Direct Measurement of Resonances in

We have performed the first direct measurement of two resonances of the ^{7}Be(α,γ)^{11}C reaction with unknown strengths using an intense radioactive ^{7}Be beam and the DRAGON recoil separator. We report on the first measurement of the 1155 and 1110 keV resonance strengths of 1.73±0.25(stat)±0.40(syst) eV and 125_{-25}^{+27}(stat)±15(syst) meV, respectively. The present results have reduced the uncertainty in the ^{7}Be(α,γ)^{11}C reaction rate to ∼9.4%-10.7% over T=1.5-3 GK, which is relevant for nucleosynthesis in the neutrino-driven outflows of core-collapse supernovae (νp process). We find no effect of the new, constrained reaction rate on νp-process nucleosynthesis.

Genetic Control of Plasticity in Root Morphology and Anatomy of Rice in Response to Water Deficit.

Elucidating the genetic control of rooting behavior under water-deficit stress is essential to breed climate-robust rice (Oryza sativa) cultivars. Using a diverse panel of 274 indica genotypes grown under control and water-deficit conditions during vegetative growth, we phenotyped 35 traits, mostly related to root morphology and anatomy, involving 45,000 root-scanning images and nearly 25,000 cross sections from the root-shoot junction. The phenotypic plasticity of these traits was quantified as the relative change in trait value under water-deficit compared with control conditions. We then carried out a genome-wide association analysis on these traits and their plasticity, using 45,608 high-quality single-nucleotide polymorphisms. One hundred four significant loci were detected for these traits under control conditions, 106 were detected under water-deficit stress, and 76 were detected for trait plasticity. We predicted 296 (control), 284 (water-deficit stress), and 233 (plasticity) a priori candidate genes within linkage disequilibrium blocks for these loci. We identified key a priori candidate genes regulating root growth and development and relevant alleles that, upon validation, can help improve rice adaptation to water-deficit stress.

Genome-Wide Transcriptome Analysis During Anthesis Reveals New Insights into the Molecular Basis of Heat Stress Responses in Tolerant and Sensitive Rice Varieties.

Rice is one of the main food crops in the world. In the near future, yield is expected to be under pressure due to unfavorable climatic conditions, such as increasing temperatures. Therefore, improving rice germplasm in order to guarantee rice production under harsh environmental conditions is of top priority. Although many physiological studies have contributed to understanding heat responses during anthesis, the most heat-sensitive stage, molecular data are still largely lacking. In this study, an RNA-sequencing approach of heat- and control-treated reproductive tissues during anthesis was carried out using N22, one of the most heat-tolerant rice cultivars known to date. This analysis revealed that expression of genes encoding a number of transcription factor families, together with signal transduction and metabolic pathway genes, is repressed. On the other hand, expression of genes encoding heat shock factors and heat shock proteins was highly activated. Many of these genes are predominantly expressed at late stages of anther development. Further physiological experiments using heat-tolerant N22 and two sensitive cultivars suggest that reduced yield in heat-sensitive plants may be associated with poor pollen development or production in anthers prior to anthesis. In parallel, induction levels of a set of heat-responsive genes in these tissues correlated well with heat tolerance. Altogether, these findings suggest that proper expression of protective chaperones in anthers is needed before anthesis to overcome stress damage and to ensure fertilization. Genes putatively controlling this process were identified and are valuable candidates to consider for molecular breeding of highly productive heat-tolerant cultivars.

Metabolic and transcriptomic signatures of rice floral organs reveal sugar starvation as a factor in reproductive failure under heat and drought stress.

Heat and drought stress are projected to become major challenges to sustain rice (Oryza sativa L.) yields with global climate change. Both stresses lead to yield losses when they coincide with flowering. A significant knowledge gap exists in the mechanistic understanding of the responses of rice floral organs that determine reproductive success under stress. Our work connects the metabolomic and transcriptomic changes in anthers, pistils before pollination and pollinated pistils in a heat-tolerant (N22) and a heat-sensitive (Moroberekan) cultivar. Systematic analysis of the floral organs revealed contrasts in metabolic profiles across anthers and pistils. Constitutive metabolic markers were identified that can define reproductive success in rice under stress. Six out of nine candidate metabolites identified by intersection analysis of stressed anthers were differentially accumulated in N22 compared with Moroberekan under non-stress conditions. Sugar metabolism was identified to be the crucial metabolic and transcriptional component that differentiated floral organ tolerance or susceptibility to stress. While susceptible Moroberekan specifically showed high expression of the Carbon Starved Anthers (CSA) gene under combined heat and drought, tolerant N22 responded with high expression of genes encoding a sugar transporter (MST8) and a cell wall invertase (INV4) as markers of high sink strength.

