Corrigendum: Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

[This corrects the article DOI: 10.3389/fpsyt.2023.1277225.].

ARTIS Pheno®: a potential tool for cochlear implant surgery

PURPOSE

Cochlear implantation is a standard approach to hearing rehabilitation and encompasses three main stages: appropriate patient selection, a challenging surgical procedure, which should be as atraumatic as possible and preserve cochlear structures, and lifelong postoperative follow-up. Computed tomography (CT) is performed to assess postoperative implant position. The Siemens Advanced Radar Target Identification System (ARTIS) Pheno provides fluoroscopic imaging during surgery and has so far been mainly used by cardiologists, neurosurgeons and trauma surgeons.

METHODS

Six patients with difficult anatomy or a challenging medical history were selected for a surgical procedure, during which we planned to use the ARTIS Pheno to accurately position and assess implant position under fluoroscopy during and immediately after surgery. In all six cases, the ARTIS Pheno was used directly in the surgical setting. The procedures were performed in cooperation with the neuroradiology department in an interdisciplinary manner.

RESULTS

In all six patients, fluoroscopy was used to visualise the procedure at different stages of surgery. In five patients, the procedure was successfully completed. This approach allowed us to finally assess implant position and confirm the correct and complete insertion of the electrode while the patient was still under anaesthesia.

CONCLUSION

These cases showed positive surgical outcomes. Although the procedure is more complex than a standard approach, patients can be managed in a safe, effective and appropriate manner. The assessment of implant position in real time during surgery leads to greater patient and surgeon satisfaction. The approach presented here ensures a high quality of cochlear implant surgery even in difficult surgical situations and meets the requirements of modern surgery.

Quantification of Remimazolam Besylate (CNS7056B) and Its Metabolite (CNS7054X) by LC-MS/MS in Human Plasma Using Midazolam-d4 Maleate as Internal Standard

A new assay was developed to measure the concentration of remimazolam besylate (CNS7056B) and its major carboxylic acid metabolite (CNS7054X) in human plasma. For this new assay method, midazolam-d4 maleate was used as an internal standard. After setting up a previously described assay method, using CNS7056-d4 and CNS7054-d4 as internal standards, analytical results of both methods were compared. For the new analytical method, ultra-high-performance liquid chromatography (UHPLC) with tandem mass spectrometry was applied. A purification method, using solid phase extraction, was developed and validated. The chromatographic separation of the analytes was achieved with a mobile phase gradient using a Water Acquity™ UHPLC-System. The Kinetex™ biphenyl 50 × 2.1 mm UHPLC column was used with a particle diameter of 1.7 μm (Phenomenex, Germany). A measuring range of 0.6-2,000 ng/mL for CNS7056B and of 6-20,000 ng/mL for CNS7054X could be achieved with this new assay. The lower limit of quantification was 0.6 ng/mL for CNS7056B and 6 ng/mL for CNS7054X. The assay was validated according to US Food and Drug Administration guidelines. The new method showed an accuracy of 96.9-110.4% and a precision of 2.1-6.7% for both analytes.

Waste LCA and the future

Life cycle assessment (LCA) models quantifying the environmental aspects of waste management have become an integral part of waste management decision-making over the last two decades and have provided ample knowledge on both environmental benefits and drawbacks in the way we handle waste. Waste management and LCA modelling of waste management systems will soon be challenged by profound changes necessary in our societies and sectors to meet sustainable development goals. Foreseen changes in energy, material, and nutrient provision will directly and indirectly affect waste management in terms of its operation and goals. This study reflects on anticipated changes in society and industrial sectors and how these changes may affect waste management and LCA modelling of waste management systems in terms of waste input, the modelling of technologies and systems and exchanges of energy, materials, and nutrients, as well as how it may affect impact assessment and the interpretation of results. The study provides practical recommendations for LCA modelling of future waste management systems, which will hopefully lead to robust assessments that can support decision-making in an evolving society subject to great changes.

Study protocol of an observational study in acute psychiatric home treatment: How does home treatment work? Identification of common factors and predictors of treatment success

BACKGROUND

Systematic reviews indicated that home treatment is an effective and cost-saving alternative to conventional acute psychiatric treatment options. Treatment success has often been defined as a reduction of hospital admissions. In the current study, symptoms and well-being are assessed regularly during treatment as an indicator for treatment success. Patients' characteristics such as diagnosis, age, substance use, and motivation for treatment were discussed as predictors for treatment success. A second focal point of the study lies in the examination of the therapeutic relationship in terms of the outcome, which has not yet been systematically investigated in home treatment.

METHODS

This is an observational study with a prospective naturalistic design. Measurements are carried out at baseline, during and at the end of treatment as well as at the 3‑month follow-up. Patients' characteristics as potential predictors for treatment success will be assessed at baseline. In addition, the perceived relationship between the patients and the team will be measured daily and weekly throughout the treatment. Treatment success is by the changes in symptoms and general well-being assessed weekly. We aim to include 82 participants assigned to home treatment. Variance analyses with repeated measurements will be conducted to evaluate treatment success.

CONCLUSION

By examining potential patient- and relationship-related predictors of treatment success, insights into relevant determining variables of treatment success in this setting are expected. The results might help to better identify who benefits the most from home treatment.

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Beam Delivery and Patient Alignment: Perspective of the Innovative Cycloton 400MEV/u Multi-Ion System

PURPOSE/OBJECTIVE(S)

The C400IONS system is the first multi-ion particle therapy system based on a cyclotron world-wide. The first treatment delivery is foreseen in Caen, France in 2026. This work provides major beam delivery and patient alignment specifications and design evaluations that will be integrated in the first installation.

MATERIALS/METHODS

The C400IONS is an innovative system developed on a 400 MeV/u isochronous cyclotron, it can generate carbon ions, protons and helium ions. The beam delivery and treatment room design of this multi-ion treatment system is based on the IBA Proteus®PLUS equipment. The C400IONS fixed horizontal beamlines use pencil beam scanning technology and provide, e.g., planar imaging, a 6D robotic patient positioning system coupled with either a couch or a chair, and options to use patient or treatment specific accessories like a ripple filter. Nozzle and chair have been designed for optimal clinical perspectives for adult and pediatric treatments.

