Background Survivors of childhood cancer develop early and severe chronic health conditions (CHCs). A quantitative landscape of morbidity among survivors, however, has not been described. Methods Among 5,522 patients treated for childhood cancer at St. Jude Children’s Research Hospital who survived ≥10 years and were ≥18 years old, 3,010 underwent prospective clinical assessment and retrospective medical validation of health records as part of the St. Jude Lifetime Cohort Study. Age- and sex-frequency-matched community-controls (n=272) were used for comparison. 168 CHCs for all participants were graded for severity using a modified Common Terminology Criteria of Adverse Events. Multiple imputation with predictive mean matching was used for missing occurrences and grades of CHCs among the 2512 survivors not clinically evaluated. Mean cumulative count and marked-point-process regression were used for descriptive and inferential cumulative burden analyses, respectively. Findings The cumulative incidence of any grade CHC at age 50 was 99·9%; 96·0% (95·3%–96·8%) for severe/disabling, life-threatening or fatal CHCs. By age 50, a survivor experienced, on average, 17·1 (16·2–18·0) CHCs including 4·7 (4·6–4·9) graded as severe/disabling, life-threatening or fatal. The cumulative burden among survivors was nearly 2-fold greater than matched community-controls (p<0·001). Second neoplasms, spinal disorders and pulmonary disease were major contributors to the excess total cumulative burden. Significant heterogeneity in CHCs among survivors with differing primary cancer diagnoses was observed. Multivariable analyses demonstrated that age at diagnosis, treatment era and higher doses of brain and chest radiation are significantly associated with a greater cumulative burden and severity of CHCs. Interpretation The burden of surviving childhood cancer is substantial and highly variable. The total cumulative burden experienced by survivors of pediatric cancer, in conjunction with detailed characterization of long-term CHCs, provide data to better inform future clinical guidelines, research investigations and health services planning for this vulnerable, medically-complex population.

It has long been assumed in physics that for information to travel between two parties in empty space, "Alice" and "Bob," physical particles have to travel between them. Here, using the "chained" quantum Zeno effect, we show how, in the ideal asymptotic limit, information can be transferred between Alice and Bob without any physical particles traveling between them.

Purpose To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

Spatial and temporal variations of pressure, temperature, and water vapor content in the atmosphere introduce significant confounding delays in interferometric synthetic aperture radar (InSAR) observations of ground deformation and bias estimates of regional strain rates. Producing robust estimates of tropospheric delays remains one of the key challenges in increasing the accuracy of ground deformation measurements using InSAR. Recent studies revealed the efficiency of global atmospheric reanalysis to mitigate the impact of tropospheric delays, motivating further exploration of their potential. Here we explore the effectiveness of these models in several geographic and tectonic settings on both single interferograms and time series analysis products. Both hydrostatic and wet contributions to the phase delay are important to account for. We validate these path delay corrections by comparing with estimates of vertically integrated atmospheric water vapor content derived from the passive multispectral imager Medium-Resolution Imaging Spectrometer, onboard the Envisat satellite. Generally, the performance of the prediction depends on the vigor of atmospheric turbulence. We discuss (1) how separating atmospheric and orbital contributions allows one to better measure long-wavelength deformation and (2) how atmospheric delays affect measurements of surface deformation following earthquakes, and (3) how such a method allows us to reduce biases in multiyear strain rate estimates by reducing the influence of unevenly sampled seasonal oscillations of the tropospheric delay. IntroductionSynthetic aperture radar interferometry (InSAR) has been successfully used to measure ground deformations related to hydrologic, volcanic, and tectonic processes [e.g., Bawden et al., 2001;Beauducel et al., 2000;Massonnet et al., 1992]. Rapid, large-amplitude deformation signals such as coseismic displacement fields [e.g., Simons et al., 2002;Lasserre et al., 2005] or volcano-tectonic episodes [e.g., Pritchard and Simons, 2002;Wright et al., 2004;Doubre and Peltzer, 2007;Grandin et al., 2010] are now routinely measured by InSAR. Still, the detection of low-amplitude, long-wavelength deformation fields such as those due to interseismic strain accumulation or postseismic motion remains challenging because of interferometric decorrelation, inaccurate orbits, and atmospheric propagation delays [e.g., Peltzer et al., 2001;Wright et al., 2001;Ryder et al., 2007;Wen et al., 2012;Jolivet et al., 2012;Grandin et al., 2012;Béjar-Pizarro et al., 2013]. Here we focus on a specific method to mitigate the impact of atmospheric artifacts.Spatiotemporal variations of the refractivity of air can introduce a change in the measured interferometric phase, hereafter called the atmospheric phase screen (APS). This phase change, or phase delay, can be on the order of several centimeters and often overwhelms the deformation signal of interest [Hanssen, 2001]. These phase delays result from the combined effects of turbulent mixing in the atmosphere (hereaft...

High-dose alkylating agents and ovarian radiotherapy at any dose are associated with POI. Patients at the highest risk should be offered fertility preservation whenever feasible. POI contributes to poor general health outcomes in childhood cancer survivors; further studies are needed to investigate the role of sex hormone replacement in improving such outcomes.

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Adolescent survivors engage in risky health behaviors at rates generally equivalent to their siblings. Aggressive health education efforts should be directed toward this high-risk population.

Background Childhood cancer survivors may develop a second malignant neoplasm during adulthood and therefore require regular surveillance. Objective To examine adherence to population cancer screening guidelines by survivors at average risk of developing a second malignant neoplasm, and to cancer surveillance guidelines by survivors at high risk of developing a second malignant neoplasm. Design Retrospective cohort study. Setting The Childhood Cancer Survivor Study (CCSS), a 26 center study of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986. Patients 4,329 male and 4,018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cancers. Measurements Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the United States Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer, or the Children’s Oncology Group guidelines for survivors at high risk for developing breast, colorectal or skin cancer as a result of their therapy. Results Among average risk female survivors, 2,743/3,392 (80.9%) reported a Papanicolaou smear within the recommended period, and 140/209 (67.0%) reported a mammogram within the recommended period. Among high risk survivors, rates of recommended mammography among females, and colonoscopy and complete skin exams among both genders were only 241/522 (46.2%), 91/794 (11.5%) and 1,290/4,850 (26.6%), respectively. Limitations Data were self report. CCSS participants are a select group of survivors and their compliance may not be representative of all childhood cancer survivors. Conclusions Female survivors at average risk for developing a second malignant neoplasm demonstrate reasonable rates of screening for cervical and breast cancer. However, surveillance for new cancers is very poor amongst survivors at highest risk for colon, breast or skin cancer, suggesting that survivors and their physicians need education about their risks and the recommended surveillance.