as an essential standard of best practice. To date, this standard has been widely accepted globally, endorsed, and now required for institutional cancer care accreditation. This chapter builds on the previous edition of Psycho-Oncology, where Jimmie Holland, considered the founder of psycho-oncology, strongly supported the inclusion of distress screening as a standard of cancer care and made a case for distress being named the sixth vital sign. The implementation of screening for distress as part of patient-reported outcomes would facilitate the timely and appropriate referral for optimal care inclusive of the need for psychosocial support. In addition to the implications for higher-quality and precision supportive care, this chapter will discuss the economic benefits to the institution by implementing standardized distress screening.
Emerging International Directions for Psychosocial Care
Authors: Dunn Jeff , Henry Melissa , Watson Maggie
Published: February 2021

Low-middle-income (LMI) countries are emerging as a priority target for the development of psycho-oncology care. This chapter describes some well-recognized barriers to progress along with ideas on how evidence-based practice can be imported from developed health care systems into the LMI context. Important to this process is the need to tailor care services to national, regional, and cultural needs in order to take account of communication issues that are idiosyncratic to different LMI health care contexts. The use of low-cost technologies to support implementation of psycho-oncology care services is discussed as well as the need for training resources to be made available to local/national psycho-oncology professionals as the most important future resource. In this way key leaders within LMI countries can be upskilled and provide snowball dissemination of skills to professionals in their own countries. Future priorities are described along with ideas for implementation.
Epidural Anesthesia
Authors: Lazar Alina
Published: February 2021

During epidural anesthesia, local anesthetics and adjuvants are administered into the epidural space by a single-shot, intermittent, or continuous technique. Epidural analgesia is used for open thoracic surgery, major intra-abdominal surgery with extensive surgical dissection, major lower extremity surgery, and long-term pain management. Epidural anesthesia is contraindicated in pediatric patients with uncorrected coagulopathy, hemophilia, liver disease causing coagulopathy, skin infection at the insertion site, bacteremia/sepsis, or lack of parental consent. Anesthesiologists should be familiar with the current American Society of Regional Anesthesia and Pain Medicine guidelines regarding anticoagulation and bleeding disorders in the setting of neuraxial anesthesia before performing epidural anesthesia.
In infants, the tip of the conus medullaris and dural sac are located lower in the spinal column than in adults. Additionally, because the epidural space contains less fat and fibrous tissue than in adults, in infants it is easier to insert an epidural catheter at a lower level and then to thread it up to a higher level. In infants younger than 6 months, the vertebral column remains cartilaginous, and epidural catheters can be visualized with ultrasonography. In infants, for the initial placement of the needle, there is a more subtle “give” as the ligamentum flavum is pierced than in adult patients. As a general rule, the depth of the epidural space is 1 mm/kg of body weight (e.g., the depth of the epidural space in a 10-kg child would be 10 mm). However, because wide variation exists in the depth of the epidural space, a test for loss of resistance is performed as soon as the epidural needle has entered the supraspinous ligament.
Anesthesia for Congenital Diaphragmatic Hernia Repair in Infants
Authors: Shah Chirag , Clebone Anna , Aveyard Caitlin
Published: February 2021

A congenital diaphragmatic hernia is a congenital condition in which a developmental defect in the diaphragm allows abdominal contents to migrate into the thoracic cavity. It occurs in about 1 in 2,000 newborns. This leads to lung underdevelopment and lung hypoplasia in utero. A defect in the diaphragm is usually on the left side, most commonly in the posterolateral region, also known as a Bochdalek hernia. A defect in the anterior region is known as a Morgagni hernia. Lung hypoplasia and the abnormal development of pulmonary vasculature resulting in pulmonary hypertension contribute to the morbidity and mortality associated with a congenital diaphragmatic hernia.
The Length of the Cervix and the Risk of Spontaneous Preterm Delivery
Authors: Stone Julie , House Michael
Published: February 2021

Measurement of the cervical length has become a central component of prenatal care. Mid-trimester cervical shortening is associated with preterm birth. This article summarizes a key study that established a strong correlation between cervical shortening and an increased risk of preterm birth. Transvaginal ultrasound was used to measure cervical length at 22 to 24 weeks’ gestation. The study showed that a short cervix was associated with an increased risk of preterm birth before 35 weeks. In addition, the shortest cervix conferred the highest risk, suggesting an inverse relationship. This article concludes by summarizing how cervical length is incorporated into current clinical practice. Also, a clinical case is presented.
Fetal Fibronectin in Cervical and Vaginal Secretions as a Predictor of Preterm Delivery
Authors: Colvin Zachary , Palatnik Anna
Published: February 2021

This article reviews the study “Fetal Fibronectin in Cervical and Vaginal Secretions as a Predictor of Preterm Delivery,” published in The New England Journal of Medicine in 1991 by Lockwood et al. The study examined the use of fetal fibronectin found in cervicovaginal secretions as a marker for preterm delivery in symptomatic women presenting with preterm contractions or with preterm premature rupture of membranes. The chapter reviews the findings of this study as well as the place of fetal fibronectin testing in current obstetrical practice based on subsequent studies.
Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants
Authors: Spiel Melissa H. , Zupancic John
Published: February 2021

Two hundred eighty-two patients at risk for premature delivery were included in this controlled trial of betamethasone therapy versus placebo. Of those included, 213 were in spontaneous premature labor. Ethanol or salbutamol infusions were used to delay delivery while steroid or placebo was given. Among those infants born to mothers who received betamethasone, there were no deaths with hyaline membrane disease or intraventricular hemorrhage. Respiratory distress syndrome occurred less often in those who received betamethasone than in controls (9% vs. 25.8%, p = 0.003), but this difference was primarily for those neonates born less than 32 weeks gestation who had been treated for at least 24 hours before delivery. This article reviews this hallmark study and provides contemporary context for its findings.