RESULTS

The Beam Delivery System will provide scan fields from 20 × 20cm2 for carbon ions up to 30 × 30cm2 for protons. Beams will be available for treatment with ranges between 4 and 32 g/cm2 for protons and helium ions and between 4 and 27 g/cm2 for carbon ions. The nozzle shape and bottom clearance have been optimized for a chair designed for brain and head and neck treatment with several backrest heights and rotation settings enabling a large treatment volume.

CONCLUSION

This work describes design investigations by Nha and its partners on nozzle and patient positioning components, supporting a reliable, comprehensive, optimized and evolutive multi-ion therapy system.

Fluctuation of Acquired Resistance Mutations and Re-Challenge with EGFR TKI in Metastatic NSCLC: A Case Report

Osimertinib has become the preferred first-line therapy for epidermal growth factor receptor (EGFR) mutation-positive metastatic non-small cell lung cancer (NSCLC) in recent years. Originally, it was approved for second-line treatment after epidermal growth factor receptor EGFR tyrosine kinase inhibitors (TKIs) of the first and second generations had failed and EGFR T790M had emerged as a mode of resistance. Osimertinib itself provokes a wide array of on- and off-target molecular alterations that can limit therapeutic success. Liquid biopsy ctDNA (circulating tumor DNA) analysis by hybrid capture (HC) next-generation sequencing (NGS) can help to identify alterations in a minimally invasive way and allows for the detection of common as well as rare resistance alterations. We describe a young female patient who was initially diagnosed with metastatic EGFR L858R-positive NSCLC. She received EGFR TKI therapy at different timepoints during the course of the disease and developed sequential EGFR resistance alterations (EGFR T790M and C797S). In the course of her disease, resistance alteration became undetectable, and the tumor was successfully rechallenged with the original first-generation EGFR TKI as well as osimertinib and altogether showed prolonged response despite a prognostically negative TP53 alteration. To date, the patient has been alive for more than seven years, though initially diagnosed with a heavy metastatic burden.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

Totally tubeless, tubeless, and tubed percutaneous nephrolithotomy for treating kidney stones

BACKGROUND

Percutaneous nephrolithotomy (PNL) is the standard of care for removing large kidney stones (> 2 cm). Once the procedure is complete, different exiting strategies exist to manage the percutaneous tract opening, including placement of an external nephrostomy tube, placement of an internal ureteral stent, or no external or internal tube. The decision to place or not place a tube is handled differently among clinicians and may affect patient outcomes.

OBJECTIVES

To assess the effects of tubeless PNL (with ureteral stenting), totally tubeless PNL (without ureteral stenting or nephrostomy), and standard PNL (nephrostomy only) for the treatment of kidney stones in adults.

SEARCH METHODS

We performed a systematic literature search in multiple biomedical databases (CENTRAL, MEDLINE, Embase, Web of Science), as well as in two clinical trial registries. We also handsearched reference lists of relevant publications and conference proceedings. We applied no language restrictions. The latest search update was conducted in September 2022.

SELECTION CRITERIA

We included randomized controlled and quasi-randomized controlled trials of adult patients who received tubeless, totally tubeless, or standard PNL for treating kidney stones. We defined tubeless PNL as no nephrostomy tube, but ureteral stenting, while totally tubeless PNL meant no nephrostomy tube or ureteral stenting. Both interventions were compared to standard PNL with placement of a nephrostomy tube (only). We considered access tubes of any sizes. We only considered unilateral PNL with single-tract access. There were no exclusions on stone composition, size, or location.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the literature, extracted data, assessed risk of bias, and rated the certainty of evidence using GRADE. Primary outcomes were severe adverse events and postoperative pain, and secondary outcomes were operating time, length of hospital stay, and stone-free rate. We used the random-effects model for meta-analysis.

MAIN RESULTS

We included 10 studies in the review. Participant age varied among studies, ranging from 20 to 60 years. Detailed information on stone characteristics was rarely presented. Tubeless PNL versus standard PNL We are very uncertain whether there is a difference in severe adverse events (SAEs) between tubeless PNL and standard PNL (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.14 to 16.46; I2 = 42%; 2 studies, 46 participants; very low-certainty evidence). Tubeless PNL may have little to no effect on pain on postoperative day one (mean difference (MD) 0.56 lower, 95% CI 1.34 lower to 0.21 higher; I2 = 84%; 4 studies, 186 participants; low-certainty evidence), and probably results in little to no difference in operating room time (MD 0.40 longer (in minutes), 95% CI 4.82 shorter to 5.62 longer; I2 = 0%; 3 studies, 81 participants; moderate-certainty evidence). Tubeless PNL may reduce length of hospital stay (MD 0.90 shorter, 95% CI 1.45 shorter to 0.35 shorter; I2 = 84%; 6 studies, 238 participants; low-certainty evidence). We are very uncertain of the effect of tubeless PNL on blood transfusions (RR 0.64, 95% CI 0.16 to 2.52; I2 = 0%; 4 studies, 161 participants; very low-certainty evidence), sepsis or fever (RR 0.50, 95% CI 0.05 to 4.75; I2 = not applicable; 2 studies, 82 participants; very low-certainty evidence), or readmissions (RR 1.00, 95% CI 0.07 to 14.21; I2 = not applicable, 1 study, 24 participants; very low-certainty evidence). Totally tubeless versus standard PNL Totally tubeless PNL may result in lower SAE rates (RR 0.49, 95% CI 0.19 to 1.25; I2 = 0%; 2 studies, 174 participants; low-certainty evidence) and pain on postoperative day one (MD 3.60 lower, 95% CI 4.24 lower to 2.96 lower; I2 = Not applicable; 1 study, 50 participants; low-certainty evidence). Totally tubeless PNL may result in little to no difference in operating room time (MD 6.23 shorter (in minutes), 95% CI 14.29 shorter to 1.84 longer; I2 = 72%; 2 studies, 174 participants; moderate-certainty evidence) and sepsis or fever (RR 0.33, 95% CI 0.01 to 7.97; I2 = not applicable; 1 study, 90 participants; low-certainty evidence). Totally tubeless PNL likely shortens the length of hospital stay (MD 1.55 shorter, 95% CI 1.82 shorter to 1.29 shorter; I2 = 0%; 4 studies, 274 participants; moderate-certainty evidence). We are very uncertain of the effect of totally tubeless PNL on blood transfusions (RR 0.62, 95% CI 0.26 to 1.48; I2 = 0%; 4 studies, 274 participants; very low-certainty evidence) or readmissions (RR not estimable, 95% CI not estimable; I2 = not applicable; 1 study, 50 participants; very low-certainty evidence). We found no studies comparing tubeless mini versus standard mini-PNL or totally tubeless mini versus standard mini-PNL.