Physiological and biochemical characterization of NERICA-L-44: a novel source of heat tolerance at the vegetative and reproductive stages in rice.

The predicted increase in the frequency and magnitude of extreme heat spikes under future climate can reduce rice yields significantly. Rice sensitivity to high temperatures during the reproductive stage is well documented while the same during the vegetative stage is more speculative. Hence, to identify and characterize novel heat-tolerant donors for both the vegetative and reproductive stages, 71 rice accessions, including approximately 75% New Rice for Africa (NERICAs), were phenotyped across field experiments during summer seasons in Delhi, India, and in a controlled environment study at International Rice Research Institute, Philippines. NERICA-L-44 (NL-44) recorded high seedling survival (52%) and superior growth and greater reproductive success exposed to 42.2°C (sd ± 2.3) under field conditions. NL-44 and the heat-tolerant check N22 consistently displayed lower membrane damage and higher antioxidant enzymes activity across leaves and spikelets. NL-44 recorded 50-60% spikelet fertility, while N22 recorded 67-79% under controlled environment temperature of 38°C (sd±1.17), although both had about 87% fertility under extremely hot field conditions. N22 and NL-44, exposed to heat stress (38°C), had similar pollen germination percent and number of pollen tubes reaching the ovary. NL-44 maintained low hydrogen peroxide production and non-photochemical quenching (NPQ) with high photosynthesis while N22 avoided photosystem II damage through high NPQ under high-temperature stress. NL-44 with its reproductive stage resilience to extreme heat stress, better antioxidant scavenging ability in both vegetative tissue and spikelets and superior yield and grain quality is identified as a novel donor for increasing heat tolerance at both the vegetative and reproductive stages in rice.

Implant retained auricular prosthesis with a modified hader bar: a case report.

Auricular prostheses for defects of external ear are retained either by mechanical means or implants. All implant retained prostheses are retained by various means such as bar and clip, magnetic attachments or a combination of bar, clip and magnets. The commonest problem encountered with the bar and clip system is loosening of the clip after 3-4 months. When magnets are used as retaining component they tend to corrode over a period of time. So various alternative retention methods which possess good retentive qualities, ease of reparability and patient friendly were tried. In the present case a newly modified Hader bar design which can act as an additional retentive feature apart from the clip is employed to increase retention. The major advantages in the modified Hader bar system were that only two implants were employed, the additional loops in the Hader bar prevented micro movements and the retentive acrylic locks were easy to repair if broken. The modified Hader bar has anti-rotational slots which prevents the sliding or rotation of the prosthesis which gave new confidence to the patient who was otherwise worried of inadvertent displacement of the ear prosthesis while playing.

Management of Broken Screw Inside Implant Screw Channel: A Case Report.

RATIONALE: This case report outlines a novel prosthodontic approach for managing a broken screw inside an implant screw channel, emphasising the importance of innovative solutions in implant dentistry. PATIENT CONCERNS: A 57-year-old male patient sought restoration for implant-supported crowns (#46 and #47). A broken screw inside the implant screw channel posed a significant concern for both the patient and the dental team. TREATMENT: Utilising an impression pickup technique of the inner surface of the implant body, a custom titanium abutment was fabricated in the laboratory and restoration was successfully replaced. A follow-up of 6 months was performed, ensuring optimal function and patient satisfaction. OUTCOME: The custom titanium abutment with a zirconia crown was placed, leading to a successful restoration. The patient reported no discomfort, demonstrating improved function and aesthetics. TAKEAWAY LESSON: This case highlights the effectiveness of tailored prosthodontic interventions in addressing complex implant-related complications.

Frequently used extraoral maxillofacial prosthetic materials and their longevity - A comprehensive review.

