Caregiver self-efficacy providing nutritional support for pediatric patients undergoing hematopoietic stem cell transplant is associated with psychosocial factors

IntroductionCaregiver self-efficacy in providing nutritional support to pediatric hematopoietic stem cell transplantation (HSCT) patients has been little studied despite the increased risk of these children potentially being over- or under-nourished after HSCT, and nutritional status could possibly affect treatment outcomes. The current study aimed to describe caregiver dietary self-efficacy and its associated psychosocial factors and barriers to following dietary recommendations.MethodsCaregivers completed questionnaires pre-HSCT and 30 days, 100 days, and one year post-HSCT. A subset provided a 24-h recall of food intake.ResultsResults showed generally high caregiver confidence and low difficulty supporting their child nutritionally. However, lower confidence was associated with higher caregiver depression, anxiety, and stress 30 days post-HSCT. Further, higher difficulty at various time points was correlated with lower income, higher depression and anxiety, stress, and miscarried helping (i.e., negative caregiver-child interactions surrounding eating), as well as child overweight status and failure to meet protein intake guidelines. Nutritional criteria for protein, fiber, added sugar, and saturated fat were met by 65%, 0%, 75%, and 75%, respectively. Caregiver attitudes and child behavior were the most frequently reported barriers to healthy eating.DiscussionResults suggest that directing resources to caregivers struggling emotionally, economically, or transactionally could support pediatric patients undergoing HSCT in maintaining optimal nutritional status

Frost flowers growing in the Arctic ocean‐atmosphere–sea ice–snow interface: 2. Mercury exchange between the atmosphere, snow, and frost flowers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95146/1/jgrd17360.pd

Promoting a holistic family care model: Ethical and practical considerations for treating adult caregivers in integrated pediatric settings

Objective: As pediatric behavioral health concerns are increasingly identified and addressed within pediatric primary care and family medicine practices, behavioral health providers (BHPs) in integrated primary care (IPC) are often faced with not only addressing the psychosocial needs of their child patients, but also confronting the needs of those patients\u27 caregivers. Given the extensive body of evidence demonstrating that child mental health is associated with caregiver mental health, continued discussions of addressing caregiver mental health within the integrated care context are warranted. Method: The current paper will discuss obstacles to establishing family-centered comprehensive behavioral care including ethical concerns around informed consent, scope of practice, and dual relations, and various practice considerations. Results: The obstacles are greater for establishing family-centered comprehensive behavioral care within pediatric settings compared to family practice settings due to the additional practice considerations. The potential benefit to children and the broader family system may warrant the effort. Conclusions: By identifying and discussing these issues, BHPs working within pediatric and family medicine settings are encouraged to engage in active dialogue with hospital and clinic administrators to overcome systemic barriers and to think flexibly about how BHPs might expand upon existing approaches in order to utilize the IPC opportunity to address parent mental health concerns that may otherwise impede a child\u27s treatment progress

Health information technology utilization by adolescent and young adult aged inpatients undergoing hematopoietic cell transplantation

This longitudinal study examined feasibility of “Roadmap 1.0,” a modular health information application integrated with the electronic medical record, provided to 30 adolescent and young adult (AYA) inpatients 11–24 years of age undergoing hematopoietic stem cell transplantation (HSCT). Feasibility was demonstrated: 70% accessed the application. Utilization was highest the first 2 weeks of hospitalization, with the laboratory results module used most. Users' tension and fatigue were higher than nonusers' at baseline, but not hospital discharge or day 100. Results suggest AYAs utilize health information technology in ways consistent with the HSCT trajectory and Roadmap 1.0 addressed informational and psychological needs

Papillary Thyroid Carcinoma with Desmoid-Type Fibromatosis: Review of Published Cases

Desmoid-type fibromatosis (DTF) is a very rare variant of papillary thyroid carcinoma (PTC). It is essentially a dual tumor with a component of classical PTC with malignant epithelial proliferation (BRAF-mutated) and another component of mesenchymal proliferation (CTNNB1-mutated). We conducted a literature review on PTC-DTF. In total, 31 articles were identified, that together reported on 54 patients. The mean age was 47 years, with a 2.2:1 female predominance. No ultrasound features were found to be helpful in differentiating PTC-DTF from other PTC variants. Of the 43 cases that reported histological details, 60% had locally infiltrative disease (T3b or T4). Around 48% had cervical lymph node metastases, but none had distant metastases. While PTC-DTF may be locally more aggressive than classic PTC, its overall behavior is similar and can include extrathyroidal extension and lymph node metastases, which may contain a stromal component and show extranodal invasion. The mainstay of treatment for PTC-DTF is surgery, and the DTF component is not expected to be sensitive to radioactive iodine. External radiotherapy, non-steroidal anti-inflammatory drugs, tyrosine kinase inhibitors and chemotherapy have also been used in selected cases. Due to the rarity of these tumors and the lack of specific treatment guidelines, management should be discussed in a multidisciplinary team

Acute Impacts of Ionizing Radiation Exposure on the Gastrointestinal Tract and Gut Microbiome in Mice

Radiation therapy for abdominopelvic malignancies often results in damage to the gastrointestinal tract (GIT) and permanent changes in bowel function. An overlooked component of the pathophysiology of radiation-induced bowel injury is the role of the gut microbiome. The goal of this research was to identify the impacts of acute radiation exposure on the GIT and gut microbiome. C57BL/6 mice exposed to whole-body X-rays (0.1–3 Gy) were assessed for histological and microbiome changes 48 h post-radiation exposure. Within the ileum, a dose of 3 Gy significantly decreased crypt depth as well as the number of goblet cells, but increased overall goblet cell size. Overall, radiation altered the microbial distribution within each of the main phyla in a dose- and tissue-dependent manner. Within the Firmicutes phylum, high dose irradiation resulted in significant alterations in bacteria from the class Bacilli within the small bowels, and from the class Clostridia in the large bowels. The 3 Gy radiation also significantly increased the abundance of bacterial families from the Bacteroidetes phylum in the colon and feces. Overall, we identified various alterations in microbiome composition following acute radiation exposure, which could potentially lead to novel biomarkers for tracking patient toxicities or could be used as targets for mitigation strategies against radiation damage

The Arctic: a sink for mercury

Mercury is a persistent, toxic and bio-accumulative pollutant of global interest. Its main mass in the troposphere is in the form of elemental gas-phase mercury. Rapid, near-complete depletion of mercury has been observed during spring in the atmospheric boundary layer of frozen marine areas in Arctic, sub-Arctic and Antarctic locations. It is strongly correlated with ozone depletion. To date, evidence has indicated strongly that chemistry involving halogen gases from surface sea-salt is the mechanism of this destruction. Precisely which halogen gases are the main players has remained unresolved. Our novel kinetic data and multiscale modelling show that Br atoms and BrO radicals are the most effective halogens driving mercury oxidation. The reduction of oxidized mercury deposited in the snow pack back to Hg⁰ and subsequent diffusion to the atmosphere is observed. However, it cannot compensate for the total deposition, and a net accumulation occurs. We use a unique global atmospheric mercury model to estimate that halogen-driven mercury depletion events result in a 44% increase in the net deposition of mercury to the Arctic. Over a 1-yr cycle, we estimate an accumulation of 325 tons of mercury in the Arctic