AUTHORS' CONCLUSIONS

When comparing tubeless to standard PNL with regard to the predefined primary outcomes of this review, there may be little difference in early postoperative pain, while we are very uncertain of the effect on SAEs. People treated with tubeless PNL may benefit from a reduced length of stay compared to standard PNL. When comparing totally tubeless to standard PNL, early postoperative pain and severe adverse events may be reduced with totally tubeless PNL. The certainty of evidence by outcome was mostly very low (range: moderate to very low) for the comparison of tubeless to standard PNL and low (range: moderate to very low) for the comparison of totally tubeless to standard PNL. The most common reasons for downgrading the certainty of the evidence were study limitations, inconsistency, and imprecision. We did not find randomized trial evidence for other comparisons. Overall, further and higher-quality studies are needed to inform clinical practice.

[Stress experience by information and communication technologies among nurses in outpatient care - A qualitative interview study]

Stress experience by information and communication technologies among nurses in outpatient care - A qualitative interview study Abstract: Background: "Work 4.0" is also becoming increasingly prevalent in outpatient care through information and communication technologies (ICT). In addition to a variety of options that ICT offers nursing staff, its use leads to additional stresses. Aims: The aim of the study is to identify relevant stress categories that are caused using ICT and provide an additional influence on the stress experience of employees in outpatient care. Methods: Problem-centred interviews were conducted with eight nurses from three outpatient care organizations as part of a qualitative study. Subsequently, these interviews were transcribed and evaluated using qualitative content analysis according to Mayring. Results: Ten factors were identified that were perceived as stress by ambulatory care employees: for example, insufficient participation and usability, increased documentation effort, information overload. Regarding the employees' ability to work and their health, no relevant impairments could be derived that could be attributed to the identified additional strains. Conclusions: Further analysis of the potential stress situations that could result from ICT use is needed to include this knowledge in primary prevention. It makes sense to establish demand-, participation-, and process-oriented structures in outpatient care organizations. The use of ICT can also be an advantage because, for example, information can be obtained more quickly.

Development of the NOGGO GIS v1 Assay, a Comprehensive Hybrid-Capture-Based NGS Assay for Therapeutic Stratification of Homologous Repair Deficiency Driven Tumors and Clinical Validation

The worldwide approval of the combination maintenance therapy of olaparib and bevacizumab in advanced high-grade serous ovarian cancer requires complex molecular diagnostic assays that are sufficiently robust for the routine detection of driver mutations in homologous recombination repair (HRR) genes and genomic instability (GI), employing formalin-fixed (FFPE) paraffin-embedded tumor samples without matched normal tissue. We therefore established a DNA-based hybrid capture NGS assay and an associated bioinformatic pipeline that fulfils our institution's specific needs. The assay´s target regions cover the full exonic territory of relevant cancer-related genes and HRR genes and more than 20,000 evenly distributed single nucleotide polymorphism (SNP) loci to allow for the detection of genome-wide allele specific copy number alterations (CNA). To determine GI status, we implemented an %CNA score that is robust across a broad range of tumor cell content (25-85%) often found in routine FFPE samples. The assay was established using high-grade serous ovarian cancer samples for which BRCA1 and BRCA2 mutation status as well as Myriad MyChoice homologous repair deficiency (HRD) status was known. The NOGGO (Northeastern German Society for Gynecologic Oncology) GIS (GI-Score) v1 assay was clinically validated on more than 400 samples of the ENGOT PAOLA-1 clinical trial as part of the European Network for Gynaecological Oncological Trial groups (ENGOT) HRD European Initiative. The "NOGGO GIS v1 assay" performed using highly robust hazard ratios for progression-free survival (PFS) and overall survival (OS), as well a significantly lower dropout rate than the Myriad MyChoice clinical trial assay supporting the clinical utility of the assay. We also provide proof of a modular and scalable routine diagnostic method, that can be flexibly adapted and adjusted to meet future clinical needs, emerging biomarkers, and further tumor entities.

Response of an HER2-Mutated NSCLC Patient to Trastuzumab Deruxtecan and Monitoring of Plasma ctDNA Levels by Liquid Biopsy

HER2-targeted therapy is currently the subject of several studies in lung cancer and other solid tumors using either tyrosine kinase inhibitors (TKI) or targeted-antibody-drug conjugates. We describe a 61-year-old female patient with HER2 mutated adenocarcinoma of the lungs who received chemo-immunotherapy, followed by trastuzumab deruxtecan (T-DXd) and third-line Ramucirumab/Docetaxel at disease progression. Plasma ctDNA monitoring was obtained at 12 timepoints during therapy and revealed HER2 mutation allele frequencies that corresponded to the clinical course of disease. HER2-targeted T-DXd therapy resulted in a profound clinical response and may be an option for NSCLC patients carrying an activated HER2 mutation. Longitudinal liquid biopsy quantification of the underlying driver alteration can serve as a powerful diagnostic tool to monitor course of therapy.

Increasing Biomarker Guidance in the Treatment of Urothelial Carcinoma: Systematic Review of International Clinical Trials

PURPOSE

Precision oncology requires biomarker testing from tumor tissue for clinical decision-making and selection of targeted therapies. We systematically evaluated the role of tissue biomarker testing within interventional clinical trials for locally advanced and metastatic urothelial carcinoma (UC).

METHODS

A systematic search within the publicly available ClinicalTrials.gov database was performed for the period 1995 to January 2020. We searched for all interventional studies on systemic treatments for advanced UC. Two investigators independently screened the records and extracted the data for statistical analyses.

RESULTS

We included 356 studies out of 827 initial records in the final analysis. The overall number of interventional trials in UC patients significantly increased during the past 25 years. Forty-three studies (12.1%) required specific biomarker testing as a prerequisite for inclusion. Of the remaining 313 trials, explorative biomarkers of interest were studied in 83 studies (23.3%). In trials with obligate biomarker testing as a precondition for study inclusion, only 3 studies (7%) required an actual fresh pretreatment biopsy, while the majority of studies did not state any tissue requirements (55.8%) or accepted archival tissue samples (37.3%). Among studies without biomarker prerequisites, freshly obtained tissue samples were required in 16.3% of studies evaluating immune checkpoint inhibition and 5.7% evaluating targeted therapy. The collection of archival tissue was allowed in 67.4% and 20% of studies evaluating immune checkpoint inhibitors and targeted therapies, respectively.

