Prolonged survival after treatment of diffuse intrinsic pontine glioma with radiation, temozolamide, and bevacizumab: report of 2 cases.

BACKGROUND: Diffuse intrinsic pontine gliomas have poor prognosis. OBSERVATION: We report on 2 patients with diffuse intrinsic pontine glioma treated with radiation, followed by temozolamide 200 mg/m/d for 5 days every 28 days and bevacizumab 10 mg/kg/dose every 14 days. Both patients have ongoing PFS of 37 and 47 months from diagnosis. A decrease in tumor size by >65% was observed in both the patients. Both patients continue treatment. No steroid requirement since 10 weeks after radiation. Quality of life is excellent and the chemotherapy regimen is well tolerated. CONCLUSIONS: A clinical trial in an expanded cohort is warranted to determine the toxicity and evaluate response.

More than a View: School Landscape Features Are Associated with Improved Student Adjustment.

OBJECTIVE: Research indicates that natural features surrounding schools are associated with better academic achievement, enhanced focus, and reduced stress in students. However, few studies have examined the associations between school landscape elements and anxiety, depression, and behavioral concerns in students. The purpose of this study was to determine whether greenery and impervious surfaces surrounding schools are associated with student internalizing and externalizing problems. METHOD: Fifth-grade students (n = 21,378) reported internalizing and externalizing behaviors on the 2016 Minnesota Student Survey, an anonymous school-based survey administered statewide. Geographic information system landscape data were available for 268 schools in metropolitan areas. We calculated the percentages of tree canopy, grass and shrub cover, and impervious surfaces within 300- and 500-m radius areas around each school building. Multilevel regression models evaluated the associations between student-level internalizing and externalizing behaviors and school-level landscape percentages, controlling for sex, race, and free/reduced-price lunch. RESULTS: Students attending metropolitan schools with a higher percentage of impervious surfaces were more likely to report externalizing behaviors and marginally more internalizing symptoms than students in schools with a lower percentage of impervious surfaces. Higher percentages of tree canopy and grass and shrub cover surrounding schools were not associated with internalizing or externalizing behaviors. CONCLUSION: Increased impervious surfaces around schools in metropolitan areas were related to increased student externalizing behaviors. Further studies are necessary to understand the significance of the built environment, types of greenery, impact of greenery on student adjustment in nonmetropolitan settings, and varying areas surrounding schools. These results could inform initiatives to improve school landscapes.

A Coordinated Research Agenda for Nature-Based Learning.

Evidence is mounting that nature-based learning (NBL) enhances children's educational and developmental outcomes, making this an opportune time to identify promising questions to carry research and practice in this field forward. We present the outcomes of a process to set a research agenda for NBL, undertaken by the Science of Nature-Based Learning Collaborative Research Network, with funding from the National Science Foundation. A literature review and several approaches to gathering input from researchers, practitioners, and funders resulted in recommendations for research questions and methodological improvements to increase the relevance and rigor of research in this field. Some questions seek to understand how learning in nature affects what children learn, how they learn, and how it varies based on age, gender, socioeconomic status, ethnic background, special needs, and individual differences. Outcomes of interest cover academic performance, practical skills, personal development, and environmental stewardship. Other questions seek to find causal explanations for observed outcomes. To create optimal conditions for NBL, the research agenda includes practical questions about how to prepare teachers to work successfully in nature and how to support their adoption of this approach. Not least, the research agenda asks whether learning in nature can address major societal issues by moderating the effect of socioeconomic disadvantage on children's academic achievement, personal development and wellbeing, and how these benefits might be attained at reasonable costs. A deeper understanding of how, why and for whom different forms of nature contact enhance learning and development is needed to guide practice and policy decision-making.

Off-therapy headaches in pediatric brain tumor patients: a retrospective review.

To determine the incidence, timing, and characteristics of headaches in a population of off-therapy pediatric brain tumor patients, a retrospective chart review was conducted on 3 subpopulations of children followed in a multidisciplinary neuro-oncology clinic in the Southeastern United States. Data collected included tumor type and location, treatment, associated symptoms, and description and timing of headaches. In all, 81 charts were reviewed from which headaches in 3 subtypes of tumors were identified (29 medulloblastomas, 36 cerebellar juvenile pilocytic astrocytomas [JPAs], and 16 craniopharyngiomas). Off-therapy headaches were noted in 6 (21%) of medulloblastomas, 10 (28%) of JPAs, and 19 (56%) of craniopharyngiomas. Almost half of those patients with prediagnosis headaches had recurrent off-therapy headaches. Given the incidence of this symptom, headache must be highlighted in posttreatment and late effects monitoring.Whether provided by the oncology team or primary care provider, headache assessment, treatment, and prevention counseling can be improved through utilization of newly developed tools and written educational materials. Experienced nurses can play key roles in this aspect of posttreatment pediatric care of brain tumor patients.