The European Grief Conference, Copenhagen 2022: An effort to unite the field of bereavement care in Europe

Bereavement care in Europe varies in quality and availability. Through greater collaboration across Europe, there could potentially be an opportunity to improve care. This article discusses the inaugural European Grief Conference held in Denmark in 2022: "Bereavement and Grief in Europe - Emerging Perspectives & Collaborations". The conference was structured around a 4-tiered public health model of bereavement care needs. It included practice, research, policy, and educational perspectives. A total of 250 people from 27 different countries participated. To determine if the conference had appealed to a broad European audience of grief professionals and to assess how the conference was received by participants, we examined registration/submission data, the results of a one-word real-time feedback exercise, and the answers to an online satisfaction survey. The results indicated wide interest in greater information sharing and collaboration across Europe among bereavement care, research, and education professionals.

Impact of individualized treatment on recovery from fatigue and return to work in survivors of advanced-stage Hodgkin's lymphoma: results from the randomized international GHSG HD18 trial

BACKGROUND

Persisting cancer-related fatigue impairs health-related quality of life (HRQoL) and social reintegration in patients with Hodgkin's lymphoma (HL). The GHSG HD18 trial established treatment de-escalation for advanced-stage HL guided by positron emission tomography after two cycles (PET-2) as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time to recovery from fatigue (TTR-F), and time to return to work (TTR-W).

PATIENTS AND METHODS

Patients received European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and life situation questionnaires at baseline, interim, end of treatment, and yearly follow-up. TTR-F was defined as time from the end of chemotherapy until the first fatigue score <30. TTR-W was analyzed in previously working or studying patients and measured from the end of treatment until the first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables.

RESULTS

HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F [hazard ratio (HR) 1.41, P = 0.008] and descriptively shorter TTR-W (HR 1.24, P = 0.084) in PET-2-negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. The addition of rituximab caused significantly slower TTR-F (HR 0.70, P = 0.0163) and TTR-W (HR 0.64, P = 0.0017) in PET-2-positive patients. HRQoL at baseline and age were the main determinants of 2-year HRQoL.

CONCLUSIONS

Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2-negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.

Prognostic value of baseline metabolic tumor volume (MTV) for forecasting chemotherapy outcome in early-stage unfavorable Hodgkin lymphoma: Data from the phase III HD17 trial

OBJECTIVES

The prognostic relevance of metabolic tumor volume (MTV) having recently been demonstrated in patients with early-stage favorable and advanced-stage Hodgkin lymphoma. The current study aimed to assess the potential prognostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in early-stage unfavorable Hodgkin lymphoma patients treated within the German Hodgkin Study Group HD17 trial.

METHODS

18 F-FDG PET/CT images were available for MTV analysis in 154 cases. We used three different threshold methods (SUV2.5 , SUV4.0 , and SUV41% ) to calculate MTV. Receiver-operating-characteristic analysis was performed to describe the value of these parameters in predicting an adequate therapy response. Therapy response was evaluated as PET negativity after 2 cycles of eBEACOPP followed by 2 cycles of ABVD.

RESULTS

All three threshold methods analyzed for MTV showed a positive correlation with the PET response after chemotherapy. Areas under the curve (AUC) were 0.70 (95% CI 0.53-0.87) and 0.65 (0.50-0.80) using the fixed thresholds of SUV4.0 and SUV2.5 , respectively, for MTV- calculation. The calculation of MTV using a relative threshold of SUV41% showed an AUC of 0.63 (0.47-0.79).

CONCLUSIONS

MTV does have predictive value after chemotherapy in early-stage unfavorable Hodgkin lymphoma, particularly when the fixed threshold of SUV4.0 is used for MTV calculation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01356680.

Web-Based Cognitive-Behavioral Therapy to Reduce Severe Cancer-Related Fatigue Among Survivors of Hodgkin Lymphoma: A Feasibility Study

We investigated the feasibility of a web-based cognitive-behavioral therapy to reduce cancer-related fatigue (CRF) among survivors of Hodgkin lymphoma. In this before-and-after trial, patients were primarily recruited via the German Hodgkin Study Group (GHSG). We assessed feasibility (response and drop-out rate) and preliminary efficacy including CRF, quality of life (QoL), and depressive symptomatology. T tests compared baseline levels with t1 (post treatment) and t2 (3 months of follow-up). Among 79 patients contacted via the GHSG, 33 provided interest (42%). Among the seventeen participants, four were treated face-to-face (pilot patients), 13 underwent the web-based version. Ten patients completed the treatment (41%). Among all participants, CRF, depressive symptomatology, and QoL improved at t1 (p ≤ .03). The effect in one of the CRF measures remained at t2 (p = .03). Except for QoL, post-treatment effects were replicated among the completers of the web-based version (p ≤ .04). The potential for this program has been demonstrated, but needs to be re-assessed after identified issues on feasibility have been resolved.Trial registration: The study was registered at ClinicalTrials.gov (Number: NCT03968250).