CONCLUSION

There has been an increase in the number of studies using biomarker-guided interventions for the treatment of advanced UC over the past 25 years. Studies investigating druggable targets in actual UC biopsies immediately before treatment are still rare. Standardized criteria for tissue-based biomarker testing may further accelerate personalized treatment of patients with advanced UC.

Continuum beliefs of mental illness: a systematic review of measures

PURPOSE

The continuum of mental health/illness has been subject to scientific debate for decades. While current research indicates that continuum belief interventions can reduce mental health stigma and improve treatment seeking in affected populations, no study has yet systematically examined measures of continuum beliefs.

METHODS

This preregistered systematic review summarizes measures of continuum beliefs. Following the PRISMA statement, three scientific databases (PubMed, PsycInfo and PsycArticles via EBSCOhost, Web of Science) are searched, instruments are described and discussed regarding their scope, and methodological quality.

RESULTS

Overall, 7351 records were identified, with 35 studies reporting relevant findings on 11 measures. Most studies examined general population samples and used vignette-based measures. Schizophrenia and depression were most commonly examined, few studies focused on dementia, ADHD, OCD, eating disorders, and problematic alcohol use, or compared continuum beliefs across disorders. Validity was very good for most measures, but reliability was rarely tested. Measures mostly assessed beliefs in the normality of mental health symptoms or the normality of persons with such symptoms but rarely nosological aspects (i.e., categorical v continuous conceptualization of mental disorders).

CONCLUSIONS

Current research provides psychometrically sound instruments to examine continuum beliefs for a variety of mental disorders. While studies suggest utility for general population samples and mental health professionals, more research is necessary to corroborate findings, for instance, regarding age (e.g., in adolescents), gender, or type of mental disorder. Future research should also compare self-report ratings, and vignette-based measures, include measures of nosological concepts to fully grasp the continuum concept of mental illness.

PREREGISTRATION

PROSPERO: CRD42019123606.

JUDICIALIZAÇÃO NOS PROCESSOS DE SAÚDE MENTAL: NARRATIVAS DE PROFISSIONAIS ACERCA DA INTERNAÇÃO INVOLUNTÁRIA DE MENORES

O artigo objetiva conhecer as narrativas de profissionais de saúde que atuam no Centro de Atenção Psicossocial da Infância e Adolescência acerca da internação involuntária, assim como a relação da família no processo de cuidado e da judicialização da assistência em saúde mental.  O estudo é de caráter descritivo e exploratório, com abordagem qualitativa. Aplicou-se uma entrevista semiestruturada com dois servidores, com questões referentes à rotina do serviço, perfil do usuário e participação da família. A análise dos dados produzidos foi dada a partir da Análise temática de Braun e Clarke. Os achados durante as entrevistas proporcionaram a criação de 3 eixos temáticos para discutir a questão: 1) Perfil dos pacientes internados, em que foi possível identificar que geralmente os usuários indicados para a internação são adolescentes infratores do gênero masculino; 2) Internação involuntária: punição ou salvação? em que buscamos compreender as condições que são aplicadas para tal prática e; 3) Judicialização como recurso de adesão das famílias e dos serviços de saúde, uma incursão nas falas para investigar a dualidade das ações judiciais em processos/tratamento por uso de drogas. Considerações finais: Observou-se que é necessário um alinhamento dos setores da saúde e do judiciário, priorizando igualmente a saúde e a segurança dos adolescentes. Ainda, o estabelecimento de uma rede de cuidados integral, que vise a reintegração do mesmo na sociedade, seguindo os princípios do Sistema Único de Saúde.

74 Ge( n , γ ) cross section below 70 keV measured at n_TOF CERN

Neutron capture reaction cross sections on 74 Ge are of importance to determine 74 Ge production during the astrophysical slow neutron capture process. We present new resonance data on 74 Ge( n , γ ) reactions below 70 keV neutron energy. We calculate Maxwellian averaged cross sections, combining our data below 70 keV with evaluated cross sections at higher neutron energies. Our stellar cross sections are in agreement with a previous activation measurement performed at Forschungszentrum Karlsruhe by Marganiec et al., once their data has been re-normalised to account for an update in the reference cross section used in that experiment.

Search for Dark Matter Axions with CAST-CAPP

The CAST-CAPP axion haloscope, operating at CERN inside the CAST dipole magnet, has searched for axions in the 19.74 μeV to 22.47 μeV mass range. The detection concept follows the Sikivie haloscope principle, where Dark Matter axions convert into photons within a resonator immersed in a magnetic field. The CAST-CAPP resonator is an array of four individual rectangular cavities inserted in a strong dipole magnet, phase-matched to maximize the detection sensitivity. Here we report on the data acquired for 4124 h from 2019 to 2021. Each cavity is equipped with a fast frequency tuning mechanism of 10 MHz/ min between 4.774 GHz and 5.434 GHz. In the present work, we exclude axion-photon couplings for virialized galactic axions down to g_aγγ = 8 × 10⁻¹⁴ GeV⁻¹ at the 90% confidence level. The here implemented phase-matching technique also allows for future large-scale upgrades.

Haloscopes aim at detecting axions by converting them into photons using high-quality resonant cavities, where the cavity resonance should be tuned with the unknown axion mass. Here, the authors improve exclusion limits using four phase-matched resonant cavities and a fast frequency scanning technique.

An acoustic based risk score in addition to pre-test probability estimation for coronary artery disease improves risk classification in patients with suspected coronary artery disease

Background

The 2021 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for Evaluation and Diagnosis of Chest Pain introduced a new pre-test probability (PTP)-table for risk stratification of patients with symptoms suggestive of coronary artery disease (CAD). The CAD-score, an acoustic-based risk score for obstructive CAD, has previously shown good rule out capability in patients with suggested CAD when added to PTP.

Purpose

To investigate the potential of the acoustic CAD-score to 1) reclassify patients from intermediate-high to low PTP, and 2) improve risk-stratification in patients with low PTP, when added to the 2021 AHA/ACC PTP.