The longevity of an extraoral prosthesis depends on its physical and mechanical properties and user maintenance. Faced with multiple outcome measures, researchers find it difficult to determine the most appropriate extraoral prosthetic material. This comprehensive review evaluates the most used extraoral prosthesis materials and qualitatively assesses their longevity and function. The study aims to identify and interpret the results of current updates on the factors that affect longevity and functionality. This comprehensive review summarizes and evaluates differences in the properties of commonly used extraoral maxillofacial prosthetic materials. The review was planned to focus on all factors related to the longevity and function of the extraoral maxillofacial prosthetics. An electronic search covered English articles in PubMed, Scopus, Google Scholar, Web of Science, and grey literature. Manual searching was also performed. Six authors participated in the screening. Search engines extracted 1107 records, and 88 studies were included for qualitative and bias assessments. Silicones are the most frequently used extraoral maxillofacial prosthetic materials. Heat-cured silicones are more color-stable than those cured at room temperature. Additional ingredients and processing techniques affect prosthesis longevity.

Evaluation of E-max Porcelain Veneer Failures: A Retrospective Study.

Aim This retrospective study aimed to evaluate if E-max veneers over five years caused changes in gingival, periodontal health, and veneer failures. Background As aesthetic dentistry progresses, dental veneers are becoming increasingly popular in both general and specialized dental practices. Due to technological advancements in dental ceramics and adhesive systems, porcelain veneers have become a highly sought-after solution for improving aesthetics in dental patients. The success of porcelain laminate veneers, a commonly used method for aesthetic restoration, relies on various factors. E-max veneers are frequently utilized, with their long-term durability contingent upon factors such as color stability, resistance to abrasion, as well as good compressive, tensile, and shear strength, along with maintaining marginal integrity. Methodology In this study, data was collected through a checklist form used to record clinical parameters. The clinical parameters evaluated were inflammation and bleeding on probing (BOP). The gingival health was evaluated by gingival index, gingival color, texture, and bleeding on probing, and periodontal health was evaluated by the pocket depth and radiographic evaluations. Finally, the veneer was visually inspected for chipping, staining, and debonding history. The score for most of the cases ranged between 0-1, with only 10 cases displaying moderate gingival inflammation and BOP (Gingival Index 2). Siemens Orthopantomogram (OPG) systems were used for radiological evaluation and documentation of cases. E-max porcelain veneers were only included in the research. Results Out of 28 patients, each with 6-to-10-unit veneer cases was examined, 18 patients (64.3%) displayed healthy gingival status with no bleeding area recorded in none of the veneers amongst the 6 to 10 units. In 10 patients (35.7%) most of the veneers had inflamed gingival tissue that was bleeding on probing. The majority revealed the presence of stippling (92.9%), absence of recession (96.4%), and pocket depth (67.9%). Half of our participants had their veneer for more than five years (50%) and the majority presented with no significant changes in veneer recorded like marginal staining, debonding, or chipping (89.3%). Conclusion Multiple factors such as patient selection, proper treatment planning, and design, including material selection, play a significant role in the long-lasting success of ceramic veneers. The retrospective study indicated that proper oral hygiene measures are vital for the long-term sustainability of E max veneers.

Challenges of breastfeeding during COVID-19 and baby friendly protocols adopted at a maternity health center in the northern Emirates of UAE: a comprehensive review.

BACKGROUND: The outbreak of Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) has caused worldwide panic in the global population taking people's lives, creating fear, and affecting mother-child relationships. Many questions were raised on the dangers of being infected with COVID-19 for newborns and safety concerns during feeding by COVID-19-positive mothers. Moreover, questions and doubts about the safety of the administration of vaccinations for nursing mothers are still open. This review attempts to fill the existing literature gap by exploring concepts concerning COVID-19 and breastfeeding mothers, the safety of vaccinations, the beneficial effects of breastfeeding on both mother and child, important hygiene recommendations for SARS-CoV-2 infected mothers, and possible solutions to optimize breastfeeding and safety precautions amidst the fear of emergence of novel variants. METHODS: All relevant publications from Google Scholar, PubMed, Web of Science, and Scopus search engines from December 2019 to October 2022 related to SARS-CoV-2, breastfeeding, COVID-19, lactating guidelines, and vaccination were included using 'Breastfeeding AND vaccine AND SARS-CoV-2' as MESH TERMS. Apart from the literature review, existing maternity protocols followed in Northern UAE were gathered from lactation consultants practicing in the UAE. RESULTS: Out of 19,391 records generated, only 24 studies were analyzed and summarized in this exhaustive review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. Previous studies suggest that breastmilk is predominantly the primary source of nutrition for neonates. Breast milk is a rich source of antibodies that help the baby to fight against infections including other benefits. Hygiene recommendations for suspected or confirmed COVID-19-infected mothers are required along with psychological and emotional support. CONCLUSIONS: The administration of vaccinations should be advised and encouraged to protect the mothers with antibodies and the neonates by the passive transmission of antibodies through breast milk. This is a significant reason for not stopping breastfeeding even in case of COVID-19 infection. With adherence to proper hygiene methods, breastfeeding is recommended to be continued as the benefits greatly outweigh the risks.