Design strategies to influence health behaviour and mental wellbeing in the urban setting

The design of objects, spaces and systems can have a profound influence on the behaviours as well as emotional and cognitive states of the people confronted with it. With regards to health behaviour, elaborating on Schwarzer's HAPA model (1992), the Design Model for Health Behaviour Change - DMHBC (Rehn, 2018) proposes the use of the built environment to act as situative barriers or opportunities to change health behaviours and overall health promoting mindsets. Regarding urban space and mental health, most environmental stimuli and related behavioural patterns focus on consumption (e.g. retail stores) or daily routines (e.g. commuting). Using objects such as specifically designed furniture, installations and other elements to act as perceived affordances and stimuli can affect both cognitive-emotional states as well as specific behavioural responses. For instance, based on the research on mindfulness, drawing people's attention towards their own bodily sensations (e.g. breath) by playful interactive installations or information signs can increase feelings of calm, appreciation and contentment. The same applies to design interventions that guide one's view towards otherwise overlooked urban features (e.g. natural scenery). While mindfulness and relaxation are powerful techniques for increasing mental health, many other approaches (such as physical activity, social interactions etc.) can be found to have similar benefits. In fact, the orchestrated combination of various forms of stimuli might prove to be more effective than the sum of the individual interventions as they create a subsequent chain of stimuli that form a coherent experience. This approach poses particular potentials to foster mental health in vulnerable groups that usually suffer most from urban environmental risk factors. Thus, providing public and open access stimuli and affordances in this way, can have a significant effect on overall urban public health and reduce social inequalities at the same time.

Risk factors and potentials for fostering mental health and wellbeing in urban space

People shape their physical environments - and vice versa. As such, cities provide both resources (e.g., job opportunities, cultural diversity) as well as stressors (e.g., crowding, noise pollution) to their residents and visitors. In this context, numerous studies illustrate a considerable influence of the built environment (townscape, architecture) on health and well-being of interacting people. This impact ranges from physical aspects (e.g., traffic safety, particulate matter) to psychological processes (e.g., stress, loneliness) and behavioral aspects (e.g., physical activity, social behavior). At the same time, phenomena such as homelessness, crime, or mental disorders (e.g., substance addictions, schizophrenia) occur more frequently in cities compared to rural areas, illustrating causal as well as selective processes in the relation of urban environment and mental health. Increasing overall incidences in mental disorders (especially anxiety disorders and depression), the short-term shortage of psychotherapeutic care as well as the long-term economic burden on the health care system ask for a twofold strategy in public health: a) an extension of preventive measures with low threshold, i.e., accessible by large shares of the population, b) an extension of mental health literacy, which will empower the population to be attentive to mental health issues in themselves and others and which in turn can help to reduce stigmatization. While urban green and blue spaces have been researched in terms of restorative environments - allowing to regenerate resources consumed during the day - the built environment is still a resource for this strategy that has received insufficient attention to date. Utilizing the urban built environment not only as restorative but also informative and engaging environments thus affords an opportunity to address and potentially foster mental health and mental health literacy in citizens across socioeconomic backgrounds.

Potentials of participatory approaches for urban mental health

Aspects of mental health, society, space and environment share entangled relations being studied in health geography. Recreational spaces as well as places that are commonly perceived as strenuous, unsafe, or highly stressful are unevenly distributed within urban areas, which is also associated with spatial differences in mental disorders. Spaces in general represent social constructions that reflect power inequalities; they are filled with subjective emotional resonances and sometimes visualize stigmatization of specific groups. As such, the interplay of socio-demographic factors, socio-economic factors and built environment is complex. To capture these entanglements represented in heterogeneous user groups, participatory approaches promise valuable insights. Yet, despite their great potential for fostering mental health in urban space, participatory approaches are still less common in health geography. Therefore, critical voices question whether the limitations of marginalized groups have been sufficiently considered in this field of study so far. Similar challenges arise in urban planning processes: Specific (vulnerable) groups such as children, women, foreign residents, and people with disabilities or elderly people are insufficiently included in planning processes, leading to an underrepresentation of their needs in the resulting environments. To tackle this shortcoming, the approach of co-creation offers a process in which participants jointly develop a solution without being the object of research or interview partners, but creators. Using rather practical or creative (e.g., joint mapping of the built environment, photo-elicitation) than discursive techniques allows contributions from population groups otherwise often excluded from planning processes. Despite certain limitations, participatory approaches promise the possibility to develop appropriate and just solutions in urban mental health.