Methods

This is a retrospective study of patients with successfully obtained CAD-score from The Danish study of Non-Invasive testing in Coronary artery Disease 1 (Dan-NICAD 1) of patients without known CAD referred for coronary computed tomography angiography with angina pectoris. Patients with suspected obstructive CAD underwent invasive angiography. CAD-score was obtained with a non-invasive acoustic device analysing heart sounds based on CAD-related turbulence. CAD-score≤20 indicated low probability of CAD. PTP was calculated from sex, age, and angina symptoms according to current AHA/ACC Guidelines. Low likelihood of CAD was defined as PTP≤15%, and intermediate-high likelihood as PTP>15%. Hemodynamic obstructive CAD was defined as visual luminal diameter stenosis >90% on angiography or FFR<0.80%.

Results

Among the 1475 included patients (52.3% women, median age 57 years IQR [50–64[), 36.4% were categorized as low likelihood of CAD (PTP≤15%), and 9.8% of patients had obstructive CAD. Compared to patients with PTP≤15%, patients with PTP>15%, were older, more often hypertensive (49.8% vs. 35.5%), had a higher median CAD-score (28 [22–38] vs. 16 [12–22]), and had more obstructive CAD (12.4% vs. 5.2%). CAD-score reclassified 17.6% of patients with intermediate-high likelihood to a low likelihood of CAD and decreased the post-test probability of obstructive CAD from 5.2% to 4.7%. Subgroup analyses showed reclassification was greater in men, patients with PTP ≤25%, age <70 years or no hypertension. In the 432 patients with PTP>15%, age<70 and no hypertension, 35.4% were reclassified to low likelihood, whereas only 2.4% of patients with PTP>15%, age≥70 years or hypertension were ruled out by CAD-score ≤20. In patients with low PTP≤15%, CAD-score≤20 risk-stratified 361 (67.2%) patients to very low and 176 (32.8%) to an intermediate-low likelihood of CAD, but the post-test probabilities of CAD in both subgroups were still below the cut-off of 15 (3.6% vs. 8.5%).

Conclusion

Adding an acoustic-based CAD-score to the AHA/ACC PTP could potentially reduce the need for further diagnostic testing by 17.6% in patients with intermediate-high likelihood of CAD and in subgroups a reduction of 35% can be achieved. Use of CAD-score in low-likelihood patients only moderately improves risk classification.

Funding Acknowledgement

Type of funding sources: None.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Forensische Altersdiagnostik mittels Niederfeld-Magnetresonanztomographie

Hintergrund

Ein rechtlich zulässiges medizinisches Altersfeststellungsverfahren mit möglichst schonenden und zuverlässigen Methoden bei unbegleiteten und fraglich minderjährigen Ausländern ist erforderlich, um den tatsächlich Minderjährigen den für sie gesetzlich vorgesehenen besonderen Schutz zukommen zu lassen.

Ziel der Arbeit

Studiendesign und erste Ergebnisse einer Studie zur forensischen Altersdiagnostik mittels Niederfeld-Magnetresonanztomographie werden vorgestellt.

Material und Methoden

Geplant ist die prospektive Untersuchung von 650 Studienteilnehmenden, gleichmäßig verteilt innerhalb der Altersgruppe 12 bis 24 Jahre zu je 25 Personen je Geschlecht. Es sollen Entwicklungsstadien von distalem Radius, distaler Ulna, distalem Femur und proximaler Tibia mithilfe eines 0,31-Tesla(T)-Niederfeld-MRT-Scanners erfasst und mittels Anwendung der Vieth-Klassifikation ausgewertet werden.

Ergebnisse

Nach Auswertung der Untersuchungen der bisher 487 untersuchten Studienteilnehmenden ist ersichtlich, dass die gewählten Sequenzen die für die Vieth-Klassifikation relevanten Charakteristika der Ossifikation der untersuchten Epiphysen erfassen. Die Untersuchungen erweisen sich überdies als einfach in der Durchführung.

Schlussfolgerung

Untersuchungen zur forensischen Altersschätzung am Lebenden unter Anwendung der Vieth-Klassifikation sind mit Niederfeld-MRT-Scannern bei einer Feldstärke von 0,31 T durchführbar. Es bleibt zu klären, ob die mit einem 0,31-T-Niederfeld-MRT-Scanner nachweisbaren Ossifikationsmerkmale am Handgelenk und am Knie einen zweifelsfreien Volljährigkeitsnachweis erlauben.

TELEPSICOTERAPIA EM TEMPOS DE PANDEMIA

A saúde mental da população foi impactada pela pandemia da COVID-19, exigindo a criação de estratégias de cuidado, como a crescente utilização da telepsicoterapia. Desta forma, o presente artigo tem como objetivo analisar a adesão à telepsicoterapia oferecida no período pandêmico, considerando o perfil sociodemográfico do público atendido, a participação no estudo pelas sessões de psicoterapia e pelo preenchimento dos questionários disponibilizados através da plataforma de atendimento online. O estudo teve caráter quantitativo e descritivo, cuja amostra incluiu pessoas maiores de 18 anos e que morassem nas regiões do Vale do Rio Pardo e Vale do Taquari -RS. As informações sociodemográficas foram coletadas por meio de questionários, que posteriormente geraram um banco de dados, no qual também foi registrada a frequência dos participantes em quatro sessões de telepsicoterapia. A análise dos dados foi realizada no Microsoft Office Excel e apresentada de modo descritivo. O período de coleta dos dados foi de janeiro a dezembro de 2021. A amostra foi composta por 153 indivíduos de 19 municípios. O perfil predominante encontrado foi de 75,51% mulheres (n=114), 71,9% adultos de 25-60 anos (n=110), 69,28% residentes de centros urbanos (n=110).  A taxa de  adesão à telepsicoterapia foi de 91,5% na quarta sessão (n=140). Os resultados encontrados demonstram que esta é uma ferramenta potente para populações que não acessam a saúde mental pública devido a sobrecarga no sistema ou por aqueles que se encontram impossibilitados de serem atendidos de forma presencial.

