Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial

OBJECTIVES

To evaluate a preventative behavioral intervention for managing early childhood caries (ECC) in a cohort of high-risk children.

METHODS

This pragmatic trial of the MySmileBuddy Program (MSB) evaluated preventive behavioral outcomes in a 1-y community health worker-delivered intervention to prevent ECC progression. Pre-/postintervention surveys assessed parent-reported child engagement in therapeutic toothbrushing (i.e., adult-assisted brushing with fluoridated toothpaste twice daily) and caries-related dietary behaviors and barriers. Generalized linear model with identity link for continuous variables and logit link for dichotomous outcomes evaluated pre-/postintervention comparisons and generalized estimating equations accounted for within-participant correlation (α = 0.05).

RESULTS

Among 1,130 children with postintervention data, the average age was 3.97 y, 99% were Medicaid insured, and 88% were Hispanic. Most parents (95%) were mothers/grandmothers, married or in a committed partnership (75%), unemployed (62%), and with modest education (80% high school degree or less). The odds of reported therapeutic brushing nearly doubled (n = 864; odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.46, 2.20, P < 0.001); day and night bottle/sippy cup frequencies dropped 0.29 units (n = 871; 95% CI = -0.37, -0.33, P < 0.001) and 0.22 units (n = 1,130; 95% CI = -0.30, -0.15, P < 0.001); nighttime breastfeeding reduced 0.15 units (n = 870; 95% CI = -0.21, -0.10, P < 0.001); sharing utensils reduced 0.30 units (n = 572; 95% CI = -0.39, -0.21, P < 0.001); not using sugary foods to calm child improved 0.37 units (n = 664; 95% CI = 0.31, 0.44, P < 0.001); odds of eating meals and snacks at a table increased (n = 572; OR = 1.57, 95% CI = 1.28, 1.93, P < 0.001; n = 572; OR = 1.80, 95% CI = 1.50, 2.15, P < 0.001) respectively; and reducing barriers to behaviors improved 0.38 units for toothbrushing (n = 666; 95% CI = 0.31, 0.44, P < 0.001) and 0.33 units for diet (n = 668; 95% CI = 0.29, 0.38, P < 0.001).

CONCLUSION

Despite limitations inherent to pragmatic trials, significant behavioral changes suggest that MSB yielded an important salutary impact. Forthcoming mediation analyses will explore causal pathways. Findings support integration of MSB's behavior change program in caries management initiatives.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians, public health leaders, and researchers to inform the development and implementation of community-based, preventative behaviorally focused early childhood caries prevention programs. Study findings may enhance the understanding of the impact of behavioral interventions that engage parents of young children and could lead to more effective prevention for populations at high-risk of caries.

The Use of Lisdexamfetamine to Treat ADHD in a Patient with Stimulant (Methamphetamine) Use Disorder

Introduction

The treatment of attention deficit hyperactivity disorder (ADHD) with stimulants among patients with stimulant use disorder carries concern for efficacy and exacerbation of addictive behaviors. Lisdexamfetamine is a unique stimulant used to treat ADHD with a lower abuse potential compared to other stimulants, as the medication is the only prodrug in its class. To our knowledge, there are no reports in the literature of the use of lisdexamfetamine to treat ADHD in patients with stimulant use disorder.

Methods

We present a 33-year-old male with a history of stimulant (methamphetamine) use disorder, who was found to have long-standing ADHD. The patient was treated with lisdexamfetamine 30 mg, which was increased and sustained at 40 mg.

Results

The patient reported significant improvement in focus, concentration, calmness, organization of thoughts, and less of a tendency to procrastinate. Additionally, he denied exacerbation of anxiety or sleep disturbances. He reported his cravings for stimulants were significantly decreased. After 2 months of treatment, he had moved out from his sober living facility, started a new job, and gained a promotion. He had no use of illicit substances, which was proven by routine urine drug screens.

