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OFP-07-013 Refining risk stratification in stage II colorectal cancer: the role of Stroma AReactive Invasion Front Areas (SARIFA) [Abstract]
No full textA walk in the park: influence of natural co-exposure to grass pollen and fungal spores on nasal mycobiome and cytokine responses
No full textBackground: During the grass flowering season, fungal spores are abundant in outdoor air. We tested for co-sensitisations to grass pollen and fungal spores, assessed the degree of co-exposure, and studied its impact on the nasal mycobiome and immune responses.
Methods: Fungi-specific IgE-levels were studied in 277 individuals with and without grass pollen sensitisation. In a small cohort (n = 7), exposure to grass pollen and fungal spores was monitored during 5 consecutive indoor and outdoor stays in a flowering meadow and correlated with changes in the nasal mycobiome. Cytokines of nasal epithelial cells were studied under stimulation with recombinant grass pollen allergens, with and without fungal spores derived from outdoor isolates.
Results: IgE-sensitisation against the studied fungi was significantly more frequent among individuals with grass pollen sensitisation than among those without grass pollen sensitisation. Outdoor exposure resulted in changes in the nasal mycobiome, with a transitory enrichment of environmental fungi, for example, Cladosporium species. Most of the fungi cultivated from outdoor air samples belonged to the genera Fusarium, Cladosporium and Penicillium. Apical co-stimulation of nasal epithelial cells with grass pollen allergens and Fusarium, Cladosporium or Penicillium spores led to an increased loss of transepithelial electrical resistance and induction of pro-inflammatory cytokine release compared to mono-stimulation.
Conclusion: Frequent co-exposure to fungal spores and grass pollen may increase the chance of acquiring a co-sensitisation to both allergens. Environmental fungi interact with and transitorily change the local mycobiome. Under co-exposure, fungal spores induce nasal inflammation and foster immune responses to otherwise poorly immunogenic pollen allergens
Artificial intelligence and machine learning in pediatric endocrine tumors: opportunities, pitfalls, and a roadmap for trustworthy clinical translation
No full textArtificial intelligence (AI) and machine learning (ML) are reshaping cancer research and care. In pediatric oncology, early evidence—most robust in imaging—suggests value for diagnosis, risk stratification, and assessment of treatment response. Pediatric endocrine tumors are rare and heterogeneous, including intra- and extra-adrenal paraganglioma (PGL), adrenocortical tumors (ACT), differentiated and medullary thyroid carcinoma (DTC/MTC), and gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Here, we provide a pediatric-first, entity-structured synthesis of AI/ML applications in endocrine tumors, paired with a methods-for-clinicians primer and a pediatric endocrine tumor guardrails checklist mapped to contemporary reporting/evaluation standards. We also outline a realistic EU-anchored roadmap for translation that leverages existing infrastructures (EXPeRT, ERN PaedCan). We find promising—yet preliminary—signals for early non-remission/recurrence modeling in pediatric DTC and interpretable survival prediction in pediatric ACT. For PGL and GEP-NEN, evidence remains adult-led (biochemical ML screening scores; CT/PET radiomics for metastatic risk or peptide receptor radionuclide therapy response) and serves primarily as methodological scaffolding for pediatrics. Cross-cutting insights include the centrality of calibration and validation hierarchy and the current limits of explainability (radiomics texture semantics; saliency ≠ mechanism). Translation is constrained by small datasets, domain shift across age groups and sites, limited external validation, and evolving regulatory expectations. We close with pragmatic, clinically anchored steps—benchmarks, multi-site pediatric validation, genotype-aware evaluation, and equity monitoring—to accelerate safe, equitable adoption in pediatric endocrine oncology
Sensitivity and scale dependence of discretization and roughness in the hydrodynamic modeling of surface runoff caused by torrential rainfall
No full textHydrodynamic surface runoff simulations are an effective method for assessing flash flood risks. In engineering, the lack of observations for model calibration poses a challenge. Therefore, understanding the sensitivity to specific model parameters is crucial for reliable flood protection planning. This study analyzes how surface discretization and roughness affect surface runoff generation and depression storage in a hydrodynamic 2D-model in a southern German alpine region.
We compare the runoff generation across five discretization methodologies at 211 selected locations within the model domain. These locations are associated with subcatchments ranging in size from 0.2 to 4 km2.
The discretization methodologies comprise a one-meter grid refined with survey data, a two-meter grid, a high-resolution and low-resolution irregular mesh and a four-meter grid. These are combined with seven different depth-dependent and constant roughness parameterizations.
The sensitivity analysis shows that a higher depth-dependent roughness is needed to achieve comparable results to those of a coarse resolution model. Significant differences were observed with varying roughness parameterizations and meshing approaches. Modest alterations to surface resolution have the potential to yield deviations of up to 20% in maximum runoff. Coarser resolution models tend to create artificial depressions, leading to unrealistic water storage on hillsides.
These findings aid in identifying the sources of sensitivity in hydrodynamic surface runoff modeling, especially in ungauged basins and provide guidance on specific model setups. This is particularly relevant given the continued use of coarse-resolution models due to computational constraints and the availability of various roughness parameterizations, while calibration data is scarce
Core values and best practice criteria for interprofessional teams in primary care: a qualitative interview study with general practitioners and other health professionals from Bavaria, Germany
No full textBackground
The German healthcare system is confronted with a shortage of general practitioners (GPs) due to demographic changes and an aging workforce. Concepts such as team-based care, which ensure high-quality primary care, are necessary to address these future challenges. This study aimed to identify values as well as best practices of such team-based concepts.