RNA polymerase I inhibition induces terminal differentiation, growth arrest, and vulnerability to senolytics in colorectal cancer cells

Ribosomal biogenesis and protein synthesis are deregulated in most cancers, suggesting that interfering with translation machinery may hold significant therapeutic potential. Here, we show that loss of the tumor suppressor adenomatous polyposis coli (APC), which constitutes the initiating event in the adenoma carcinoma sequence for colorectal cancer (CRC), induces the expression of RNA polymerase I (RNAPOL1) transcription machinery, and subsequently upregulates ribosomal DNA (rDNA) transcription. Targeting RNAPOL1 with a specific inhibitor, CX5461, disrupts nucleolar integrity, and induces a disbalance of ribosomal proteins. Surprisingly, CX5461-induced growth arrest is irreversible and exhibits features of senescence and terminal differentiation. Mechanistically, CX5461 promotes differentiation in an MYC-interacting zinc-finger protein 1 (MIZ1)- and retinoblastoma protein (Rb)-dependent manner. In addition, the inhibition of RNAPOL1 renders CRC cells vulnerable towards senolytic agents. We validated this therapeutic effect of CX5461 in murine- and patient-derived organoids, and in a xenograft mouse model. These results show that targeting ribosomal biogenesis together with targeting the consecutive, senescent phenotype using approved drugs is a new therapeutic approach, which can rapidly be transferred from bench to bedside.

Original Article Phytotherapy in Adults With Recurrent Uncomplicated Cystitis

BACKGROUND

Uncomplicated urinary tract infections are among the commonest bacterial infections. Because antibiotic resistance is on the rise, there is growing interest in alternative, non-antimicrobial treatment options. This systematic review presents the current evidence on phytotherapy for the treatment and prevention of recurrent uncomplicated cystitis.

METHODS

A systematic search of the relevant literature from January 2011 to August 2021 was carried out in the MEDLINE, Embase, and Cochrane Library databases and in two clinical trial registries. The trials included in the present review are ran - domized controlled trials (RCTs) of phytotherapeutic agents as monotherapy or combination therapy, in comparison to placebo, no treatment, non-pharmacological treatment, or drug treatment without any phytotherapeutic component. Two of the authors independently selected the publications, extracted the data, and estimated the risk of bias using the Cochrane Risk of Bias Tool.

RESULTS

12 RCTs with a total of 1797 female patients were included. A trial of acute therapy with Chinese plant-based medicine revealed non-inferiority to antibiotic treatment. Six trials of prophylaxis with cranberry products yielded mixed results with regard to efficacy against recurrent urinary tract infections. A trial of Seidlitzia rosmarinus for the prevention of cystitis showed that its use was associated with a lower cystitis rate than placebo (at 6 months: 33 vs. 73%, p <0.001). In all trials but one, the risk of bias was unclear or high. No standardized assessment of adverse events was carried out.

CONCLUSION

Phytotherapeutic agents are an option for the treatment and prevention of recurrent cystitis in women. Given the heterogeneous state of the evidence on phytotherapy, no dependable recommendations can now be made for the clinical management of these patients with respect to phytotherapeutic agents.

Remineralisation capability of silver diamine fluoride in artificial enamel lesions on smooth surfaces using quantitative light-induced fluorescence measurements in-vitro

Enamel demineralisation can develop on smooth surfaces as an undesirable side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the ability of 38% silver diamine fluoride in remineralisation (as estimated by fluorescence gain) of artificial initial lesions in smooth surfaces of human enamel. The smooth surfaces of 50 human tooth samples were artificially demineralised and 45 samples were allocated randomly into three groups receiving a single treatment with a varnish: group I: Riva Star (silver diamine fluoride, SDF), group II: Bifluorid 12 (NaF, CaF₂), and group III: Cervitec F (CHX, CPC, NH₄F). Five samples were assigned as a negative control group without treatment. All samples were exposed to pH-cycling for 28 days. Fluorescence behavior was measured using Quantitative light-induced fluorescence before and after demineralisation and up to four weeks on a weekly basis. Analysis of variance (ANOVA) with Tukey–Kramer post-hoc tests and repeated measures ANOVA were used for statistical evaluation (α = 0.05). After demineralisation, all samples showed mean ΔF of − 16.22% ± 4.35, without significance differences between the fluorescence behaviour of the samples (p = 0.251). After 28 days group comparison showed a statistically significant difference (p = 0.034) for ΔF values: the lowest fluorescence values were found in group I (SDF, mean ΔF − 16.47 ± 6.08) with a significant difference compared to group III (Cervitec F, mean ΔF − 11.71 ± 4.83). In group II (Bifluorid 12) mean ΔF value was − 15.55 ± 2.15) without statistically significant differences to groups I and III. The fluorescence behaviour of SDF varnish on smooth surfaces with artificial initial enamel lesions was significantly lower compared to Cervitec F varnish after short time use.

Application of modern radiochemical techniques to the determination of Sr-89/Sr-90 in environmental samples

A method for the determination of Sr-89/-90 in different types of environmental samples (German IMIS program) was to be adopted to the 2nd Saxon state laboratory for environmental radioactivity. Resulting from literature studies a combination of variable extraction steps for Y and Sr was chosen to be able for determining Sr-90 or Sr-89/-90 in a common as well as a rapid way. Measurements with a liquid-scintillation counter (LSC) and a low-background proportional counter (LBC) were performed after the same chemical separation steps in each case to find out the detector which is the best suitable one for our requirements. Different steps of the analytical procedure are discussed in detail and its characteristic parameters are given.

Screening two biodegradable polymers in enhanced efficiency fertiliser formulations reveals the need to prioritise performance goals

Enhanced efficiency fertilisers (EEF) may reduce nitrogen (N) losses and improve uptake efficiency through synchronising N release with in-season plant requirements. We hypothesised that EEF formed via matrix encapsulation in biodegradable polymers will improve N use efficiency when compared to conventional urea fertiliser. This hypothesis was investigated for two biodegradable polymer matrices: polyhydroxyalkanoate (PHA), containing 11.6% urea (by mass), and polybutylene-adipate-co-terephthalate (PBAT), containing either 19.4 or 32.7% urea; and two contrasting soil types: sand and clay. Nitrogen availability and form was investigated under leaching conditions (water) with a growth accelerator pot experiment involving a horticultural crop and novel non-destructive three-dimensional scanning to measure in-season biomass development. The PBAT 32.7% formulation enabled greater above ground biomass production at both 50 and 100 kg N ha^-1 equivalent application rates compared to conventional urea. For the sandy soil, plant scanning indicated that improved uptake performance with PBAT 32.7% was probably the result of greater N availability after 25 days than for conventional urea. Two of the encapsulated formulations (PHA and PBAT 19.4%) tended to decrease nitrogen leaching losses relative to urea (P < 0.05 for the red clay soil). However, decreased N leaching loss was accompanied by poorer N uptake performance, indicative of N being less available in these biopolymer formulations. A snapshot of nitrous oxide emissions collected during peak nitrate concentration (prior to planting and leaching) suggested that the biopolymers promoted N loss via gaseous emission relative to urea in the sandy soil (P < 0.05), and carbon dioxide emissions data suggested that biopolymer-carbon increased microbial activity (P < 0.1). Controlled testing of N release in water was a poor predictor of biomass production and leaching losses. The diverse behaviours of the tested formulations present the potential to optimise biopolymers and their N loadings by taking into account soil and environmental factors that influence the efficient delivery of N to target crops. The greater N uptake efficiency demonstrated for the PBAT 32.7% formulation confirms our hypothesis that matrix encapsulation can enable better synchronisation of N release with crop requirements and decrease leaching losses.