Conclusion

Our patient's ADHD was successfully treated with lisdexamfetamine. Not only did the patient's ADHD symptoms improve, but his cravings for stimulants were relieved. ADHD is common among patients with stimulant use disorder. Patients with ADHD and stimulant use disorder should not necessarily forgo pharmacologic treatment with stimulants for concerns of abuse. Due to its unique pharmacokinetic profile, lisdexamfetamine is a feasible treatment for patients with ADHD and a history of stimulant use disorder.

The Initiation of Long-Term Pharmacotherapy in Schizophrenia: Dosage and Side Effect Comparisons Between Oral and Depot Fluphenazine*

This report focuses on two comparisons between oral and depot fluphenazine specifically FPZ decanoate: 1) can equivalent dosages for the two drugs be established and do these equivalencies change over six months of treatment; 2) what are the side effects seen with the two drugs during the early weeks of administration.

Patients in the study receive either oral or depot FPZ as the active treatment but in order to preserve double blind conditions, they are also given the other treatment in placebo form. No dosage equivalence is established by the protocol, however, if dosage is adjusted, both forms must be changed and in the same direction. During the first weeks of treatment there is a linear relationship between the two dosage forms but a range of relatively low dosages of the oral compound (5-20 mg) is associated with a single dose (25 mg/q 3 weeks) of FPZ decanoate. At higher dosages of the oral drug the relationship is linear.

Side effects of some kind are noted in over 60 percent of patients in both treatment groups after four weeks of treatment, while symptoms of at least moderate severity occur in almost 40 percent. Only symptoms involving the extrapyramidal system and sleep disturbance are observed in more than 20 percent of the patients.

Benztropine was prescribed only if needed and was administered to 65 percent of patients. In general, those receiving benztropine had more side effects than those who did not. These differences reached significance for extrapyramidal symptoms and depression.

Based on these data, we conclude that at the dosages used in this study there are no side effect differences between these two forms of fluphenazine in the early weeks of administration. Dosage equivalence between the two drugs can be set within the range of 5- 60 mg/day oral and 12.5-100 mg/three weeks depot.

The Statistics of Computer Clocks and the Design of Synchronization Algorithms

In this study, I used standard statistical tools (such as the various forms of the two-sample Allan variance) to characterize the clocks in computers, and I show how the results of this study are used to design algorithms to synchronize the computer clocks. These synchronization algorithms can be used to synchronize the time of a computer to a local reference clock or to a remote server. The algorithms by themselves are not intended to be a simple replacement for software that implements the Network Time Protocol (NTP) or any other similar application. Instead, they describe the statistical principles that should be used to design an algorithm to synchronize any computer clock by using data from any external reference received in any format. These algorithms have been used to synchronize the clocks of the computers that support the Internet Time Service operated by the National Institute of Standards and Technology (NIST), and I illustrate the performance of the algorithm with real-time data from these servers. In addition to presenting the design principles of the algorithm, I illustrate the principles with two specific examples: synchronizing a computer clock to a local reference signal, and the design of a synchronization process that is based on time-difference data received from a remote server over the public Internet. The message exchange between the local system and the remote server in this configuration is realized in NTP format, but that is not a fundamental requirement.

Synthesis of isobemisiose, neosartose, and fischerose: three α-1,6-linked trehalose-based oligosaccharides identified from Neosartorya fischeri

Three complex α-1,6-linked trehalose-based oligosaccharides with unique preservation properties, isobemisiose, neosartose, and fischerose, were recently identified from the extreme stress-tolerant ascospores of Neosartorya fischeri. Herein, we report the first concise, scalable, and iterative chemical synthesis of these oligosaccharides from a differentially protected thioglycoside donor and a selectively protected, asymmetric trehalose acceptor. This work constitutes an improved synthesis of isobemisiose, and is also the first reported synthesis of neosartose, a tetrasaccharide, and fischerose, a pentasaccharide, in good yield. Importantly, in-depth studies of biological function are enabled by this synthetic platform.

The first concise and scalable chemical synthesis of three complex α-1,6-linked trehalose-based oligosaccharides, isobemisiose, neosartose, and fischerose, are reported for the first time.

