A qualitative exploration of parental caregivers' experience caring for children who have survived medulloblastoma.

BACKGROUND: Approximately 70% of children diagnosed with a medulloblastoma will become long-term survivors. Medulloblastoma therapy frequently causes long-term morbidities in survivors, which places a considerable burden on parental caregivers. We aimed to explore the experience of parental caregivers caring for medulloblastoma survivors. METHODS: We conducted a qualitative study using grounded theory thematic analysis. We used semi-structured parental caregiver interviews to explore family experiences, social circumstances, and family-reported impact within families of children who had survived medulloblastoma. Parental caregivers were recruited from specialized survivor clinics at two large quaternary centers in Toronto, Canada. RESULTS: Sixteen of 22 eligible families participated, and 20 parental caregiver interviews were completed. Survivors were a median age of 6 years (range: 1-9 years) at diagnosis, and were 9.5 years (range: 5-12 years) from treatment at the time of the interview. Three major themes and associated subthemes emerged: (i) parental caregivers described significant long-term challenges associated with their child's survivorship. Subthemes included medical treatment sequelae, school issues and behavioral concerns, and surveillance and access to care. (ii) Parental caregivers recognized the impact that their child's quality of life (QOL) had on both their personal and family QOL. Subthemes included parental QOL, parental mental health and coping, spousal relationships, and effects on the family unit as a whole. (iii) Parental caregivers reported experiencing conflicting emotions related to their child's survivorship status and long-term effects. Subthemes included feeling happiness with concurrent worry, fear, and stress, as well as concerns about the future. CONCLUSIONS: Parental caregivers of medulloblastoma survivors experience long-term challenges, with personal and family impacts. Further work is needed to improve care models and support systems for families with a child who has survived medulloblastoma.

Future area expansion outweighs increasing drought risk for soybean in Europe.

The European Union is highly dependent on soybean imports from overseas to meet its protein demands. Individual Member States have been quick to declare self-sufficiency targets for plant-based proteins, but detailed strategies are still lacking. Rising global temperatures have painted an image of a bright future for soybean production in Europe, but emerging climatic risks such as drought have so far not been included in any of those outlooks. Here, we present simulations of future soybean production and the most prominent risk factors across Europe using an ensemble of climate and soybean growth models. Projections suggest a substantial increase in potential soybean production area and productivity in Central Europe, while southern European production would become increasingly dependent on supplementary irrigation. Average productivity would rise by 8.3% (RCP 4.5) to 8.7% (RCP 8.5) as a result of improved growing conditions (plant physiology benefiting from rising temperature and CO2 levels) and farmers adapting to them by using cultivars with longer phenological cycles. Suitable production area would rise by 31.4% (RCP 4.5) to 37.7% (RCP 8.5) by the mid-century, contributing considerably more than productivity increase to the production potential for closing the protein gap in Europe. While wet conditions at harvest and incidental cold spells are the current key challenges for extending soybean production, the models and climate data analysis anticipate that drought and heat will become the dominant limitations in the future. Breeding for heat-tolerant and water-efficient genotypes is needed to further improve soybean adaptation to changing climatic conditions.

Estimating the carbon storage potential and greenhouse gas emissions of French arable cropland using high-resolution modeling.