[German-language translation of the PANELVIEW instrument to evaluate the guideline development process from the perspective of the guideline group]

INTRODUCTION

The development process for clinical guidelines is influenced by factors that are relevant to the validity of a guideline but often are not captured sufficiently in the final guideline documents. PANELVIEW is an English-language tool that can be used to explore the guideline development process from the perspective of guideline group members. Our aim was to translate the PANELVIEW tool into German, taking into account national contexts and linguistic differences.

METHODS

The PANELVIEW tool was initially translated by a core team, then refined and approved by a group of experts in a consensus-based Delphi process. The experts were selected on the basis of their experience in guideline development covering different fields (clinical, methodological, organisational, health professional, patient perspective) and geographical regions (Germany, Austria, Switzerland). A representative of the original PANELVIEW team was also involved. The Delphi steps included an online survey, an online consensus conference and final approval by circulating the results via email. Individual items were seen as generally agreed upon if the level of agreement in the respective steps was 75 % or more.

RESULTS

The expert group consisted of 12 persons. Of these, 11 (92 %) participated in the online survey and 10 (83 %) in the subsequent consensus conference. After the first Delphi step, sufficient agreement was achieved for 19 of 34 items (56 %). The remaining 15 items were discussed in the consensus conference and finally obtained 100 % agreement. The discussion focused on clarifying and adapting terms whose meaning was ambiguous or inadequate in the German context, which led to a deviation from the original wording in some instances.

DISCUSSION

The PANELVIEW tool was translated into German by means of a Delphi process. PANELVIEW complements existing instruments for assessing the methodological quality of guidelines by capturing the perspective of the guideline group. This will enable guideline developers and organisations to identify problems in the drafting process and avoid them in future projects. User testing and validation of the German-language PANELVIEW tool are planned for the future.

CONCLUSION

The German-language translation of PANELVIEW will enable guideline developers in German-speaking countries to continuously evaluate and, where necessary, improve the process and methods of guideline development.

Can magnetic resonance imaging replace conventional computerized tomography for follow-up of patients with testicular cancer? A systematic review

PURPOSE

Follow-up protocols for patients with testicular cancer (TC) have significantly reduced the number of cross-sectional imaging studies to reduce radiation exposure. At present, it is unclear whether magnetic resonance imaging (MRI) could replace conventional computerized tomography (CT) imaging. The objective of this study is to summarize the scientific evidence on this topic and to review guideline recommendations with regard to the use of MRI.

METHODS

A systematic literature review was performed searching Medline and Cochrane databases for prospective studies on patients with TC in the follow-up care (last search in February 2021). Additionally, guideline recommendations for TC were screened. Data extraction and quality assessment of included studies were performed and used for a descriptive presentation of results.

RESULTS

A total of four studies including two ongoing trials were identified. Overall, the scientific evidence of prospective comparative studies is based on 102 patients. Data suggest that abdominal imaging with MRI can replace conventional CT for detection of lymph node metastasis of the retroperitoneum to spare radiation exposure and contrast media application. However, experienced radiologists are needed. Clinical guidelines are aware of the risk of diagnosis-induced secondary malignancy due to CT imaging and some have adapted their recommendations accordingly. Results of the two ongoing trials on 738 patients are expected soon to provide more reliable results on this topic.

CONCLUSIONS

There is growing evidence that abdominopelvic MRI imaging can replace CT imaging during follow-up of patients with TC in order to reduce radiation exposure and diagnosis-induced secondary malignancy.

Continuum beliefs and mental illness stigma: A systematic review and meta-analysis of correlation and Intervention studies

Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. In a systematic review and meta-analysis, we examined whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma. We searched three electronic databases (PubMed, Web of Science and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness and stigma. Of these, 13 studies were included in meta-analysis. Continuum beliefs are consistently associated with lower stigma. Interventions were effective in manipulating continuum beliefs but differ in their effects on stigmatizing attitudes. We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of “us” and a process of identification with the person with mental illness. We discuss implications for the design of future interventions using the example of our current online anti-stigma intervention, which was developed on the basis of these considerations, containing gamified elements with the purpose of identification and involvement.

Validity and reliability of a clinical non-exercise method for assessment of cardiorespiratory fitness using seismocardiography

Introduction

Low cardiorespiratory fitness expressed as a low maximal oxygen consumption (V̇O2max) is associated with cardiovascular disease and all-cause mortality (1). Thus, V̇O2max is recognised as an important clinical tool in the assessment of patients (1,2). However, assessment of V̇O2max by exercise testing is both physically demanding and methodologically challenging and hence the clinical applicability is limited.

Purpose

Therefore, the aim of this study was to investigate the accuracy and precision of a clinical non-exercise method for assessment of V̇O2max.

Methods

On three separate days 20 healthy men (n=10) and women (n=10) with varying age (22–72 years) and fitness levels performed two tests for determination of V̇O2max; (a) a non-exercise test using seismocardiography (SCG V̇O2max) and (b) a graded exercise test to voluntary exhaustion on a cycle ergometer based on indirect calorimetry (IC V̇O2max). These tests were performed in order to examine the day-to-day reliability and the validity of SCG V̇O2max, respectively. Furthermore, SCG V̇O2max was assessed twice on each test day to investigate test-retest reliability. The SCG V̇O2max was performed in prone position following a short resting period by placing the SCG recording device on the xiphisternal joint with double adhesive tape. V̇O2max was assessed during a 5-minute recording of the sternal movement using SCG in combination with demographic data of the participants (3).