Predictive value of baseline metabolic tumor volume in early-stage favorable Hodgkin Lymphoma - Data from the prospective, multicenter phase III HD16 trial

Background

¹⁸F -fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the staging and response assessment of lymphoma patients. Our aim was to explore the predictive relevance of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with early stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD16 trial.

Methods

¹⁸F-FDG PET/CT images were available for MTV and TLG analysis in 107 cases from the HD16 trial. We calculated MTV and TLG using three different threshold methods (SUV_4.0, SUV_41% and SUV_140%L), and then performed receiver-operating-characteristic analysis to assess the predictive impact of these parameters in predicting an adequate therapy response with PET negativity after 2 cycles of chemotherapy.

Results

All three threshold methods analyzed for MTV and TLG calculation showed a positive correlation with the PET response after 2 cycles chemotherapy. The largest area under the curve (AUC) was observed using the fixed threshold of SUV_4.0 for MTV- calculation (AUC 0.69 [95% CI 0.55–0.83]) and for TLG-calculation (AUC 0.69 [0.55–0.82]). The calculations for MTV and TLG with a relative threshold showed a lower AUC: using SUV_140%L AUCs of 0.66 [0.53–0.80] for MTV and 0.67 for TLG [0.54–0.81]) were observed, while with SUV_41% an AUC of 0.61 [0.45–0.76] for MTV, and an AUC 0.64 [0.49–0.80]) for TLG were seen.

Conclusions

MTV and TLG do have a predictive value after two cycles ABVD in early stage Hodgkin lymphoma, particularly when using the fixed threshold of SUV_4.0 for MTV and TLG calculation.

Trial registration

ClinicalTrials.gov NCT00736320.

Chronic ozone exposure preferentially modifies root rather than foliar metabolism of date palm (Phoenix dactylifera) saplings

In their natural environment, date palms are exposed to chronic atmospheric ozone (O₃) concentrations from local and remote sources. In order to elucidate the consequences of this exposure, date palm saplings were treated with ambient, 1.5 and 2.0 times ambient O₃ for three months in a free-air controlled exposure facility. Chronic O₃ exposure reduced carbohydrate contents in leaves and roots, but this effect was much stronger in roots. Still, sucrose contents of both organs were maintained at elevated O₃, though at different steady states. Reduced availability of carbohydrate for the Tricarboxylic acid cycle (TCA cycle) may be responsible for the observed reduced foliar contents of several amino acids, whereas malic acid accumulation in the roots indicates a reduced use of TCA cycle intermediates. Carbohydrate deficiency in roots, but not in leaves caused oxidative stress upon chronic O₃ exposure, as indicated by enhanced malonedialdehyde, H₂O₂ and oxidized glutathione contents despite elevated glutathione reductase activity. Reduced levels of phenolics and flavonoids in the roots resulted from decreased production and, therefore, do not indicate oxidative stress compensation by secondary compounds. These results show that roots of date palms are highly susceptible to chronic O₃ exposure as a consequence of carbohydrate deficiency.

[Effect of a multimodal pain management protocol and age on wound healing after thermal disbudding of female German Holstein calves]

