Self-reported late effects and long-term follow-up care among 1889 long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (the NOR-CAYACS study).

PURPOSE: The majority of childhood, adolescent, and young adult cancer survivors (CAYACS) are at risk of late effects but may not receive long-term follow-up care for these. Here, we investigated (1) self-reported late effects, (2) long-term follow-up care, and (3) factors associated with receiving follow-up care in a population-based sample of Norwegian long-term CAYACS. METHODS: Survivors were identified by the Cancer Registry of Norway. All > 5-year survivors diagnosed between 1985 and 2009 with childhood cancer (CCS, 0-18 years old, excluding CNS), breast cancer (BC, stages I-III), colorectal cancer (CRC), leukemias (LEUK), non-Hodgkin lymphoma (NHL), or malignant melanoma (MM) at age 19-39 years were mailed a questionnaire (NOR-CAYACS study). Descriptive statistics and logistic regression models were used to analyze occurrence of late effects, long-term follow-up care for these, and associated factors. RESULTS: Of 2104 responding survivors, 1889 were eligible for analyses. Of these, 68% were females, with a mean age of 43 years at survey, on average 17 years since diagnosis, and diagnosed with CCS (31%), BC (26%), CRC (8%), NHL (12%), LEUK (7%), and MM (16%). Overall, 61.5% reported the experience of at least one late effect, the most common being concentration/memory problems (28.1%) and fatigue (25.2%). Sixty-nine percent reported not having received long-term follow-up care focusing on late effects. Lower age at survey (p = 0.001), higher education (p = 0.012), and increasing number of late effects (p = < 0.001) were associated with increased likelihood of follow-up care in the multivariate model. CONCLUSIONS: The majority of survivors reported at least one late effect, but not receiving specific follow-up care for these. This indicates a need for structured models of long-term follow-up to ensure adequate access to care.

Reproduction and marriage among male survivors of cancer in childhood, adolescence and young adulthood: a national cohort study.

BACKGROUND: Increased survival after cancer in young age has made long-term follow-up studies of high external validity important. In this national cohort study, we explored the impact of cancer in young age on reproduction and marital status in male survivors. METHODS: Hazard ratios (HRs) and relative risks (RRs) of reproductive and marital outcomes were studied for male survivors of cancer in young age (<25 years) and cancer-free male comparisons, born during 1965-1985, by linking compulsory national registries in Norway. RESULTS: Male cancer survivors (n=2687) had reduced paternity (HR: 0.72, 95% confidence interval (CI): 0.68-0.76). This was most apparent in survivors of testicular cancer, brain tumours, lymphoma, leukemia and bone tumours, and when diagnosed with cancer before 15 years of age. Male cancer survivors were more likely to avail of assisted reproduction (RR: 3.32, 95% CI: 2.68-4.11). There was no increased risk of perinatal death, congenital malformations, being small for gestational age, of low birth weight or preterm birth in their first offspring. Male cancer survivors were less likely to marry (HR: 0.93, 95% CI: 0.86-1.00), in particular brain tumour survivors. CONCLUSIONS: In this national cohort study, we demonstrated reduced paternity and increased use of assisted reproduction among male cancer survivors, but no adverse outcome for their first offspring at birth.

Exploration of external light trapping for photovoltaic modules.

The reflection of incident sunlight by photovoltaic modules prevents them from reaching their theoretical energy conversion limit. We explore the effectiveness of a universal external light trap that can tackle this reflection loss. A unique feature of external light traps is their capability to simultaneously recycle various broadband sources of reflection on the module level, such as the reflection from the metal front grid, the front interfaces, the reflective backside of the cell, and the white back sheet. The reflected light is recycled in the space between the solar cell and a mirror above the solar cell. A concentrator funnels the light into this cage through a small aperture in the mirror. As a proof-of-principle experiment, a significant reflectance reduction of a bare crystalline silicon (c-Si) photodiode is demonstrated. In contrast to conventional light trapping methods, external light trapping does not induce any damage to the active solar cell material. Moreover, this is a universally applicable technology that enables the use of thin and planar solar cells of superior electrical quality that were so far hindered by limited optical absorption. We considered several trap designs and identified fabrication issues. A series of prototype millimeter-scale external metal light traps were milled and applied on an untextured c-Si photodiode, which is used as a model for future thin solar cells. We determined the concentrator transmittance and analyzed the effect of both the concentration factor and cage height on the absorptance and spatial intensity distribution on the surface of the solar cell. This relatively simple and comprehensive light management solution can be a promising candidate for highly efficient solar modules using thin c-Si solar cells.