In addition, body composition was measured and a resting blood sample collected each test day.

Results

On average SCG V̇O2max was 3.3±2.4 ml/min/kg (mean ± 95% CI) lower than IC V̇O2max (p=0.013, SCG V̇O2max: 36.6±3.3 ml/min/kg, IC V̇O2max: 39.9±3.0 ml/min/kg). A significant positive correlation was found between SCG V̇O2max and IC V̇O2max (Pearson, r=0.72, p&lt;0.001). Both SCG V̇O2max and IC V̇O2max was similar between test days (p=0.972) and the intra-individual coefficient of variation was 4.5±2.9% and 4.0±2.5%, respectively.

Within each test day SCG V̇O2max was highly correlated (r=0.99, p&lt;0.0001) and no difference was observed between tests (p=0.993).

Conclusions

The accuracy of the current non-exercise assessment of cardiorespiratory fitness based on seismocardiography is not optimal as SCG V̇O2max was systematically lower than the gold standard assessment applying indirect calorimetry during a graded exercise test. Despite the abovementioned difference, SCG V̇O2max and IC V̇O2max were highly correlated. Furthermore, the precision of SCG V̇O2max is very high as both day-to-day and test-retest reliability were high.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): VentriJect ApS, Copenhagen, Denmark

Organoid Models for Cancer Research-From Bed to Bench Side and Back

Organoids are a new 3D ex vivo culture system that have been applied in various fields of biomedical research. First isolated from the murine small intestine, they have since been established from a wide range of organs and tissues, both in healthy and diseased states. Organoids genetically, functionally and phenotypically retain the characteristics of their tissue of origin even after multiple passages, making them a valuable tool in studying various physiologic and pathophysiologic processes. The finding that organoids can also be established from tumor tissue or can be engineered to recapitulate tumor tissue has dramatically increased their use in cancer research. In this review, we discuss the potential of organoids to close the gap between preclinical in vitro and in vivo models as well as clinical trials in cancer research focusing on drug investigation and development.

[Guidelines-a European project]

Clinical guidelines represent the latest standard of medical knowledge concerning diagnostics, treatment and follow up of diseases and should support doctors and patients to choose the best treatment. Depending on the prevalence of a disease there exist less or more published data. Therefore, several levels of guidelines are possible. In case of few data the expertise of the attending physicians is of greater importance (S1, S2-guidelines). In case of a huge amount of literature, especially phase III studies or metaanalyses, a S3-guideline can be written. The article describes the process of developing a guideline in Germany under the guidance of the Association of the Scientific Medical Societies in Germany (AWMF) in comparison to the process by the European Association of Urology (EAU). The aim for the future is to join resources. Another aspect of the article is to inform about different procedures how to control the implementation of the guidelines.

Insideout project: Using big data and machine learning for prevention in psychiatry

Introduction

Social Media might represent an amazing and valuable source of information on mental health and well-being. Several researches revealed that adolescents aged 13 to 17 years old go “online” daily or stay online “almost constantly”.

Objectives

The aim of this project is to identify distress in pre-clinical stages using Social media screening methods. The system can be modelled to centre on different several health-related topics.

Methods

We created a digital system able to analyse scripts written by adolescents on Twitter. InsideOut works using machine learning techniques and computational linguistic items to catch significant and sense of written messages and it improves its performances with iterations. The system is able to automatically identify semantic information relevant to different topics: in this case “distress in teenagers”.

Results

The task of our system is considered correct when it is able to identify triples of Life Event, Sentiment and Experience of a tweet in agreement with the Gold Standard established among the annotators. The system has around 70% of accuracy in identifying triples. The analysis has been carried out both in Italian and English collecting over 4 million Italian tweets and 30 million English tweets. Comparative analysis with self-report questionnaires show that tweet analysis is able to suggest similar statistics.

Conclusions

This study analyzed contents of messages posted on Social Media Twitter meta-dating them with psychological and health-related information. Using InsideOut, we can plan clinical intervention in district and regions where high levels of uneasiness are revealed.

Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

INTRODUCTION

As part of the development of the evidence-based (S3) clinical practice guidelines for kidney and bladder cancer by the German Guideline Program in Oncology, quality indicators (QIs) were defined to measure the quality of care. Based on these guidelines and QIs, the German Cancer Society (DKG) developed two new certification systems. The aim of this article is to show the process of development and implementation of QIs in certified cancer centres.

METHODS

Based on strong recommendations of each guideline and an additional systematic literature review for national and international QIs, two sets of QIs were derived in a multistep standardized approach. These QIs were implemented in the centres in certification data sheets to measure their outcomes. First results of treatment years 2018 and 2019 are available.

RESULTS

The final sets include 9 QIs for kidney cancer and 12 QIs for bladder cancer. Two-thirds of the QIs were transferred to the data sheets. In 2018 and 2019, the results of all but one QI are within the plausibility limits. From 2020 on, they are replaced by stricter target values that will challenge centres to improve their outcomes.

CONCLUSIONS

Guideline-derived QIs make relevant aspects of patient care measurable and consequently improvable. The first QI results are encouraging. However, the DKG certification system and the methods of measuring quality are under ongoing development. Systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.

Social behaviour and vocalizations of the tent-roosting Honduran white bat

Bats are highly gregarious animals, displaying a large spectrum of social systems with different organizational structures. One important factor shaping sociality is group stability. To maintain group cohesion and stability, bats often rely on vocal communication. The Honduran white bat, Ectophylla alba, exhibits an unusual social structure compared to other tent-roosting species. This small white-furred bat lives in perennial stable mixed-sex groups. Tent construction requires several individuals and, as the only tent roosting species so far, involves both sexes. The bats´ social system and ecology render this species an interesting candidate to study social behaviour and vocal communication. In our study, we investigated the social behaviour and vocalizations of E. alba in the tent by observing two stable groups, including pups, in the wild. We documented 16 different behaviours, among others play and fur chewing, a behaviour presumably used for scent-marking. Moreover, we found 10 distinct social call types in addition to echolocation calls, and for seven call types we were able to identify the corresponding broad behavioural context. Most of the social call types were affiliative, including two types of contact calls, maternal directive calls, pup isolation calls and a call type related to the fur-chewing behaviour. In sum, this study entails an ethogram and describes the social vocalizations of a tent-roosting phyllostomid bat, providing the basis for further in-depth studies about the sociality and vocal communication in E. alba.