A social program for adolescent and young adult survivors of pediatric brain tumors: The power of a shared medical experience.

Survivors of pediatric brain tumors experience several medical and psychosocial late effects including deficits in social competence. This mixed methods study investigated the experience of 19 adolescent and young adult survivors of pediatric brain tumors and 17 parents who participated in a social support program. Qualitative results demonstrated a significant social isolation that was compounded by medical late effects. Survivors perceived social support and acceptance from interactions with peers who have similar medical backgrounds as a key aspect of the group experience. Parents reported increased social confidence among survivors, although they did not report that social gains generalized beyond the group setting. Interventions to promote the transfer of specific social skills are needed.

Suicide ideation in pediatric and adult survivors of childhood brain tumors.

Survivors of pediatric brain tumors are at risk for long-term psychological morbidities. The current study investigated the prevalence and predictors of suicide ideation (SI) in a clinical sample of youth and adult survivors. Retrospective chart reviews were completed for 319 survivors of pediatric brain tumors who were assessed via clinical interview during routine neuro-oncology clinic visits between 2003 and 2007. Survivors were, on average, 18.0 years of age (SD = 4.9) and 10 years from diagnosis (SD = 5.0) at their most recent follow-up. The most common diagnosis was low-grade glioma (n = 162) followed by embryonal tumors (PNET/medulloblastoma; n = 64). Multivariable logistic regression was used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for SI. Nearly 12 % of survivors (11.7 %, n = 37) reported SI. Five survivors (1.5 %) had documented suicide attempts, though none were fatal. In a multivariable model, adjusting for sex and age, history of depression (OR = 20.6, 95 % CI = 4.2-101.1), psychoactive medication treatment (OR = 4.5, 95 % CI = 1.8-11.2), observation or surgery only treatment (OR = 3.7, 95 % CI = 1.5-9.1), and seizures (OR = 3.6, 95 % CI = 1.1-11.1) were significantly associated with SI in survivors. Survivors of pediatric brain tumors appear to be at risk for experiencing SI. Our results underscore the importance of a multidisciplinary approach to providing follow-up care for childhood brain tumor survivors, including routine psychological screenings.

An Examination of the Effects of Virtual Reality Training on Spatial Visualization and Transfer of Learning.

Spatial visualization ability (SVA) has been identified as a potential key factor for academic achievement and student retention in Science, Technology, Engineering, and Mathematics (STEM) in higher education, especially for engineering and related disciplines. Prior studies have shown that training using virtual reality (VR) has the potential to enhance learning through the use of more realistic and/or immersive experiences. The aim of this study was to investigate the effect of VR-based training using spatial visualization tasks on participant performance and mental workload using behavioral (i.e., time spent) and functional near infrared spectroscopy (fNIRS) brain-imaging-technology-derived measures. Data were collected from 10 first-year biomedical engineering students, who engaged with a custom-designed spatial visualization gaming application over a six-week training protocol consisting of tasks and procedures that varied in task load and spatial characteristics. Findings revealed significant small (Cohen's d: 0.10) to large (Cohen's d: 2.40) effects of task load and changes in the spatial characteristics of the task, such as orientation or position changes, on time spent and oxygenated hemoglobin (HbO) measures from all the prefrontal cortex (PFC) areas. Transfer had a large (d = 1.37) significant effect on time spent and HbO measures from right anterior medial PFC (AMPFC); while training had a moderate (d = 0.48) significant effect on time spent and HbR measures from left AMPFC. The findings from this study have important implications for VR training, research, and instructional design focusing on enhancing the learning, retention, and transfer of spatial skills within and across various VR-based training scenarios.

Medical, psychological, cognitive and educational late-effects in pediatric low-grade glioma survivors treated with surgery only.

BACKGROUND: Surgical resection is often the only treatment necessary for pediatric low-grade gliomas (LGGs) and is thought to define a population with an excellent long-term prognosis. The goal of this study was to describe the multidimensional late-effects of pediatric LGG survivors treated exclusively with surgery. METHODS: A retrospective chart review of "surgery-only" LGG survivors followed at Dana-Farber/Children's Hospital Cancer Care was undertaken. Patients had to be diagnosed with an LGG before the age of 22 years, treated with "surgery-only" and be at least 2 years from diagnosis. RESULTS: Sixty survivors were eligible with a median age at the time of review of 16.3 years and the median time since diagnosis of 8.4 years. Tumor locations were predominantly posterior fossa (47%) or cortical (33%). Eighty-five percent of patients had at least one ongoing late-effect, and 28% had three or more. The most common late-effects consisted of motor dysfunction (43%), visual problems (32%), anxiety (19%), social difficulties (19%), seizure disorders (17%), depression (15%), poor coordination/ataxia (14%), behavioral problems (13%), and endocrinopathies (10%). Nine patients had a history of suicidal ideation; two with suicide attempts. The mean full-scale IQ was normal, however, the number of survivors scoring one standard deviation below the mean was twice the expected number. Special education services were utilized by more than half of the survivors. CONCLUSIONS: "Surgery-only" LGG survivors may be more affected by their tumor and its resection than previously appreciated. A prospective study is needed to address this survivor population.

Fast Model Adaptation for Automated Section Classification in Electronic Medical Records.

Medical information extraction is the automatic extraction of structured information from electronic medical records, where such information can be used for improving healthcare processes and medical decision making. In this paper, we study one important medical information extraction task called section classification. The objective of section classification is to automatically identify sections in a medical document and classify them into one of the pre-defined section types. Training section classification models typically requires large amounts of human labeled training data to achieve high accuracy. Annotating institution-specific data, however, can be both expensive and time-consuming; which poses a big hurdle for adapting a section classification model to new medical institutions. In this paper, we apply two advanced machine learning techniques, active learning and distant supervision, to reduce annotation cost and achieve fast model adaptation for automated section classification in electronic medical records. Our experiment results show that active learning reduces the annotation cost and time by more than 50%, and distant supervision can achieve good model accuracy using weakly labeled training data only.

Psychosocial and behavioral functioning among pediatric brain tumor survivors.

OBJECTIVE: To describe the psychosocial and behavioral functioning, as described by patient, parent and teacher, of a cohort of adolescents who have been previously treated for a brain tumor. METHODS: A cohort of 32 patients, 12-18 years old, were evaluated between 1 and 5 years post-treatment for brain tumor during the patient's regularly scheduled follow-up clinic appointment at the Dana-Farber Cancer Institute. The Self-Report questionnaire and the Parent-Report of the Behavioral Assessment System for Children (BASC) were administered to the patient and to one of the patient's parents, respectively. In addition, the BASC Teacher-Report was completed by the patient's teacher. Descriptive statistics were generated; binomial distribution analyses were carried out to assess whether the proportion of individuals with impaired performance on each measure exceeded normative expectations. RESULTS: Comparison of the proportion of patients with elevated scores to normative expectations indicated no excess of elevated scores on any of the BASC scales of the Self-Report. However, parents endorsed items in the areas of attention problems and leadership; teachers endorsed items concerning learning problems; and both parents and teachers endorsed items indicative of somatization behaviors. CONCLUSIONS: Parent and teacher feedback indicate some level of psychosocial and behavioral morbidity for adolescents treated for a brain tumor; this finding contrasts with adolescent Self-Report indicating no difficulties in behavioral and psychosocial functioning. The extent to which these vulnerabilities impact quality of life and the discrepancy between reporters should be assessed in follow-up studies with a larger cohort of patients.