Using Computational Text Classification for Qualitative Research and Evaluation in Extension

This article introduces a process for computational text classification that can be used in a variety of qualitative research and evaluation settings. The process leverages supervised machine learning based on an implementation of a multinomial Bayesian classifier. Applied to a community of inquiry framework, the algorithm was used to identify evidence of cognitive presence, social presence, and teaching presence in the text contributions (44,000 unique posts) of more than 4,000 participants in an online environmental education course. Results indicate that computational text classification can significantly reduce labor costs and can help Extension research faculty scale, accelerate, and ensure reproducibility of their research

Body composition of patients with neuroblastoma using computed tomography

Background: Computed tomography (CT) is often used to investigate muscle and fat mass in adult patients with cancer. However, this method has rarely been used in the pediatric cancer population. The present retrospective study aimed to investigate changes in body composition using CT during treatment in children with neuroblastoma. Procedure: CT images of 29 patients with high-risk neuroblastoma were retrospectively analyzed at diagnosis and longitudinally during treatment. The cross-sectional area of skeletal muscle, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) and skeletal muscle density at the level of the third lumbar vertebra were examined. To correct for height, cross-sectional areas were divided by height in meters squared. A linear mixed model was estimated to investigate changes in body composition over time. Results: A small increase in skeletal muscle (p =.029), skeletal muscle density (p =.002), and IMAT (p <.001) was found. Furthermore, a rapid increase in VAT (p <.001) and SAT (p =.001) was seen early during treatment with the highest volumes after six cycles of chemotherapy. Conclusions: CT scans obtained during standard care provide insight into the direction and timing of changes in skeletal muscle and different types of adipose tissue in childhood cancer patients. Future research is needed regarding the consequences of the rapid increase of VAT and SAT early during treatment

Eating and feeding problems in children with cancer:Prevalence, related factors, and consequences

Background & aims: During treatment for cancer, children experience many side effects such as lack of appetite, nausea, and vomiting. As a result, ensuring adequate intake puts pressure on both the child and the parent. This study aims to determine the prevalence, causes and consequences of eating and feeding problems in children treated for cancer. Methods: Parents of 85 children with cancer completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and symptoms, BMI, energy intake, feeding style, and parental distress were measured at 0, 3, 6 and 12 months after diagnosis. Results: Parent-reports revealed that almost a quarter of the children experienced eating disorder: 15.7% experienced problems related to diminished intake and 8.6% related to excessive intake. Prevalence of feeding disorders related to parents’ behavior was 21.1%. In children <8 years prevalence of eating and feeding disorders was significantly higher: 31% and 36% for child and parent behavior respectively. Younger age, poor pre-illness eating behavior, increase in symptoms and a demanding feeding style were associated with more eating problems. Excessive eating resulted in higher energy intake, however, no association was found between eating problems and nutritional status. Food refusal resulted in more parental distress. Conclusions: Especially younger children with cancer are at risk for eating and feeding problems. In addition, poor pre-illness eating behavior, symptoms and a demanding feeding style aggravate eating problems. Therefore, interventions should focus at diminishing side effects of treatment and instructing parents to be less demanding regarding their child's eating behavior

Malnutrition is associated with worse health-related quality of life in children with cancer

Purpose:\ud Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer.\ud \ud Methods:\ud In 104 children, aged 2–18 years and diagnosed with hematological, solid, or brain malignancies, nutritional status and HRQOL were assessed at diagnosis and at 3, 6, and 12 months using the child- and parent-report versions of the PedsQL 4.0 Generic scale and the PedsQL 3.0 Cancer Module. Scores on both scales range from 0 to 100.\ud \ud Results:\ud Undernourished children (body mass index (BMI) or fat-free mass < −2 standard deviation score (SDS)) reported significantly lower PedsQL scores compared with well-nourished children on the domains physical functioning (−13.3), social functioning (−7.0), cancer summary scale (−5.9), and nausea (−14.7). Overnourished children (BMI or fat mass >2 SDS) reported lower scores on emotional (−8.0) and cognitive functioning (−9.2) and on the cancer summary scale (−6.6), whereas parent-report scores were lower on social functioning (−7.5). Weight loss (>0.5 SDS) was associated with lower scores on physical functioning (−13.9 child-report and −10.7 parent-report), emotional (−7.4) and social functioning (−6.0) (child-report), pain (−11.6), and nausea (−7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS) compared with children with stable weight status.\ud \ud Conclusions:\ud Undernutrition and weight loss were associated with worse physical and social functioning, whereas overnutrition and weight gain affected the emotional and social domains of HRQL. Interventions that improve nutritional status may contribute to enhanced health outcomes in children with cancer

Pitfalls and novel experimental approaches to optimize microbial interventions for chemotherapy-induced gastrointestinal mucositis