Demonstration of a Timescale Based on a Stable Optical Carrier

We report on the first timescale based entirely on optical technology. Existing timescales, including those incorporating optical frequency standards, rely exclusively on microwave local oscillators owing to the lack of an optical oscillator with the required frequency predictability and stability for reliable steering. We combine a cryogenic silicon cavity exhibiting improved long-term stability and an accurate ^{87}Sr lattice clock to form a timescale that outperforms them all. Our timescale accumulates an estimated time error of only 48±94  ps over 34 days of operation. Our analysis indicates that this timescale is capable of reaching a stability below 1×10^{-17} after a few months of averaging, making timekeeping at the 10^{-18} level a realistic prospect.

Optical-Clock-Based Time Scale

A time scale is a procedure for accurately and continuously marking the passage of time. It is exemplified by Coordinated Universal Time (UTC) and provides the backbone for critical navigation tools such as the Global Positioning System. Present time scales employ microwave atomic clocks, whose attributes can be combined and averaged in a manner such that the composite is more stable, accurate, and reliable than the output of any individual clock. Over the past decade, clocks operating at optical frequencies have been introduced that are orders of magnitude more stable than any microwave clock. However, in spite of their great potential, these optical clocks cannot be operated continuously, which makes their use in a time scale problematic. We report the development of a hybrid microwave-optical time scale, which only requires the optical clock to run intermittently while relying upon the ensemble of microwave clocks to serve as the flywheel oscillator. The benefit of using a clock ensemble as the flywheel oscillator instead of a single clock can be understood by the Dick-effect limit. This time scale demonstrates for the first time subnanosecond accuracy over a few months, attaining a fractional frequency stability of 1.45 × 10-16 at 30 days and reaching the 10-17 decade at 50 days, with respect to UTC. This time scale significantly improves the accuracy in timekeeping and could change the existing time-scale architectures.

Abstract P5-17-01: Lobular breast cancer alliance - Advocates advancing research, screening, treatment and follow-up care for lobular breast disease

Introduction

Thirty patient advocates attended the First International Invasive Lobular Breast Cancer Symposium in 2016 at the University of Pittsburgh Cancer Center. The conference underscored that invasive lobular breast cancer (ILC) and other lobular pathologies are understudied. Specifically:

ILC is the sixth most prevalent cancer of women and the second most frequently diagnosed histological subtype of breast cancer impacting up to 34,000 patients a year in the US.

ILC is a molecularly distinct breast cancer with unique subtypes and variants with differences in presentation and behavior, including physical findings of thickening and a tendency to metastasize to unique locations.

While ILC is frequently associated with a good initial prognosis, recent analysis suggests that long-term outcomes of ILC may be worse than those stage-matched to ductal breast cancer.

Current imaging tools are less reliable for early detection of lobular disease and detection of distant recurrence.

Standard of care chemotherapy and endocrine therapies may have different effectiveness applied to ILC and IDC.

Challenges

Growing interest in ILC research requires improved methods to identify, communicate with and link patients with ILC to clinical trials and research. Advocates with advanced science training are needed as partners for research proposals and grant reviews.

Lobular breast cancer is under-represented in key meetings and literature. Encouraging opportunities to share ILC research as agenda topics and fostering collaborations between researchers, clinicians and advocates can accelerate progress and refine clinical practices for screening, treatment and follow-up.

Patients living with ILC lack a central on-line source of lobular breast cancer information and resources. This information gap is a barrier to help patients recognize signs of lobular breast cancer's unique presentation and metastatic behaviors.

Results

The Lobular Breast Cancer Alliance (LBCA) was formed by patient advocates who attended the First International ILC Symposium in response to advocate-identified opportunities to advance research, refine treatments and enhance patient education.

LBCA's mission is to bridge patients, clinicians and researchers to increase our knowledge of lobular breast disease and promote research that leads to advancements in prevention, diagnosis, treatment and patient follow-up care.

Conclusions

LBCA is driving an increased awareness of lobular breast cancer with specific goals:

Build a clinically accurate, patient centered website devoted to lobular breast cancer at www.LobularBreastCancer.org.

Elevate lobular research and foster opportunities for researcher, advocate and clinician collaborations at prominent conferences and meetings.