INTRODUCTION

Hot-iron disbudding of calves is a stressful and painful procedure and leaves a burn wound. Pain management procedures and the effects of hot-iron disbudding on biochemical markers of pain perception and stress response have been widely investigated in recent years. The aim of this study was to investigate the potential effects of pain management and age of the calf on the healing of burn wounds caused by disbudding. 327 healthy female German Holstein calves were included in this randomised, triple-blinded, prospective study. Calves were either disbudded at the age of four to 10 or 15 to 28 days using a gas-powered hot iron. Each calf was randomly allocated to one of nine possible treatment groups (BG). All calves received either the active ingredients to be tested (xylazine hydrochloride with 0.2 or 0.05 mg / kg body mass (BM) intramuscular for sedation, procaine hydrochloride (2 %) each 8 ml locally on both sides subcutaneously (SC) to the cornual nerves, meloxicam with 0,5 mg / kg BM SC for anti-inflammatory purposes) or an identical amount of saline solution (placebo). Calves in the group `thermE` and `ScheinE` received only placebo. In group `ScheinE` disbudding was simulated and in `thermE` it was carried out. The calves were clinically monitored starting one day before and ending 28 days after the procedure and the burn wounds were assessed. Both the rectal temperature and parameters of wound healing changed significantly during the study period and had characteristic profiles over time. Wound healing was not influenced by the different analgesic protocols, indicating that a multimodal analgesia does not pose a risk for wound healing after thermal disbudding. There were no observed differences between the age groups. The results of this study show, that disbudding of young calves and a multimodal pain management protocol does not affect wound healing in calves.

Reinduction therapy with everolimus in combination with dexamethasone, high-dose cytarabin and cisplatinum in patients with relapsed or refractory classical Hodgkin lymphoma: an experimental phase I/II multicentre trial of the German Hodgkin Study Group (GHSG HD-R3i)

Reinduction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (HDCT + ASCT) is second-line standard of care for transplant-eligible patients with relapsed/refractory classical Hodgkin lymphoma (r/r cHL) but has a high failure rate. Because response to reinduction is predictive of the outcome after HDCT + ASCT, we aimed to improve the standard dexamethasone, high-dose cytarabine and cisplatinum (DHAP) reinduction regimen by addition of the oral mammalian target of rapamycin inhibitor everolimus (everDHAP). Transplant-eligible patients aged 18-60 years with histologically confirmed r/r cHL were included in this experimental phase I/II trial. Everolimus (10 mg/day, determined in phase-I-part) was administered on day 0-13 of each DHAP cycle. From July 2014 to March 2018, 50 patients were recruited to the phase II everDHAP group; two were not evaluable, three discontinued due to toxicity. Randomization to a placebo group stopped in October 2015 due to poor recruitment after nine patients. The primary end-point of computed tomography (CT)-based complete remission (CR) after two cycles of everDHAP was expected to be ≥40%. With a CT-based CR rate of 27% (n = 12/45) after two cycles of everDHAP the trial did not meet the primary end-point. Adding everolimus to DHAP is thus feasible; however, the everDHAP regimen failed to show an improved efficacy.

[Cortisol concentrations in sheep before, during and after sham foot trimming on a tilt table - the suitability of different matrices]

INTRODUCTION

Matrices that can be collected non-invasively for quantification of a stress response in sheep have received little attention in the veterinary literature. This study examines the suitability of blood, tears and saliva for determining a stress response in sheep undergoing sham foot trimming on a tilt table. The cortisol concentration of blood, tears and saliva and the concentration of cortisol metabolites in faeces were measured in 13 healthy Meat Merino ewes once a day for six days. Sham foot trimming on a tilt table was used as the stressor and was done during a one-hour period on day 4; cortisol concentrations of blood and tears were measured at 0, 10, 20, 30, 40 and 60 minutes. Cortisol concentrations of blood (maximum at 30 minutes) and tears (maximum at 40 minutes) increased during the procedure and then decreased. There were significant correlations between cortisol concentrations of blood and tears (p = 0,04) during sham foot trimming (area under the curve, 0 to 60 minutes). Over the entire 6-day study period, significant correlations were seen between the cortisol concentrations of blood and tears (r = 0,55; p.

On the psychological importance of control and valorisation in psychiatric environments

When people suffering from severe mental illnesses are treated in psychiatric facilities, there appear conflicting priorities between security and individual control that are often skewed towards security. As a result, patients admitted to highly institutionalised psychiatric wards do not only suffer from mental illness but also from loss of control as a basic human need (Grawe, 2000). Through this loss of control (e.g., not being able to choose where to go), people become especially dependent on their immediate social and spatial surroundings. From a psychological point of view, the concept of control reflects in concepts such as self-efficacy (Bandura, 1977), internal vs. external locus of control (Rotter, 1966), or environmental mastery (Ryff, 1989), all pointing to a beneficial influence on well-being and health. Yet, depending on their current situation, psychiatric patients may also feel overwhelmed by an excess of choices. Increasing patients' sense of control by offering them small choices during their stay at a psychiatric environment, however, might increase well-being (cf. Langer & Rodin, 1968). This possibility of control has the potential to also activate the feeling of valorisation in patients: As a positive fundamental attitude towards another person, implying appreciation and respect, valorisation poses an important element of psychotherapy (e.g., Rogers, 1951). Especially as people with psychiatric disorders are still stereotyped and stigmatized (e.g., as a homogenous group of “the mentally ill”), actively searching for new ways to foster valorisation in psychiatric environments may further contribute to patients' well-being and individualisation. Transferring the concept of valorisation to physical objects as primes affords an opportunity to extend feeling appreciated beyond immediate social interaction.