Esthetic Rehabilitation of Pediatric Patients Using Direct Bonding Technique-A Case Series Report.

Pediatric esthetic dentistry is a sensitive technique, as children can be less cooperative; hence, minimal appointments are preferred. The most conservative treatment modality for anterior esthetic rehabilitation is using direct composite veneer restorations. In many instances, esthetic improvements using composite resin are the only possible option until the growth phase of the pediatric patient is complete. In this article, we present three different case scenarios in young teenagers with different treatment needs requiring esthetic restorations. The first case report is a patient with amelogenesis imperfecta, the second is with generalized spacing, and the third is with localized microdontia. All three patients were followed up for six months post direct composite veneering and were highly satisfied with their treatment outcomes, which boosted their self-confidence.

A Comparative Evaluation of the Cleaning Efficacy of Five Different Root Canal Irrigation Devices: A Histological Study.

OBJECTIVES: This study is aimed to evaluate the cleaning efficacy of five different irrigation systems as SonicMax, RinsEndo, EndoVac, passive ultrasonic irrigation (PUI), and manual needle irrigation (MNI) to histologically evaluate the presence of organic structures and the penetration of irrigation solution. MATERIALS AND METHODS: Forty-two single-rooted, extracted human mandibular premolars were used in the study. Each tooth was decoronated at the cementoenamel junction and the root canals were instrumented using ProTaper rotary instruments in a crown-down manner. The specimens were randomly divided into five experimental groups (n = 7) Group (1) SonicMax, group (2) RinsEndo,group (3) EndoVac, group (4) PUI, group (5) MNI, and the control groups (n = 7). Each system used 2.5% sodium hypochlorite (NaOCl), 17% ethylenediamine tetraacetic acid (EDTA), and 2.5% NaOCl, respectively, in the experimental groups. The control group did not receive any final irrigation.The measurements were analyzed by employing two-way analysis of variance multivariate results to show significant differences between the length of the dentin tubules in the apical, middle, and coronal of the six groups. The post-hoc test was used when groups were compared by pairs. RESULTS: The results of this study indicate that among the five groups, the RinsEndo and EndoVac were found to be most effective in the cleaning of root canals. The RinsEndo shows highly significant results in the cleaning efficiency of the coronal and middle parts compared with the other groups. The cleaning efficiency in the apical area was the same for RinsEndo and EndoVac. CONCLUSION: The result of our study indicates that RinsEndo and EndoVac may be more effective in clinical practice.

Students Perception toward Effectiveness of Online Learning during COVID-19 Pandemic among University Dental Students in India and United Arab Emirates: A Multi Centric Study.

Objectives: The rationale of this study was to compare the efficiency of online learning and the differences in outcome between the two universities in India and United Arab Emirates (UAE). Materials and Methods: A cross-sectional study was conducted with a validated questionnaire among dental students of a dental college in India and a dental college in the UAE. The data were analyzed using the SPSS software version 22, and comparison was done using the Chi-square test, ANOVA, correlation, and regression analysis. Statistical significance was set at P < 0.05. Results: A total of 491 students responded to the questionnaire, of which 314 were from India and 177 from UAE. The awareness of online learning among students had increased after COVID-19, and Zoom was the most common platform (30.9%). The satisfaction ratio was 78.4%, and smartphones were commonly used by students. Based on the satisfaction of online learning, study participants from UAE had a higher mean attitude score (2.72 ± 0.98) as compared to Indian students (2.47 ± 0.77) (P < 0.027*). Conclusion: The study results show that online learning was comparable to traditional method of learning. Although poor network connectivity was a deterrent for online learning among students from India and UAE, future teaching methods could inculcate online teaching methods and hence encourage blended learning as part of the teaching curriculum.