Many studies have assessed the potential of agricultural practices to sequester carbon (C). A comprehensive evaluation of impacts of agricultural practices requires not only considering C storage but also direct and indirect emissions of greenhouse gases (GHG) and their side effects (e.g., on the water cycle or agricultural production). We used a high-resolution modeling approach with the Simulateur mulTIdisciplinaire pour les Cultures Standard soil-crop model to quantify soil organic C (SOC) storage potential, GHG balance, biomass production and nitrogen- and water-related impacts for all arable land in France for current cropping systems (baseline scenario) and three mitigation scenarios: (i) spatial and temporal expansion of cover crops, (ii) spatial insertion and temporal extension of temporary grasslands (two sub-scenarios) and (iii) improved recycling of organic resources as fertilizer. In the baseline scenario, SOC decreased slightly over 30 years in crop-only rotations but increased significantly in crop/temporary grassland rotations. Results highlighted a strong trade-off between the storage rate per unit area (kg C ha-1  year-1 ) of mitigation scenarios and the areas to which they could be applied. As a result, while the most promising scenario at the field scale was the insertion of temporary grassland (+466 kg C ha-1  year-1 stored to a depth of 0.3 m compared to the baseline, on 0.68 Mha), at the national scale, it was by far the expansion of cover crops (+131 kg C ha-1  year-1 , on 17.62 Mha). Side effects on crop production, water irrigation and nitrogen emissions varied greatly depending on the scenario and production situation. At the national scale, combining the three mitigation scenarios could mitigate GHG emissions of current cropping systems by 54% (-11.2 from the current 20.5 Mt CO2 e year-1 ), but the remaining emissions would still lie far from the objective of C-neutral agriculture.

Cover crops mitigate direct greenhouse gases balance but reduce drainage under climate change scenarios in temperate climate with dry summers.

Cover crops provide ecosystem services such as storing atmospheric carbon in soils after incorporation of their residues. Cover crops also influence soil water balance, which can be an issue in temperate climates with dry summers as for example in southern France and Europe. As a consequence, it is necessary to understand cover crops' long-term influence on greenhouse gases (GHG) and water balances to assess their potential to mitigate climate change in arable cropping systems. We used the previously calibrated and validated soil-crop model STICS to simulate scenarios of cover crop introduction to assess their influence on rainfed and irrigated cropping systems and crop rotations distributed among five contrasted sites in southern France from 2007 to 2052. Our results showed that cover crops can improve mean direct GHG balance by 315 kg CO2 e ha-1  year-1 in the long term compared to that of bare soil. This was due mainly to an increase in carbon storage in the soil despite a slight increase in N2 O emissions which can be compensated by adapting fertilization. Cover crops also influence the water balance by reducing mean annual drainage by 20 mm/year but increasing mean annual evapotranspiration by 20 mm/year compared to those of bare soil. Using cover crops to improve the GHG balance may help to mitigate climate change by decreasing CO2 e emitted in cropping systems which can represent a decrease from 4.5% to 9% of annual GHG emissions of the French agriculture and forestry sector. However, if not well managed, they also could create water management issues in watersheds with shallow groundwater. Relationships between cover crop biomass and its influence on several variables such as drainage, carbon sequestration, and GHG emissions could be used to extend our results to other conditions to assess the cover crops' influence in a wider range of areas.

Impact of Spatial Soil and Climate Input Data Aggregation on Regional Yield Simulations.

We show the error in water-limited yields simulated by crop models which is associated with spatially aggregated soil and climate input data. Crop simulations at large scales (regional, national, continental) frequently use input data of low resolution. Therefore, climate and soil data are often generated via averaging and sampling by area majority. This may bias simulated yields at large scales, varying largely across models. Thus, we evaluated the error associated with spatially aggregated soil and climate data for 14 crop models. Yields of winter wheat and silage maize were simulated under water-limited production conditions. We calculated this error from crop yields simulated at spatial resolutions from 1 to 100 km for the state of North Rhine-Westphalia, Germany. Most models showed yields biased by <15% when aggregating only soil data. The relative mean absolute error (rMAE) of most models using aggregated soil data was in the range or larger than the inter-annual or inter-model variability in yields. This error increased further when both climate and soil data were aggregated. Distinct error patterns indicate that the rMAE may be estimated from few soil variables. Illustrating the range of these aggregation effects across models, this study is a first step towards an ex-ante assessment of aggregation errors in large-scale simulations.

Tele-practice guidelines for the symptom management of children undergoing cancer treatment.