Non-Hodgkin lymphoma after treatment for classical Hodgkin lymphoma: a report from the German Hodgkin Study Group

Data on non-Hodgkin lymphoma (NHL) after classical Hodgkin lymphoma (cHL) are scarce. We therefore performed a retrospective analysis comprising 11·841 cHL patients who had first-line treatment within the randomized German Hodgkin Study Group (GHSG) HD7-HD15 studies. After a median follow-up of 106 months, 175 patients (1·5%) had developed NHL. The median time to NHL was 44 months, the median age at NHL diagnosis was 54 years. The five-year event-free survival and overall survival estimates from the diagnosis of NHL were 36·9% and 44·2%, respectively. Thus, NHL after cHL is a rare event primarily affecting older individuals and often resulting in the patient´s death.

Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy

PURPOSE

We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx).

METHODS

We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics.

RESULTS

A total of 174 patients' disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations.

CONCLUSION

After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.

[Thermographic monitoring of skin surface temperature associated with hot-iron disbudding in calves]

INTRODUCTION

The goal of this study was to determine the skin surface temperatures of the head using thermography in 28 German Holstein heifer calves at the time of hot iron disbudding. Calves were divided into group 1 (hot-iron disbudding, n = 14) and 2 (sham disbudding, n = 14). Thermographic measurements were made at eight locations of the head (area surrounding both horn buds, both horn buds, muzzle, mucous membranes of the muzzle, both eyes) at nine time points (- 60 min (basal value), time of disbudding, 5, 30, 60, 90, 120, 240 and 480 min after disbudding) using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). The rectal temperature was measured 60 min before and 5, 240 and 480 min after disbudding. The statistical software SAS version 9.4 was used for analysis. Skin surface temperatures and rectal temperature correlated at several locations (rp ≥ 0.45; p ≤ 0.05). The maximum temperature (approx. 67 ºC) was measured at the horn buds immediately after the hot-iron procedure. By five and 30 min after hot-iron disbudding, the temperature of the horn buds had decreased by up to 50%, whereas the temperatures at the other locations had increased significantly (p.

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

BACKGROUND

Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive.

METHODS

Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined.

RESULTS

Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms.

CONCLUSION

Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.

Health-Related Quality of Life in Patients With Hodgkin Lymphoma: A Longitudinal Analysis of the German Hodgkin Study Group

PURPOSE

Many important details of health-related quality of life (HRQoL) after diagnosis and treatment of Hodgkin lymphoma (HL) are still unknown because large longitudinal studies of HRQoL are rare. Therefore, we analyzed a systematically assessed, comprehensive range of HRQoL domains in patients with HL of all stages from diagnosis up to 5 years of survivorship.

PATIENTS AND METHODS

We included patients with HL age 18-60 years at diagnosis from the German Hodgkin Study Group trials HD13, HD14, and HD15. We analyzed HRQoL using all functional and symptom scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 including deviations from reference values. We estimated the effect of different disease, patient, and treatment characteristics using multiple regression and repeated measures analysis and computed correlations of HRQoL scores.

RESULTS

We analyzed 4,215 patients with any HRQoL assessment within 5 years after treatment. Higher tumor burden at diagnosis was associated with impaired baseline scores in many HRQoL domains. During survivorship, cognitive, emotional, role, and social functioning and fatigue, dyspnea, sleep, and financial problems were severely and persistently affected. From year 2 on, mean deviations from reference values ranged between 12 and 29 points, with 10 points being a commonly used margin of clinical relevance. In all 3 trials, HRQoL domains 2 and 5 years after therapy were significantly influenced by baseline scores and age but not by randomized treatments. Fatigue was most closely correlated with other symptoms and scales.