Thymoquinone Alterations of the Apoptotic Gene Expressions and Cell Cycle Arrest in Genetically Distinct Triple-Negative Breast Cancer Cells.

Breast cancer (BC) is the most common cancer in women worldwide, and it is one of the leading causes of cancer death in women. triple-negative breast Cancer (TNBC), a subtype of BC, is typically associated with the highest pathogenic grade and incidence in premenopausal and young African American (AA) women. Chemotherapy, the most common treatment for TNBC today, can lead to acquired resistance and ineffective treatment. Therefore, novel therapeutic approaches are needed to combat medication resistance and ineffectiveness in TNBC patients. Thymoquinone (TQ) is shown to have a cytotoxic effect on human cancer cells in vitro. However, TQ's mode of action and precise mechanism in TNBC disease in vitro have not been adequately investigated. Therefore, TQ's effects on the genetically different MDA-MB-468 and MDA-MB-231 human breast cancer cell lines were assessed. The data obtained show that TQ displayed cytotoxic effects on MDA-MB-468 and MDA-MB-231 cells in a time- and concentration-dependent manner after 24 h, with IC50 values of 25.37 µM and 27.39 µM, respectively. Moreover, MDA-MB-231 and MDA-MB-468 cells in a scratched wound-healing assay displayed poor wound closure, inhibiting invasion and migration via cell cycle blocking after 24 h. TQ arrested the cell cycle phase in MDA-MB-231 and MDA-MB-468 cells. The three cell cycle stages in MDA-MB-468 cells were significantly affected at 15 and 20 µM for G0/G1 and S phases, as well as all TQ concentrations for G2/M phases. In MDA-MB-468 cells, there was a significant decrease in G0/G1 phases with a substantial increase in the S phase and G2/M phases. In contrast, MDA-MB-231 showed a significant effect only during the two cell cycle stages (S and G2/M), at concentrations of 15 and 20 µM for S phases and all TQ values for G2/M phases. The TQ effect on the apoptotic gene profiles indicated that TQ upregulated 15 apoptotic genes in MDA-MB-231 TNBC cells, including caspases, GADD45A, TP53, DFFA, DIABLO, BNIP3, TRAF2/3, and TNFRSF10A. In MDA-MB-468 cells, 16 apoptotic genes were upregulated, including TNFRSF10A, TNF, TNFRSF11B, FADD TNFRSF10B, CASP2, and TRAF2, all of which are important for the apoptotic pathway andsuppress the expression of one anti-apoptotic gene, BIRC5, in MDA-MB-231 cells. Compared to MDA-MB-231 cells, elevated levels of TNF and their receptor proteins may contribute to their increased sensitivity to TQ-induced apoptosis. It was concluded from this study that TQ targets the MDA-MB-231 and MDA-MB-468 cells differently. Additionally, due to the aggressive nature of TNBC and the lack of specific therapies in chemoresistant TNBC, our findings related to the identified apoptotic gene profile may point to TQ as a potential agent for TNBC therapy.

The retrieval of a surgical blade broken within the alveolar bone during minimally traumatic tooth extraction.

Minimally traumatic tooth removal is the norm for removing teeth when a dental implant is planned at that site. The quantity of available bone is the primary requisite to place an implant. The initial use of a scalpel blade to widen the periodontal space followed by the use of luxators is one of the techniques that is being followed for atraumatic extraction. A case of accidental breakage of a number 11 scalpel blade while attempting tooth removal and the method adopted in removing this portion of the blade without further bone destruction is reported here. The authors have not found any previously published cases, reporting the breakage of a scalpel blade during the bone expansion procedure and its management.

Is computed tomographic scanning necessary in patients with tentorial herniation? Results of immediate surgical exploration without computed tomography in 100 patients.