The provision of tele-practice symptom management is often without the provision of evidence-based guidelines. Under the auspices of the Pediatric Oncology Group of Ontario, a nursing task force was established to appraise the evidence and develop guidelines. Promising new efforts to enhance symptom management through tele-practice are emerging. Seven guidelines and one documentation tool were created from evidence compiled from case reports, clinical examples, and nonexperimental studies. The symptom management guidelines contribute to the paucity of literature and may serve as a useful resource for health professionals providing telephone advice and conducting tele-practice symptom management assessments.

No association between protein C levels and bacteremia in children with febrile neutropenia.

BACKGROUND: Little is known about protein C levels and outcomes of pediatric febrile neutropenia. The primary aim was to evaluate the relationship between markers of activated coagulation including protein C levels and bacteremia in pediatric oncology patients with febrile neutropenia. METHODS: In this prospective cohort study, we collected a blood specimen from pediatric oncology patients who were admitted to a tertiary care hospital between October 2, 2002 and February 3, 2006 with febrile neutropenia. Levels of protein C, soluble thrombomodulin, soluble endothelial protein C receptor, thrombin-antithrombin complex, fibrinogen degradation products and activated protein C were measured. Associations between markers of activated coagulation and bacteremia were examined using univariate logistic regression. RESULTS: Of the 73 evaluable patients, 10 had bacteremia. None of the above measured markers of activated coagulation were associated with bacteremia. More specifically, the median level of protein C in those with bacteremia was 0.64 U/mL (interquartile range: 0.58 to 0.72) in comparison with the median level in those without bacteremia of 0.73 U/mL (interquartile range: 0.61 to 0.92), odds ratio 0.18 (95% confidence interval 0.00 to 8.33); P=0.38. CONCLUSIONS: Protein C levels do not differ between pediatric febrile neutropenic patients with and without bacteremia.

Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study.

BACKGROUND: The primary objective of this study was to determine the prevalence of oral herpes simplex virus (HSV) as detected by polymerase chain reaction, in pediatric oncology patients with febrile neutropenia. Our secondary objectives were to describe the association between oral HSV and prolonged fever, neutropenia, mucositis, and response to initial antimicrobial therapy. METHODS: In this prospective cohort study, we obtained a mouth swab and blood specimen from oncology patients with febrile neutropenia, and tested them for HSV by polymerase chain reaction. Prolonged fever was defined as the presence of fever 48 hours after initiation of broad-spectrum antibiotic therapy. RESULTS: Of the 75 oral and blood specimens obtained, only 7 oral swabs (9%) and 2 blood samples (3%) were positive for HSV. Oral HSV was not associated with prolonged fever or neutropenia. However, oral HSV was associated with longer median duration of mucositis (8 days; interquartile range, 0-12 days) compared with negative episodes (0 days; interquartile range, 0-2.5 days); P = 0.005. Oral HSV also was associated with inferior successful response to initial antimicrobial therapy (1 of 7, 14.3%) compared with negative episodes (51 of 67, 76.1%); P = 0.002. CONCLUSIONS: The prevalence of HSV infection in pediatric oncology patients with febrile neutropenia was low and was not associated with prolonged fever. However, oral HSV was associated with prolonged mucositis and poorer response to initial therapy. It is unknown whether early intervention with acyclovir can alter these associations.

Challenges to participation in paediatric palliative care research: a review of the literature.

It has been identified that there is a need for increased palliative care research within the paediatric setting. The assessment of parental views is necessary for this population. However, the conduct of research and recruitment of participants is often challenging. While conducting a study that involved parents of children receiving palliative or end-of-life care, the authors found that there were particular challenges to recruiting these parents. This comprehensive review of the literature aims to address the ethical and recruitment issues of involving parents of children that are receiving palliative or end-of-life care. Key elements, that may maximize completion of research and a more representative sample, are also discussed. These elements include obtaining the opinions on study design and interview script from experienced families and maximizing the partnership between health care professionals and the research team.