CONCLUSION

Our results show a high and persistent amount of different HRQoL deficits in survivors of HL that are largely independent of the applied chemotherapies. Our analysis underscores the high, unmet medical need of these rather young survivors of HL regarding the psychosocial adverse effects of the cancer experience.

Thrombosis as a treatment complication in Hodgkin lymphoma patients: a comprehensive analysis of three prospective randomized German Hodgkin Study Group (GHSG) trials

BACKGROUND

The prognosis of Hodgkin lymphoma (HL) is excellent rendering research into treatment complications highly important. An important complication of cancer and its treatment is thrombosis. Thrombotic events are regularly observed in HL patients but precise information on incidence and risk factors is lacking and the value of prophylactic anticoagulation unclear.

PATIENTS AND METHODS

Thus, we comprehensively studied thrombotic events in 5773 patients from the German Hodgkin Study Group (GHSG) HD13-15 trials in early-favorable, intermediate and advanced HL. We estimated the incidence of and identified risk factors for thrombotic events. Additionally, we provide detailed data on the time course and characteristics of thrombotic events.

RESULTS

A total of 193 thrombotic events occurred for an incidence of 3.3%. Out of these, 175 (90.7%) were venous thromboses, 3 (1.5%) newly emerging post-thrombotic syndromes and 15 (7.8%) arterial thromboses. There were 11 (0.7%) events in early-favorable, 27 (1.3%) in early-unfavorable and 155 (7.3%) in advanced patients, the latter incidence being significantly higher (P < 0.001). The most common locations were deep vein thrombosis of the arm (46.3%) and leg (24.6%). Most venous thrombotic events occurred during chemotherapy (78.9%). We observed 59 (30.6%) catheter-associated events and a descriptively increased risk of venous thrombotic events in patients with oral contraception use during treatment (6.8% versus 3.9%). In advanced HL, the incidence of venous thrombotic events was increased upon treatment with BEACOPP-14 (9.4%, P = 0.0079) compared with 5.1% with 6×BEACOPPesc and 5.7% with 8×BEACOPPesc. Among commonly applied risk factors, including the Khorana score, only age and smoking were prognostic.

CONCLUSIONS

The incidence of thrombotic events in advanced stage HL is comparable to other high-risk cancer patients, especially if treated with dose-dense regimens. Additional risk factors are higher age and smoking. Selected HL patients could benefit from prophylactic anticoagulation, however, further interventional studies are needed before general recommendations can be made.

The interplay between cancer-related fatigue and functional health in Hodgkin lymphoma survivors

OBJECTIVE

Cancer-related fatigue (CRF) is among the most distressing symptoms reported by cancer survivors as compromising their quality of life. This study investigates the complex interplay between CRF and functional health (FH) in survivors of Hodgkin lymphoma by using longitudinal data to clarify the etiology of CRF.

METHODS

Data from N = 3596 survivors (HD13-15) from the German Hodgkin Study Group was analyzed using bivariate latent curve models with structured residuals to model how the interplay between CRF and FH unfolds over time across and within individuals. CRF and FH were measured with the EORTC QLQ-C30. Assessed FH domains were physical, cognitive, emotional, social, and role functioning. Age at diagnosis, gender, country, baseline fatigue, and cancer stage were included as covariates.

RESULTS

The latent curve models with structured residuals had an adequate model fit (χ² = 416.63-548.28, df = 114, p < .001, root mean square error of approximation = .03, comparative fit index = .98-.99, Tucker-Lewis index = .97-.98). On the between-person level, CRF and all FH domains were strongly negatively correlated (r = -.72 to r = -.84). On the within-person level, earlier CRF (ρ_F = -.05 to ρ_F = -.12) and FH deviations (ρ_FH = -.05 to ρ_FH = -.13) negatively predicted subsequent deviations of the respective other variable. Time-specific within-person improvements in physical, cognitive, and emotional functioning reduced CRF more than vice versa, whereas the effect of CRF was stronger for social functioning. Role functioning had a balanced relation with CRF.