PURPOSE OF REVIEW: There is a growing number of studies implicating gut dysbiosis in mucositis development. However, few studies have shed light on the causal relationship limiting translational potential. Here, we detail the key supportive evidence for microbial involvement, candidate mechanisms by which the microbiome may contribute to mucositis and emerging approaches to model host-microbe interactions with clinical relevance and translational potential. RECENT FINDINGS: Synthesis of existing clinical data demonstrate that modulating the microbiome drastically alters the development and severity of mucositis, providing a strong rationale for its involvement. Review of the literature revealed potential microbiome-dependent mechanisms of mucosal injury including altered drug metabolism, bile acid synthesis and regulation of the intestinal barrier. Current studies are limited in their mechanistic insight due to cross-sectional and would benefit from longitudinal analyses and baseline phenotyping. SUMMARY: The causative role of the microbiome in mucositis development remains unclear. Future studies must adopt comprehensive microbial analyses with functional assessment, and utilize emerging ex-vivo models to interrogate host-microbe interactions in mucositis

Clinical Pharmacokinetics of Triazoles in Pediatric Patients

Triazoles represent an important class of antifungal drugs in the prophylaxis and treatment of invasive fungal disease in pediatric patients. Understanding the pharmacokinetics of triazoles in children is crucial to providing optimal care for this vulnerable population. While the pharmacokinetics is extensively studied in adult populations, knowledge on pharmacokinetics of triazoles in children is limited. New data are still emerging despite drugs already going off patent. This review aims to provide readers with the most current knowledge on the pharmacokinetics of the triazoles: fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole. In addition, factors that have to be taken into account to select the optimal dose are summarized and knowledge gaps are identified that require further research. We hope it will provide clinicians guidance to optimally deploy these drugs in the setting of a life-threatening disease in pediatric patients

Treatment of High Dose Methotrexate Toxicity with Glucarpidase

High Dose Methotrexate (HD-MTX) toxicity can cause renal dysfunction in patients due to a presence of risk factors such as body mass index >25 kg/m2, comedication (salicylates, NSAID`s, sulfonamides, beta-lactam antibiotics, aminoglycosides), urine pH<7, iv fluid intake <3 l/m2/24 hours, hepatic dysfunction, renal insufficiency prior to HD-MTX, diarrhea and pleural effusions. To prevent renal dysfunction and further MTX toxicity Glucarpidase can be used which degrades MTX to its metabolites. Cases: A 17 year-old and a 14 year-old boy were treated with HD-MTX, developed renal insufficiency and were treated with Glucarpidase. In both patients unexpected renal dysfunction was seen still 3-4 weeks after treatment with Glucarpidase. A theoretic concern regarding the use of Glucarpidase is that the rapid formation of MTX metabolite called DAMPA, which is almost 10-fold less soluble than MTX, may lead to further renal toxicity by precipitation in the renal tubules. If we compare our patient data with data we found in the literature there is almost no difference in renal dysfunction duration between patients who got Glucarpidase (21 days) and those with only supportive therapy (19 and 12 days). After treatment with Glucarpidase the question on how and when to restart HDMTX therapy raised. The safe option for our two patients would be first a rechallange with 50-75% HD-MTX after a full recovery of the renal function. After the first rechallange kindey function and MTX levels should be closely monitored and if no problems are observed the second rechallange should be with 100% HD-MTX. If we closely look at our data and available data from the published articles there is a concern on how effective and safe Glucarpidase is. Glucarpidase should be given only in cases if supportive therapy is not effective enough in lowering MTX plasma levels. Even then, health care professionals should use Glucarpidase cautiously because of its uncertain benefits unpredictable side effect

Smell and taste function in childhood cancer patients:a feasibility study

Purpose Chemotherapy can affect smell and taste function. This has never been investigated in childhood cancer patients during chemotherapy. The objective of this study was to determine whether psychophysical smell and taste tests are suitable for children with cancer. Taste and smell function, fungiform papillae density, and eating behavior were measured before (T1) and after (T2) a cycle of chemotherapy and compared with healthy controls. Methods Thirty-one childhood cancer patients treated for a hematological, solid, or brain malignancy (median age 12 years, 16 girls), and 24 healthy controls (median age: 11 years, 10 girls) participated. Smell function was measured using Sniffin' Sticks, including a threshold, discrimination, and identification test. Taste Strips were used to determine recognition thresholds for sweet, sour, salty, and bitter taste. Papillae density was investigated by counting the fungiform papillae of the anterior tongue. Eating behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS). Results Smell and taste function could be investigated in more than 90% of the patients, while fungiform papillae density could be determined in 61% of the patients. A significant difference in smell threshold was found between patients and controls (p = 0.001), showing lower thresholds in patients. In patients, sweet taste (p <0.001), bitter taste (p = 0.028), and total taste function (p = 0.004) were significantly different after a cycle of chemotherapy, with higher scores at T2. Conclusion The assessment of smell, taste, and fungiform papillae density is feasible in children with cancer. Results of the current study suggest that smell and taste sensitivity increased in children with cancer