3D-printed external light trap for solar cells.

We present a universally applicable 3D-printed external light trap for enhanced absorption in solar cells. The macroscopic external light trap is placed at the sun-facing surface of the solar cell and retro-reflects the light that would otherwise escape. The light trap consists of a reflective parabolic concentrator placed on top of a reflective cage. Upon placement of the light trap, an improvement of 15% of both the photocurrent and the power conversion efficiency in a thin-film nanocrystalline silicon (nc-Si:H) solar cell is measured. The trapped light traverses the solar cell several times within the reflective cage thereby increasing the total absorption in the cell. Consequently, the trap reduces optical losses and enhances the absorption over the entire spectrum. The components of the light trap are 3D printed and made of smoothened, silver-coated thermoplastic. In contrast to conventional light trapping methods, external light trapping leaves the material quality and the electrical properties of the solar cell unaffected. To explain the theoretical operation of the external light trap, we introduce a model that predicts the absorption enhancement in the solar cell by the external light trap. The corresponding calculated path length enhancement shows good agreement with the empirically derived value from the opto-electrical data of the solar cell. Moreover, we analyze the influence of the angle of incidence on the parasitic absorptance to obtain full understanding of the trap performance. © 2015 The Authors. Progress in Photovoltaics: Research and Applications published by John Wiley & Sons, Ltd.

Emotional concerns in follow-up consultations between paediatric oncologists and adolescent survivors: a video-based observational study.

OBJECTIVE: The present study aimed to explore (a) to what extent adolescent cancer survivors express emotional concerns during follow-up consultations, (b) the content of these expressions, and (c) the responses to their concerns by the paediatric haemato-oncologists (oncologists). METHODS: Sixty-six follow-up consultations between adolescent patients (aged 12-20 years old; mean = 16) and oncologists (n = 10) were video recorded. Emotional concerns were coded using the Verona coding definitions of emotional sequences (VR-CoDES). The content of the concerns was analysed using thematic analysis. RESULTS: Emotional concerns (n = 115) were identified in 50% of the consultations. Of the concerns, 87% were expressed implicitly as hints to the underlying emotion (cues) rather than explicitly (concerns). The oncologists elicited 66.9% of these expressions. Four main categories of emotional concerns were identified in the thematic analysis: physical (31%), psychological (29%), social (17%), and cancer related (23%). The majority (76.5%) of the oncologists' responses to the cues and/or concerns provided space for further disclosure. The oncologists responded less explicitly to the emotional aspects of physical and cancer-related issues in comparison with the cues or concerns of psychological origin. More cues and concerns were expressed when parents were not present in the consultation. CONCLUSIONS: In this study, almost half of the adolescent patients presented emotional concerns, and a subgroup presented many concerns; these were mainly expressed when initiated by the oncologists. Oncologists should therefore be attentive to hints to underlying emotions to help the adolescent bring forward his or her concerns.

Efficient and Stable Perovskite Solar Modules Enabled by Inhibited Escape of Volatile Species.

The intrinsically weak bonding structure in halide perovskite materials makes components in the thin films volatile, leading to the decomposition of halide perovskite materials. The reactions within the perovskite film are reversible provided that components do not escape the thin films. Here, a holistic approach is reported to improve the efficiency and stability of PSMs by preventing the effusion of volatile components. Specifically, a method for in situ generation of channel barrier layers for perovskite photovoltaic modules is developed. The resulting PSMs attain a certified aperture PCE of 21.37%, and possess remarkable continuous operation stability for maximum power point tracking (MPPT) of T90 > 1100 h in ambient air, and damp heat (DH) tracking of T93 > 1400 h.