Identify barriers to conduct research on ILC and metastasis and link patients and advocates to ILC tumor research and clinical trials.

Initiate peer-to-peer clinician outreach strategy through targeted literature, meetings and education services to share information on ILC presentation, metastatic patterns and screening and treatment challenges of patients with ILC.

Build partnerships with existing breast cancer organizations to integrate ILC into existing information resources and work on common goals.

Citation Format: Petitti L, Axelrod J, Campbell-Kotler M, Frank E, Jaremek J, Levine J, McWilliams M, Migyanka F, Ryan N, Viggiano E, Metzger-Filho O, Oesterreich S, Pate L. Lobular breast cancer alliance - Advocates advancing research, screening, treatment and follow-up care for lobular breast disease [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-17-01.

Incorporating an Optical Clock Into a Time Scale

This paper discusses the results of a simulation of a time scale based on continuously operating commercial hydrogen masers and an optical frequency standard that does not operate continuously as a clock. The simulation compares the performance of this time scale with one that is based on the same commercial devices but incorporates a continuously operating cesium fountain instead of the optical standard. The results are independent of the detailed characteristics of the optical frequency standard; the only requirement is that the optical device be much more stable than the masers in the ensemble. We discuss two methods for realizing the results of this simulation in an operational time scale.

Biochars Reduce Mine Land Soil Bioavailable Metals

Biochar has been proposed as an amendment to remediate mine land soils; however, it could be advantageous and novel if feedstocks local to mine land sites were used for biochar production. Two different feedstocks (pine beetle-killed lodgepole pine [] and tamarisk [ spp.]), within close proximity to mine land-affected soils, were used to create biochars to determine if they have the potential to reduce metal bioavailability. Four different mine land soils, contaminated with various amounts of Cd, Cu, Pb, and Zn, received increasing amounts of biochar (0, 5, 10, and 15% by wt). Soil pH and metal bioavailability were determined, and the European Community Bureau of Reference (BCR) sequential extraction procedure was used to identify pools responsible for potential shifts in bioavailability. Increasing biochar application rates caused increases in soil pH (initial, 3.97; final, 7.49) and 55 to 100% (i.e., no longer detectable) decreases in metal bioavailability. The BCR procedure supported the association of Cd with carbonates, Cu and Zn with oxyhydroxides and carbonates, and Pb with oxyhydroxides; these phases were likely responsible for the reduction in heavy metal bioavailability. This study proved that both of these feedstocks local to abandoned mining operations could be used to create biochars and reduce heavy metal bioavailability in mine land soils.

A Study of GPS Carrier-Phase Time Transfer Noise Based on NIST GPS Receivers

To do a better time comparison between high-precision clocks (such as a Cesium-fountain clock and Hydrogen-maser clock), we want to study and eventually lower the GPS carrier-phase time transfer noise. The GPS carrier-phase time transfer noise comes from four sources: GPS satellite, GPS signal path, ground receiving equipment (receiver and antenna), and data-processing algorithm. This paper focuses on the noise introduced by the ground receiving equipment. At NIST, we have installed seven GPS receivers. All receivers have the same reference time, i.e., UTC(NIST). Three of them are connected to the same antenna. The other four are connected to four different antennas. This architecture enables us to study the time-transfer noise from the ground receiving equipment. We study both long-term (> 100 days) noise and short-term (< 1 day) noise. For the long-term noise, the time-transfer result using one receiver can vary from that using another receiver by up to 1.8 ns, during 1.3 years. To achieve sub-nanosecond GPS timing accuracy, a careful monitoring of the time delays or a more frequent calibration is needed. For the short-term noise, we find that the common-clock difference between receivers using the same antenna is less noisy than that using two different antennas, at an averaging time of less than 0.5 hour. This indicates that the antenna and antenna cable contribute to the super-short-term noise of GPS carrier-phase time transfer significantly. In addition, the response to the GPS receiver's reference-time change is tested in this paper. The variation in the response can be up to ± 350 ps. Last, this paper gives the best carrier-phase time transfer result we can currently achieve with the available equipment at NIST. The best frequency stability is 4.0×10^-16 at 3 hours, 1.1×10^-16 at 1 day, 4.0×10^-17 at 10 days, and 1.3×10^-17 at 48 days.