Computed tomographic (CT) scans are performed on virtually all patients with severe head injury at the time of admission. Because of the time involved in obtaining these studies, the evacuation of significant intracranial mass lesions is delayed. To avoid such delays, the authors performed burr-hole exploration for the diagnosis of intracranial hematomas before CT scans were obtained in 100 consecutive head-injured patients with clinical signs of tentorial herniation or upper brain stem dysfunction upon admission to the emergency room. Patients in whom a hematoma was discovered had a craniotomy for evacuation of the clot; those in whom the exploration was negative had a CT brain scan immediately after operation. Burr-hole exploration revealed extracerebral mass lesions in 56 patients. In 38 patients, the exploration was negative, and postoperative CT scanning showed no significant hematoma. Of 6 patients in whom the CT scan demonstrated extraaxial hematomas requiring surgical evacuation, 4 had subdural hematomas that were missed because the exploration was incomplete; 1 patient had an epidural hematoma and 1 had a subdural hematoma contralateral to a craniotomy on the side of a positive initial burr-hole exploration. Our results indicate that the relatively small subgroup of head-injured patients with early tentorial herniation or upper brain stem compression have a high incidence of immediate extraaxial hematomas and a low incidence of intracerebral hematomas. This is particularly true of patients over 30 years of age and those who suffer low speed trauma, such as falls and vehicle-pedestrian accidents.

Outcome from severe head injury in children and adolescents.

A consecutive series of 37 children (17 years old and under) with severe head injury is presented. The data confirm that morbidity and mortality are lower in children than in adults: 51% of these young patients had a good recovery or moderate disability at 6 months. The mortality rate in this series (33%) is higher than in some reports, but probably more closely approximates the death rate from these injuries in an unselected pediatric population than do statistics from tertiary care hospitals. There was no significant relationship between age and outcome in this age group, but mass lesions and uncontrolled intracranial hypertension adversely affected outcome. Diffuse cerebral swelling was commonly seen on computerized tomography scans, and generally was associated with a satisfactory outcome (75%). Two of 13 deaths were considered preventable, emphasizing the narrow therapeutic safety margin and extreme care required in treating these patients.

The cost-effectiveness of community services in a frail elderly population.

We use an integrated model incorporating simple principles of decision analysis and marginal cost analysis to discuss cost-effectiveness of community long-term care services as a substitute for nursing home care. By taking individuals as the unit of analysis and analyzing different types of community services separately, the model defines the targeting issue precisely and permits key policy parameters to be estimated empirically. When applied to data from the National Long Term Care Channeling Demonstration, 41% of those screened into the control group were found to have some potential for net long-term care cost reduction through program services.

Reducing nursing home use through community long-term care: an optimization analysis.

Can community services be made more effective in reducing nursing home use through better management of their mix and allocation? To test this idea, we used data from the National Long-Term Care Channeling Demonstration to estimate logistic regression models relating the use of various types of community services to nursing home use. We then used these estimates to form an objective function for a mathematical optimization procedure which minimizes total expected population nursing home use as a function of community service use, subject to a total expenditure constraint. We find through this simulated reallocation that, in theory, significant reductions in nursing home use can be produced without increasing total community expenditures.

Relationship between fatigue and quality of life in patients with glioblastoma multiformae.

PURPOSE/OBJECTIVES: To evaluate changes in fatigue at the time of diagnosis (Time 1) and two weeks after the completion of radiation therapy (Time 2) and to determine the relationship between fatigue and quality of life (QOL) at each time interval in patients with glioblastoma multiformae (GBM). DESIGN: Descriptive study to evaluate fatigue and QOL. SETTING: Neuro-oncology clinic for accrual. Clinic, home, or office for patients interviews. SAMPLE: 60 adult patients diagnosed with GBM who received radiation therapy. METHODS: Participants completed a demographic data sheet, the Profile of Mood States, and the Multidimensional Quality of Life Scale-Cancer Version 2 at both time points. MAIN RESEARCH VARIABLES: Fatigue and QOL. FINDINGS: Fatigue significantly increased from Time 1 to Time 2 (t = -2.69, p = 0.009). Increases in fatigue were associated with significant decreases in QOL at Time 1 (r = -0.57) and Time 2 (r = -0.60). CONCLUSIONS: Patients with GBM experience increases in fatigue after radiation therapy. Increases in fatigue are associated with decreases in almost all aspects of patients' QOL. IMPLICATIONS FOR NURSING PRACTICE: Nurses must provide patients with information about the occurrence of fatigue during radiation therapy and recommend interventions to deal with this devastating symptom.