Elongated nanostructures for radial junction solar cells.

In solar cell technology, the current trend is to thin down the active absorber layer. The main advantage of a thinner absorber is primarily the reduced consumption of material and energy during production. For thin film silicon (Si) technology, thinning down the absorber layer is of particular interest since both the device throughput of vacuum deposition systems and the stability of the devices are significantly enhanced. These features lead to lower cost per installed watt peak for solar cells, provided that the (stabilized) efficiency is the same as for thicker devices. However, merely thinning down inevitably leads to a reduced light absorption. Therefore, advanced light trapping schemes are crucial to increase the light path length. The use of elongated nanostructures is a promising method for advanced light trapping. The enhanced optical performance originates from orthogonalization of the light's travel path with respect to the direction of carrier collection due to the radial junction, an improved anti-reflection effect thanks to the three-dimensional geometric configuration and the multiple scattering between individual nanostructures. These advantages potentially allow for high efficiency at a significantly reduced quantity and even at a reduced material quality, of the semiconductor material. In this article, several types of elongated nanostructures with the high potential to improve the device performance are reviewed. First, we briefly introduce the conventional solar cells with emphasis on thin film technology, following the most commonly used fabrication techniques for creating nanostructures with a high aspect ratio. Subsequently, several representative applications of elongated nanostructures, such as Si nanowires in realistic photovoltaic (PV) devices, are reviewed. Finally, the scientific challenges and an outlook for nanostructured PV devices are presented.

Increased uptake of social security benefits among long-term survivors of cancer in childhood, adolescence and young adulthood: a Norwegian population-based cohort study.

BACKGROUND: As the number of cancer survivors increases, their health and welfare have come into focus. Thus, long-term medical consequences of cancer at a young age (<25 years), obtained from social security benefit records, were studied. METHODS: Standardised incidence ratios (SIRs) of long-term medical consequences for 5-year cancer survivors, born during 1965-1985, were explored by linking population-based registries in Norway. RESULTS: Among the 5-year cancer survivors (4031 individuals), 29.7% received social security benefits. The survivors had an overall 4.4 times (95% confidence interval (95% CI): 4.1-4.6) higher risk of social security benefit uptake than the cancer-free population. Survivors of malignancies of bone and connective tissues (SIR: 10.8; 95% CI: 9.1-12.9), CNS tumours (SIR: 7.7; 95% CI: 6.9-8.6) and malignancies of the haematopoietic system (SIR: 6.1; 95% CI: 5.3-7.0) had the highest risks of social security benefits uptake. The most notified causes of social security benefit uptake were diseases of the nervous system, and injury and poisoning. CONCLUSION: The uptake of social security benefits among 5-year cancer survivors increased substantially and it may represent a solid outcome measure for the burden of the most severe late effects, especially in countries with comparable social welfare systems.

Plasmonic nano-antenna a-Si:H solar cell.

In this work the effects of plasmonics, nano-focusing, and orthogonalization of carrier and photon pathways are simultaneously explored by measuring the photocurrents in an elongated nano-scale solar cell with a silver nanoneedle inside. The silver nanoneedles formed the support of a conformally grown hydrogenated amorphous silicon (a-Si:H) n-i-p junction around it. A spherical morphology of the solar cell functions as a nano-lens, focusing incoming light directly on the silver nanoneedle. We found that plasmonics, geometric optics, and Fresnel reflections affect the nanostructured solar cell performance, depending strongly on light incidence angle and polarization. This provides valuable insight in solar cell processes in which novel concepts such as plasmonics, elongated nanostructures, and nano-lenses are used.

Optimized spatial correlations for broadband light trapping nanopatterns in high efficiency ultrathin film a-Si:H solar cells.

Nanophotonic structures have attracted attention for light trapping in solar cells with the potential to manage and direct light absorption on the nanoscale. While both randomly textured and nanophotonic structures have been investigated, the relationship between photocurrent and the spatial correlations of random or designed surfaces has been unclear. Here we systematically design pseudorandom arrays of nanostructures based on their power spectral density, and correlate the spatial frequencies with measured and simulated photocurrent. The integrated cell design consists of a patterned plasmonic back reflector and a nanostructured semiconductor top interface, which gives broadband and isotropic photocurrent enhancement.