Methods
We conducted n = 15 individual interviews with health professionals primarily working in primary care settings, including GP trainees, employed or self-employed GPs, medical assistants, primary care management or physician assistant students, and other health professionals (mean age = 36.13 years, 66.67% female). The interviews were transcribed verbatim and coded using a deductive category system based on prior research. For data analysis, we used qualitative content analysis following the framework method.
Results
Participants emphasized patient-centred and continuous care as core values of primary care, highlighting the importance of establishing trusting relationships through sufficient time with patients. In this context, they rated interprofessional team-based care as particularly beneficial for patients who are chronically ill and disadvantaged. The participants supported primary care models characterized by GP-centredness and gatekeeping, a high degree of digitalization, cooperation with non-physician health professionals, and well-defined roles within interprofessional teams. They also stressed the importance of remuneration and work-life balance. To evaluate future concepts of primary care, the interviewees recommended using both staff- and patient-reported measures, as well as operational metrics.
Conclusions
Our results indicate that the core values of primary care, such as patient-centredness and continuity of care, may be enhanced through interprofessional teamwork. While these values contribute to the intrinsic motivation of high-quality care, structural factors such as fair remuneration and digitalization are crucial for effective practice. To evaluate care models, the patient perspective, along with staff satisfaction and team performance, is regarded as an essential outcome measure
Multicenter evaluation of an interoperable system for automated guideline adherence monitoring in ICUs
No full textEinfluss von Infarktlokalisation und Vorhofflimmern auf die Langzeitmortalität von hospitalisierten Patienten mit inzidentem Herzinfarkt. Ergebnisse aus dem Augsburger Herzinfarktregister
No full textDer AWS galt in der Literatur lange als tödlicher verglichen mit dem NAWS. Als Ursache wurde die höhere Masse an infarziertem linksventrikulärem Myokard bei dieser Infarktlokalisation diskutiert. Diese resultiert anatomisch bedingt bei Verschlüssen der LAD, welche 40-50 % des linksventrikulären Myokards versorgt. Bei einem Teil der Herzinfarktpatienten geht das Akutereignis auch mit konsekutiven Herzrhythmusstörungen wie Vorhofflimmern einher. Die vorgelegte kumulative Dissertation untersuchte anhand von Daten des Augsburger Herzinfarktregisters in zwei Publikationen zum einen das Langzeitüberleben nach inzidentem STEMI abhängig von der STEMI-Lokalisation, zum anderen das Langzeitüberleben mit Vorhofflimmern im Aufnahme EKG nach inzidentem Herzinfarkt. In verschiedenen multivariabel adjustierten COX-Regressionsmodellen konnte kein erhöhtes Langzeitmortalitätsrisiko von N=1118 AWS im Vergleich zu N=1077 NAWS gezeigt werden, die sich in den Jahren 2009-2017 ereigneten (durchschnittliche Nachbeobachtungszeit: 4,3 Jahre). Im voll adjustierten Modell ergab sich für AWS verglichen mit NAWS eine HR von 0,91 (95 % CI [0,75-1,10]). Somit konnte anhand unserer Daten die in früheren Publikationen beschriebene höhere Mortalität nach AWS nicht bestätigt werden. Daraus ergibt sich ein Überdenken der Parameter zur Risikostratifizierung nach STEMI. Im dynamic TIMI risk score und der ESC-Leitlinie zur Behandlung von STEMI aus 2017, wird der AWS weiterhin als Prädiktor eines ungünstigeren Outcomes gewertet. Im Rahmen der zweiten Publikation konnte für Vorhofflimmer-Herzinfarktpatienten im Vergleich zu Sinusrhythmus-Patienten in multivariablen COX-Regressionsmodellen, ein signifikantes und unabhängiges Langzeitmortalitätsrisiko (HR von 1,40 (95 % CI [1,05–1,87]) gezeigt werden. Insgesamt wurden N=2313 inzidente Herzinfarkte (STEMI und NSTEMI) aus den Jahren 2009-2017 untersucht, von denen N=156 Vorhofflimmern im Aufnahme EKG zeigten (Nachbeobachtungszeit im Durchschnitt 4,5 Jahre). Unsere Ergebnisse bestätigten damit die Ergebnisse diverser früherer Studien. Vorhofflimmern im Aufnahme-EKG stellt somit einen unabhängigen Prognosefaktor für die Langzeitmortalität nach inzidentem Herzinfarkt dar, -woraus die Wichtigkeit einer adäquaten Behandlung von Vorhofflimmern nach Herzinfarkten, zur möglichen Prognoseverbesserung resultiert
Preferences for biodiversity-promoting private garden designs: a basket-based choice experiment
No full textThis study introduces the basket-based choice experiment (BBCE) as suggested by Caputo and Lusk (2022) into the field of environmental economics and management. The application is a survey to assess garden owners’ preferences for installing design elements conducive to biodiversity conservation in private gardens. In addition to showcasing this approach in the context of environmental management, the present application of the BBCE adds two new methodological features to this approach. First, an experimental design is used to provide context attributes for each basket-based choice task to assess the extent to which policy levers set by local councils can affect how garden owners design their gardens. Second, the econometric model to analyse the resulting basket-based choice data is augmented by a latent class structure to accommodate the empirical finding that a substantial share of respondents never chose to add any new element to their gardens (i.e. chose an empty basket). Results show that the policy instruments have mixed effects on the element-specific choice probabilities, with financial support for new garden elements exhibiting the strongest effect on demand. Furthermore, it is demonstrated how prediction can be used to assess the uptake of biodiversity friendly garden elements as a function of policy instruments