CONCLUSIONS

This analysis reveals a complex reciprocal relation between CRF and FH with distinct between- and within-person effects. The results contribute to a better understanding of CRF in survivors of Hodgkin lymphoma and could inform the development of much-needed targeted interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

[Patient safety: current problems and challenges]

Two decades after "To Err Is Human", the groundbreaking report published by the Institute of Medicine in the US, the German Patient Safety Alliance (Aktionsbündnis Patientensicherheit, APS) has published the "White Paper on Patient Safety". Based on the throughput model of health services research, the paper proposes a revised concept and definition of patient safety that focuses not only on the presence of adverse events (AE), but also on the ability of organizations and systems to adequately prioritize patient safety and implement this sustainably with improvement processes. Accordingly, a concept for measuring patient safety will be developed that no longer only quantitatively records AE, but also focuses on patient safety indicators that describe innovation competence. The epidemiological data will be updated; the rates of approximately 2-4% avoidable AE and 0.1% avoidable deaths among hospital patients appear to be highly conservative estimates. Data from non-representative sources, such as on legal procedures, underestimate frequencies by a factor of 30 ("litigation gap"). The most important obstacles to improving the situation are analyzed and give rise to the recommendation that, instead of one-point interventions (e.g., of a technical nature, such as IT-supported procedures), complex multicomponent interventions should increasingly be used in Germany, combining interventions with different approaches. Interventions at team level and with regard to management structures are focused on here.

[Thermographic examination of head surface temperatures of calves under field conditions]

INTRODUCTION

Thermographic examination of 157 German Holstein heifer calves was performed to investigate the feasibility of this technique for on-farm recording of surface temperature of the head and to examine potential factors that affect the recordings. Baseline values were obtained from six defined locations on the head including both eyes, both horn buds, the muzzle and the mucous membrane of the muzzle using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). Evaluation of the influence of various factors on thermographic measurements showed that ambient temperature had the largest effect on surface temperature of the head (regression coefficient, 0.10 to 0.32, p ≤ 0.01) whereas humidity had no effect (in t-test p ≥ 0.33 over all locations). There was a no correlation between rectal temperature and surface temperature (rp ≤ 0.05). The surface temperature decreased with increasing age of the calves (regression coefficient, - 0.42 to - 0.14, p ≤ 0.01). The agreement between double readings made shortly after one another was excellent at all locations (r ≥ 0.95). The emission of infrared energy varied among different locations; the most infrared energy was emitted by the eyes and the least by the muzzle. Paired locations (eyes and horn buds) had symmetric emission patterns of infrared energy. Measuring the surface temperature of the head of calves in their normal barn environment using a standardised protocol was feasible and thus could potentially be used for monitoring calves under field conditions.

Recent developments in the Inorganic Crystal Structure Database: theoretical crystal structure data and related features

The article discusses how theoretical crystal data are supplementing experimental data for simulation and prediction of structures of inorganic solids in the Inorganic Crystal Structure Database.

The Inorganic Crystal Structure Database (ICSD) is the world’s largest database of fully evaluated and published crystal structure data, mostly obtained from experimental results. However, the purely experimental approach is no longer the only route to discover new compounds and structures. In the past few decades, numerous computational methods for simulating and predicting structures of inorganic solids have emerged, creating large numbers of theoretical crystal data. In order to take account of these new developments the scope of the ICSD was extended in 2017 to include theoretical structures which are published in peer-reviewed journals. Each theoretical structure has been carefully evaluated, and the resulting CIF has been extended and standardized. Furthermore, a first classification of theoretical data in the ICSD is presented, including additional categories used for comparison of experimental and theoretical information.

On the residual six-fold astigmatism in DCOR/ASCOR

After the introduction of the hexapole C_s-correctors for scanning transmission electron microscopes (STEM), the next big step forward was the strong reduction of the six-fold astigmatism A₅ by means of an advanced hexapole design (DCOR/ASCOR). As a result all axial aberrations up to fifth order are sufficiently small to allow for large semi-aperture angles beyond 40 mrad for electron energies in the range of 30 to 300 kV without deterioration of the STEM resolution. In this paper we derive simple expressions for the optimum hexapole strength for minimum A₅ and the size of the residual A₅. Both quantities are intrinsic properties of the hexapoles and the transfer lens doublet in between. The optimum hexapole strength scales with the inverse of the electron wavelength, while the residual A₅ does not depend on the electron energy directly, but on the spherical aberration C_s of the pole piece. With the given properties of the DCOR/ASCOR and typical values of C_s in the range of 0.5 to 2.7 mm, at all acceleration voltages A₅ remains in the range from 0.03 to 0.4 mm, the latter even for a large-gap pole piece.