Sb2 Se3 Thin-Film Solar Cells Exceeding 10% Power Conversion Efficiency Enabled by Injection Vapor Deposition Technology.

Binary Sb2 Se3 semiconductors are promising as the absorber materials in inorganic chalcogenide compound photovoltaics due to their attractive anisotropic optoelectronic properties. However, Sb2 Se3 solar cells suffer from complex and unconventional intrinsic defects due to the low symmetry of the quasi-1D crystal structure resulting in a considerable voltage deficit, which limits the ultimate power conversion efficiency (PCE). In this work, the creation of compact Sb2 Se3 films with strong [00l] orientation, high crystallinity, minimal deep level defect density, fewer trap states, and low non-radiative recombination loss by injection vapor deposition is reported. This deposition technique enables superior films compared with close-spaced sublimation and coevaporation technologies. The resulting Sb2 Se3 thin-film solar cells yield a PCE of 10.12%, owing to the suppressed carrier recombination and excellent carrier transport and extraction. This method thus opens a new and effective avenue for the fabrication of high-quality Sb2 Se3 and other high-quality chalcogenide semiconductors.

Br Vacancy Defects Healed Perovskite Indoor Photovoltaic Modules with Certified Power Conversion Efficiency Exceeding 36.

Indoor photovoltaics (IPVs) are expected to power the Internet of Things ecosystem, which is attracting ever-increasing attention as part of the rapidly developing distributed communications and electronics technology. The power conversion efficiency of IPVs strongly depends on the match between typical indoor light spectra and the band gap of the light absorbing layer. Therefore, band-gap tunable materials, such as metal-halide perovskites, are specifically promising candidates for approaching the indoor illumination efficiency limit of ∼56%. However, perovskite materials with ideal band gap for indoor application generally contain high bromine (Br) contents, causing inferior open-circuit voltage (VOC ). By fabricating a series of wide-bandgap perovskites (Cs0.17 FA0.83 PbI3- x Brx , 0.6 ≤ x ≤ 1.6) with varying Br contents and related band gaps, it is found that, the high Br vacancy (VBr ) defect density is a significant reason that leading to large VOC deficits apart from the well-accepted halide segregation. The introduction of I-rich alkali metal small-molecule compounds is demonstrated to suppress the VBr and increase the VOC of perovskite IPVs up to 1.05 V under 1000 lux light-emitting diode illumination, one of the highest VOC values reported so far. More importantly, the modules are sent for independent certification and have gained a record efficiency of 36.36%.

Executive Function and Psychosocial Adjustment in Adolescent Survivors of Pediatric Brain Tumor.

Adolescent survivors of pediatric brain tumor (PBT) are a sparsely studied subset of childhood cancer survivors. Sustaining a PBT may complicate the development of executive functions (EFs), which play a vital role in long-term psychosocial adjustment. In this study, 48 adolescent survivors and their parents completed questionnaires assessing EF, psychological symptoms, fatigue, and adaptive functioning, and 26 survivors underwent neuropsychological assessment. Survivors reported significantly more problems with adaptive functioning than a healthy control group, and this was most strongly associated to executive dysfunction, compared to psychological symptoms and fatigue. The findings have important implications for long-term follow-ups.

Central nervous system relapse in high-risk stage 4 neuroblastoma: The HR-NBL1/SIOPEN trial experience.