An Algorithm for Synchronizing a Clock When the Data Are Received Over a Network With an Unstable Delay

A method is presented for synchronizing the time of a clock to a remote time standard when the channel connecting the two has significant delay variation that can be described only statistically. The method compares the Allan deviation of the channel fluctuations to the free-running stability of the local clock, and computes the optimum interval between requests based on one of the three selectable requirements: 1) choosing the highest possible accuracy; 2) choosing the best tradeoff of cost versus accuracy; or 3) minimizing the number of requests to realize a specific accuracy. Once the interval between requests is chosen, the final step is to steer the local clock based on the received data. A typical adjustment algorithm, which supports both the statistical considerations based on the Allan deviation comparison and the timely detection of errors, is included as an example.

A Historical Perspective on the Development of the Allan Variances and Their Strengths and Weaknesses

Over the past 50 years, variances have been developed for characterizing the instabilities of precision clocks and oscillators. These instabilities are often modeled as nonstationary processes, and the variances have been shown to be well-behaved and to be unbiased, efficient descriptors of these types of processes. This paper presents a historical overview of the development of these variances. The time-domain and frequency-domain formulations are presented and their development is described. The strengths and weaknesses of these characterization metrics are discussed. These variances are also shown to be useful in other applications, such as in telecommunication.

Usage Analysis of the NIST Internet Time Service

The Internet Time Service (ITS) at the National Institute of Standards and Technology (NIST) currently receives over 16 billion time requests per day. ITS servers derive their system time from the NIST atomic-referenced time scale and distribute it freely to the public. Here we explore ITS usage patterns discovered by analysis of inbound network traffic. For example, over a period of four weeks, just two of the ≈ 20 ITS servers received requests from 316 million unique Internet Protocol (IPv4) addresses, which is at least 8.5 % of the entire Internet. We offer recommendations for networked device/software manufacturers, and providers and consumers of network time services.

Toward Continuous GPS Carrier-Phase Time Transfer: Eliminating the Time Discontinuity at an Anomaly

The wide application of Global Positioning System (GPS) carrier-phase (CP) time transfer is limited by the problem of boundary discontinuity (BD). The discontinuity has two categories. One is "day boundary discontinuity," which has been studied extensively and can be solved by multiple methods [1-8]. The other category of discontinuity, called "anomaly boundary discontinuity (anomaly-BD)," comes from a GPS data anomaly. The anomaly can be a data gap (i.e., missing data), a GPS measurement error (i.e., bad data), or a cycle slip. Initial study of the anomaly-BD shows that we can fix the discontinuity if the anomaly lasts no more than 20 min, using the polynomial curve-fitting strategy to repair the anomaly [9]. However, sometimes, the data anomaly lasts longer than 20 min. Thus, a better curve-fitting strategy is in need. Besides, a cycle slip, as another type of data anomaly, can occur and lead to an anomaly-BD. To solve these problems, this paper proposes a new strategy, i.e., the satellite-clock-aided curve fitting strategy with the function of cycle slip detection. Basically, this new strategy applies the satellite clock correction to the GPS data. After that, we do the polynomial curve fitting for the code and phase data, as before. Our study shows that the phase-data residual is only ~3 mm for all GPS satellites. The new strategy also detects and finds the number of cycle slips by searching the minimum curve-fitting residual. Extensive examples show that this new strategy enables us to repair up to a 40-min GPS data anomaly, regardless of whether the anomaly is due to a data gap, a cycle slip, or a combination of the two. We also find that interference of the GPS signal, known as "jamming", can possibly lead to a time-transfer error, and that this new strategy can compensate for jamming outages. Thus, the new strategy can eliminate the impact of jamming on time transfer. As a whole, we greatly improve the robustness of the GPS CP time transfer.