Evaluation of arterial digital blood flow in dairy cows with claw horn disruption lesions using Doppler ultrasonography

Vascular changes play an important role in the pathogenesis of claw horn disruption lesions in cattle. The aim of the study was to measure arterial blood flow in the hind limbs of German Holstein cows with claw horn disruption lesions. A 10-MHz linear transducer was used to assess blood flow in the interdigital artery in the dorsal pastern region in the hind limbs of 11 non-lame and 33 lame German Holstein cows in which lameness was scored clinically. Qualitative and quantitative blood flow parameters were compared in affected limbs and unaffected contralateral hind limbs in lame cows and in the hind limbs of lame cows and non-lame cows. A pulsed-wave Doppler signal suitable for analysis was obtained in 78 of 88 limbs (33 affected and contralateral limbs, 22 limbs of control cows). Blood flow curve types 1 and 2 were predominant in the hind limbs of lame cows. Vessel diameter, end-diastolic velocity, and blood flow rate were significantly greater in lame cows than in non-lame cows and were numerically greater in moderately lame cows than in mildly lame cows. The differences in the qualitative and quantitative parameters between lame and non-lame cows were most likely caused by inflammation of the pododerm. The role of weight distribution between the paired hind limbs and the existence of claw horn disruption appeared to have an effect on the differences in local circulation in the affected and unaffected contralateral hind limbs in lame cows.

Evaluation of arterial digital blood flow in dairy cows with claw horn disruption lesions using Doppler ultrasonography

Vascular changes play an important role in the pathogenesis of claw horn disruption lesions in cattle. The aim of the study was to measure arterial blood flow in the hind limbs of German Holstein cows with claw horn disruption lesions. A 10-MHz linear transducer was used to assess blood flow in the interdigital artery in the dorsal pastern region in the hind limbs of 11 non-lame and 33 lame German Holstein cows in which lameness was scored clinically. Qualitative and quantitative blood flow parameters were compared in affected limbs and unaffected contralateral hind limbs in lame cows and in the hind limbs of lame cows and non-lame cows. A pulsed-wave Doppler signal suitable for analysis was obtained in 78 of 88 limbs (33 affected and contralateral limbs, 22 limbs of control cows). Blood flow curve types 1 and 2 were predominant in the hind limbs of lame cows. Vessel diameter, end-diastolic velocity, and blood flow rate were significantly greater in lame cows than in non-lame cows and were numerically greater in moderately lame cows than in mildly lame cows. The differences in the qualitative and quantitative parameters between lame and non-lame cows were most likely caused by inflammation of the pododerm. The role of weight distribution between the paired hind limbs and the existence of claw horn disruption appeared to have an effect on the differences in local circulation in the affected and unaffected contralateral hind limbs in lame cows.

Magnetic Cc/Cs-corrector compensating for the chromatic aberration and the spherical aberration of electron lenses

Aberration correction in transmission electron microscopy has proven feasible and useful over a large range of acceleration voltages. The spherical aberration has been corrected for beam energies from 15 kV [1] up to 1.2 MeV [2] while the correction of the chromatic aberration has been achieved for beam energies ranging from 20 kV[3] up to 300 kV[4]. Above this threshold the conventional correction principle based on mixed electric and magnetic focusing elements becomes infeasible with present technology [5]. For conventional electron sources at high voltages the relative energy width of the beam gets so small that chromatic correction becomes less important. Nevertheless, for new applications with pulsed electron sources with energy spreads in the order of 100 eV chromatic aberration will become a limiting factor even at high energies [6]. To enable chromatic aberration correction for such systems a novel type of a feasible, purely magnetic multipole aberration corrector with curved optic axis is proposed which is capable of compensating for the chromatic and spherical aberration up to several MeV.

Evidence for the Existence of Foetal Fibrinogen

Human fibrinogen was isolated from the blood of adults and from umbilical cord blood. The fibrinogen preparations obtained were clottable with thrombin to between 97 and 98% and homogeneous in acrylamide gel electrophoresis. Comparative analyses of these highly purified foetal and adult fibrinogen showed that they have the same quantitative amino acid composition and the same mobility in acrylamide gel electrophoresis at pH 9.2.

Chromatography on DEAE-cellulose made it likely that foetal and adult fibrinogen have a slightly different electrical charge. The pH-dependency of the thrombin clotting time is strikingly different. The fingerprints of the tryptic peptides showed at least 3 peptides with different mobility in chromatography.

From these data it is assumed that foetal and adult fibrinogen have a different molecular structure. Hitherto it cannot be decided if the two proteins have a different primary structure, which is most probable, or if they are chemical modifications.