BACKGROUND: There is rising concern on the impact of new strategies, such as high-dose chemotherapy (HDC) and immunotherapy, on the pattern of relapse in high-risk neuroblastoma (HR-NBL). Our aim is to evaluate the incidence and identify risk factors for first recurrence in the central nervous system (CNS) in HR-NBL. PATIENTS AND METHODS: Data from patients with stage 4V HR-NBL included from February 2002 to June 2015 in the prospective HR-NBL trial of the European International Society of Pediatric Oncology Neuroblastoma Group were analysed. Characteristics at diagnosis, treatment and the pattern of first relapse were studied. CNS imaging at relapse was centrally reviewed. RESULTS: The 1977 included patients had a median age of 3 years (1 day-20 years); 1163 were boys. Among the 1161 first relapses, 53 were in the CNS, with an overall incidence of 2.7%, representing 6.2% of all metastatic relapses. One- and three-year post-relapse overall survival was 25 ± 6% and 8 ± 4%, respectively. Higher risk of CNS recurrence was associated with female sex (hazard ratio [HR] = 2.0 [95% confidence interval {CI}: 1.1-3.5]; P = 0.016), MYCN-amplification (HR = 2.4 [95% CI: 1.2-4.4]; P = 0.008), liver (HR = 2.5 [95% CI: 1.2-5.1]; P = 0.01) or >1 metastatic compartment involvement (HR = 7.1 [95% CI: 1.0-48.4]; P = 0.047) at diagnosis. Neither HDC nor immunotherapy was associated with higher risk of CNS recurrence. Stable incidence of CNS relapse was reported over time. CONCLUSIONS: The risk of CNS recurrence is linked to both patient and disease characteristics, with neither impact of HDC nor immunotherapy. These findings support the current treatment strategy and do not justify a CNS prophylactic treatment.

Light trapping in ultrathin plasmonic solar cells.

We report on the design, fabrication, and measurement of ultrathin film a-Si:H solar cells with nanostructured plasmonic back contacts, which demonstrate enhanced short circuit current densities compared to cells having flat or randomly textured back contacts. The primary photocurrent enhancement occurs in the spectral range from 550 nm to 800 nm. We use angle-resolved photocurrent spectroscopy to confirm that the enhanced absorption is due to coupling to guided modes supported by the cell. Full-field electromagnetic simulation of the absorption in the active a-Si:H layer agrees well with the experimental results. Furthermore, the nanopatterns were fabricated via an inexpensive, scalable, and precise nanopatterning method. These results should guide design of optimized, non-random nanostructured back reflectors for thin film solar cells.

Tailoring C60 for Efficient Inorganic CsPbI2 Br Perovskite Solar Cells and Modules.

Although inorganic perovskite solar cells (PSCs) are promising in thermal stability, their large open-circuit voltage (VOC ) deficit and difficulty in large-area preparation still limit their development toward commercialization. The present work tailors C60 via a codoping strategy to construct an efficient electron-transporting layer (ETL), leading to a significant improvement in VOC of the inverted inorganic CsPbI2 Br PSC. Specifically, tris(pentafluorophenyl)borane (TPFPB) is introduced as a dopant to lower the lowest unoccupied molecular orbital (LUMO) level of the C60 layer by forming a Lewis acidic adduct. The enlarged free energy difference provides a favorable enhancement in electron injection and thereby reduces charge recombination. Subsequently, a nonhygroscopic lithium salt (LiClO4 ) is added to increase electron mobility and conductivity of the film, leading to a reduction in the device hysteresis and facilitating the fabrication of a large-area device. Finally, the as-optimized inorganic CsPbI2 Br PSCs gain a champion power conversion efficiency (PCE) of 15.19%, with a stabilized power output (SPO) of 14.21% (0.09 cm2 ). More importantly, this work also demonstrates a record PCE of 14.44% for large-area inorganic CsPbI2 Br PSCs (1.0 cm2 ) and reports the first inorganic perovskite solar module with the excellent efficiency exceeding 12% (10.92 cm2 ) by a self-developed quasi-curved heating method.

Efficient and Stable Planar n-i-p Sb2Se3 Solar Cells Enabled by Oriented 1D Trigonal Selenium Structures.