Autophagy has a key role in the pathophysiology of schizophrenia

Autophagy is a process preserving the balance between synthesis, degradation and recycling of cellular components and is therefore essential for neuronal survival and function. Several key proteins govern the autophagy pathway including beclin1 and microtubule associated protein 1 light chain 3 (LC3). Here, we show a brain-specific reduction in beclin1 expression in postmortem hippocampus of schizophrenia patients, not detected in peripheral lymphocytes. This is in contrast with activity-dependent neuroprotective protein (ADNP) and ADNP2, which we have previously found to be deregulated in postmortem hippocampal samples from schizophrenia patients, but that now showed a significantly increased expression in lymphocytes from related patients, similar to increases in the anti-apoptotic, beclin1-interacting, Bcl2. The increase in ADNP was associated with the initial stages of the disease, possibly reflecting a compensatory effect. The increase in ADNP2 might be a consequence of neuroleptic treatment, as seen in rats subjected to clozapine treatment. ADNP haploinsufficiency in mice, which results in age-related neuronal death, cognitive and social dysfunction, exhibited reduced hippocampal beclin1 and increased Bcl2 expression (mimicking schizophrenia and normal human aging). At the protein level, ADNP co-immunoprecipitated with LC3B suggesting a direct association with the autophagy process and paving the path to novel targets for drug design.

BioAssay Research Database (BARD): chemical biology and probe-development enabled by structured metadata and result types

BARD, the BioAssay Research Database (https://bard.nih.gov/) is a public database and suite of tools developed to provide access to bioassay data produced by the NIH Molecular Libraries Program (MLP). Data from 631 MLP projects were migrated to a new structured vocabulary designed to capture bioassay data in a formalized manner, with particular emphasis placed on the description of assay protocols. New data can be submitted to BARD with a user-friendly set of tools that assist in the creation of appropriately formatted datasets and assay definitions. Data published through the BARD application program interface (API) can be accessed by researchers using web-based query tools or a desktop client. Third-party developers wishing to create new tools can use the API to produce stand-alone tools or new plug-ins that can be integrated into BARD. The entire BARD suite of tools therefore supports three classes of researcher: those who wish to publish data, those who wish to mine data for testable hypotheses, and those in the developer community who wish to build tools that leverage this carefully curated chemical biology resource.

Invited review article: The statistical modeling of atomic clocks and the design of time scales

I will show how the statistical models that are used to describe the performance of atomic clocks are derived from their internal design. These statistical models form the basis for time scales, which are used to define international time scales such as International Atomic Time and Coordinated Universal Time. These international time scales are realized by ensembles of clocks at national laboratories such as the National Institute of Standards and Technology, and I will describe how ensembles of atomic clocks are characterized and managed.

Perforator flap breast reconstruction in thin patients

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Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques.

Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue.

Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses.

Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.

Fertility preservation in children and adolescents with cancer

With excellent survival rates for individuals diagnosed with cancer during childhood or adolescence an awareness of quality of life, including fertility preservation is essential. Chemotherapeutic regimens that include alkylating agents and radiation treatments directed at the gonads or pituitary, including total body irradiation are particularly gonadotoxic. Assessment of potential for gonadotoxicity and appropriateness of fertility preservation techniques prior to the start of cancer directed therapies in every individual pediatric patient is crucial for limiting this late effect of therapy. Sperm banking for postpubertal males prior to the initiation of gonadotoxic therapy should be considered standard of care. Postpubertal females receiving highly gonadotoxic therapy that places them at risk of acute ovarian failure should consider embryo or oocyte cryopreservation prior to the initiation of therapy. Oocyte cryopreservation, as well as cryopreservation of gonadal tissue, whether ovarian or testicular, remain experimental and as such should be offered as part of a research protocol. Females who receive treatment that deplete their ovarian reserve should be evaluated for the development of premature menopause following their treatment. Embryo or oocyte cryopreservation post therapy may offer females at risk of premature menopause the opportunity to preserve their reproductive window. Further research clarifying gonadotoxicity of contemporary treatment regimens and improving interventions to preserve fertility are necessary to prevent infertility as a long term adverse effect of cancer treatment. The establishment of programs that streamline access to current fertility preservation techniques will assist in ensuring that all eligible patients can avail themselves of current options.