Environmentally benign and potentially cost-effective Sb2Se3 solar cells have drawn much attention by continuously achieving new efficiency records. This article reports a compatible strategy to enhance the efficiency of planar n-i-p Sb2Se3 solar cells through Sb2Se3 surface modification and an architecture with oriented 1D van der Waals material, trigonal selenium (t-Se). A seed layer assisted successive close spaced sublimation (CSS) is developed to fabricate highly crystalline Sb2Se3 absorbers. It is found that the Sb2Se3 absorber exhibits a Se-deficient surface and negative surface band bending. Reactive Se is innovatively introduced to compensate the surface Se deficiency and form an (101) oriented 1D t-Se interlayer. The p-type t-Se layer promotes a favored band alignment and band bending at the Sb2Se3/t-Se interface, and functionally works as a surface passivation and hole transport material, which significantly suppresses interface recombination and enhances carrier extraction efficiency. An efficiency of 7.45% is obtained in a planar Sb2Se3 solar cell in superstrate n-i-p configuration, which is the highest efficiency for planar Sb2Se3 solar cells prepared by CSS. The all-inorganic Sb2Se3 solar cell with t-Se shows superb stability, retaining ≈98% of the initial efficiency after 40 days storage in open air without encapsulation.

9.2%-efficient core-shell structured antimony selenide nanorod array solar cells.

Antimony selenide (Sb2Se3) has a one-dimensional (1D) crystal structure comprising of covalently bonded (Sb4Se6)n ribbons stacking together through van der Waals force. This special structure results in anisotropic optical and electrical properties. Currently, the photovoltaic device performance is dominated by the grain orientation in the Sb2Se3 thin film absorbers. Effective approaches to enhance the carrier collection and overall power-conversion efficiency are urgently required. Here, we report the construction of Sb2Se3 solar cells with high-quality Sb2Se3 nanorod arrays absorber along the [001] direction, which is beneficial for sun-light absorption and charge carrier extraction. An efficiency of 9.2%, which is the highest value reported so far for this type of solar cells, is achieved by junction interface engineering. Our cell design provides an approach to further improve the efficiency of Sb2Se3-based solar cells.

The role of users in innovation in the pharmaceutical industry.

Traditionally, innovation in the pharmaceutical industry is organised according to the linear model. Over the past two decades this model lost its meaning as a result of rising costs, increased competition, new scientific developments and better-informed, more demanding users. The linear model is not well equipped to involve these new actors and to include their feedback. Starting from a systemic approach, the involvement of actors in pharmaceutical innovation processes, more in particular users, is put central. It is discussed and illustrated with three cases why a systemic model may be more effective to cope with present developments and why users should be involved. To wind up, conclusions are drawn regarding the implications of a systemic approach for policymakers, researchers and firms.

Granulomatous lesions in lymph nodes of slaughter pigs bacteriologically negative for Mycobacterium avium subsp. avium and positive for Rhodococcus equi.

The prevalence of granulomatous lesions in lymph nodes of pigs was studied. From January till August 2004 in two slaughterhouses in The Netherlands 2,116,536 pigs were examined for the presence of granulomatous lesions in the sub-maxillary lymph nodes. In 15,900 (0.75%) of these pigs, lesions could be detected. Nine farms with the highest incidence of lesions were selected for a more detailed pathological and bacteriological examination. On these farms, the prevalence of lesions in sub-maxillary lymph nodes ranged from 2.3 to 5.7% with a mean of 3.0%. From 1276 pigs that were sampled, 98 (7.7%) displayed granulomatous lesions in the sub-maxillary lymph nodes and one (0.1%) pig showed lesions in its mesenteric lymph node. Mycobacterium avium subsp. avium (MAA) could not be isolated from the lymph nodes of the 99 pigs with lesions and from a selection of lymph nodes (n=61) of pigs without lesions. Rhodococcus equi was isolated from 44 out of 98 (44.9%) of the sub-maxillary lymph nodes with granulomatous lesions and from two mesenteric lymph nodes without lesions. A comparison of former studies and the current results indicate that the prevalence of MAA infections in slaughter pigs has strongly decreased over the last decade, whereas R. equi is highly prevalent. The high incidence of granulomatous lesions associated with the bacteriological presence of R. equi could be considered as a serious cause of misdiagnosis of MAA infections in cases where meat inspection is carried out by inspection for granulomatous changes of lymph nodes only.