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ResearcherID
- B-4606-2017 (1)
In der vorliegenden Arbeit wurden mehrere konventionelle und 3D-konformale Radiotherapie ("3D-CRT")-Techniken in der Bestrahlung von Wirbelsäulenmetastasen miteinander verglichen. Dafür wurde, basierend auf reellen Planungs-CT-Datensätzen, die Bestrahlung von 41 Wirbelsäulen-Zielvolumina mit verschiedenen Techniken simuliert.
Es konnte gezeigt werden, dass im Vergleich zu konventionellen Techniken bereits sehr einfache 3D-CRT-Techniken eine homogenere Abdeckung von Wirbelsäulen-Zielvolumina bei gleichzeitig zuverlässiger Limitierung der Rückenmarksdosis ermöglichen. Angesichts steigender Lebenserwartungen und dem zunehmenden Bedarf an Re-Bestrahlungen kann dies einen entscheidenden Vorteil darstellen.
Die MRD Diagnostik ist von erheblicher Bedeutung für die Risikostratifizierung kindlicher Leukämien. Um aber gesunde, sich regenerierende Vorstufen von blastären Zellen unterscheiden zu können ist die genaue Kenntnis des Antigenverlaufs sowohl der Vorstufen der B-Zellreihe als auch der Blasten notwendig. In dieser Arbeit wird eine Vergleichende Analyse von B-Zellvorstufen und Blasten mittels Durchflusszytometrie durchgeführt. Von besonders diskriminativem Wert waren die Vorläufermarker CD10, CD34, sowie die lymphatischen Marker CD19, CD20, CD22, CD45, cyCD79a und cyTdT.
Zur Beschreibung des individuellen LAIP eigneten sich vor allem die Marker CD11b, CD38, CD58, CD123 und CD133, sowie die myeloischen Marker CD13 und CD33.
Die Bessere Unterscheidung zwischen gesunden und kranken Zellen zusammen mit neuen Entwicklungen in Diagnostik und Therapie muss in Zukunft zur weiteren Verbesserung der Überlebensraten, auch im Rezidiv führen.
Im Rahmen des BUKA-Projektes (Beratung und Unterstützung für Patienten mit Krebs und ihren Angehörigen) wurden im Universitätsklinikum Würzburg Krebspatienten auf Palliativbedarf gescreent. Ziel war es, bei einem positiven Screening die spezialisierte Palliativmedizin möglichst frühzeitig in onkologische Entscheidungsprozesse miteinzubeziehen.
Konzentriert wurde sich in diesem Projekt auf Patienten, die aufgrund eines metastasierten Primärfalles oder aufgrund eines Rezidives/ Progresses im Tumorboard der Universität Würzburg vorgestellt wurden. Als Tumordiagnose lag ein Bronchialkarzinom, ein gastrointestinaler Tumor oder ein malignes Melanom vor. Für die Auswertung unserer Studie wurden ausschließlich Patienten einbezogen, die innerhalb von 12 Monaten nach Vorstellung im Tumorboard verstorben sind.
Um die Wirkung des Screenings beurteilen zu können, wurden Patientendaten zweier Beobachtungszeiträume verglichen. Die erste Kohorte aus dem Jahr 2011 umfasste 143 Patienten mit einem mittleren Alter von 65,9 Jahren. 67,8% der Patienten waren Männer und 32,2% Frauen. Bei dieser Kohorte erfolgte kein Screening auf Palliativbedarf. Die zweite, palliativmedizinisch gescreente Kohorte aus dem Jahr 2014/15 bestand aus 263 Patienten mit einem mittleren Alter von 65,5 Jahren. Das Patientenkollektiv setzte sich zu 65,0% aus Männern und 35,0% Frauen zusammen.
Anhand eines Datenvergleiches des Jahres 2011 mit 2014/15, sollte untersucht werden, ob die Versorgung von Tumorpatienten am Lebensende durch eine Screening gestützte palliativmedizinische Mitbetreuung verbessert werden konnte.
Im Folgenden werden die Ergebnisse zusammengefasst.
Im Jahr 2014/15 konnte eine Erhöhung des Anteils an Patienten mit Kontakt zur Palliativmedizin um knapp 20% erreicht werden. 72,2% des Kollektivs nahmen in unserer Studie palliativmedizinische Angebote in Anspruch, 2011 waren dies 56,6%.
Der Anteil an Patienten mit Erstkontakt ≤ 3 Tage vor dem Tod reduzierte sich um 15% (23,5% vs. 8,9%).
Eine signifikante Erhöhung an dokumentierten Patientenverfügungen wurde nicht verzeichnet (19,6% vs. 26,6%).
Ebenso fand kein Rückgang an tumorspezifischen Therapiemaßnahmen in den letzten 14 Lebenstagen statt. Hier kam es im Vergleich zum Jahr 2011 zu einer leichten Steigerung um 3% (24,5% vs. 27,8%). Die Ursache scheint in der Zunahme an Patienten mit einer zielgerichteten Therapie zu liegen.
Der Vergleich beider Studien ergab, dass eine Verbesserung der Versorgungsqualität von Tumorpatienten am Lebensende durch die Screening gestützte palliativmedizinische Mitbetreuung in Teilpunkten erreicht werden konnte.
Unsere Ergebnisse zeigen aber auch auf, dass es im Vergleich zur Kohorte des Jahres 2011 weiterhin zu einer Überversorgung am Lebensende bei Tumorpatienten kam. Deutlich wird dies im Hinblick auf die Konstanz bzw. leichte Zunahme an tumorspezifischer Therapie in den letzten 14 Lebenstagen. Vor allem neue Therapieansätze und Medikamente bei der zielgerichteten Therapie scheinen einen Rückgang zu verhindern.
Es ist daher entscheidend, die Palliativmedizin möglichst frühzeitig in die Behandlung von Krebspatienten miteinzubeziehen, um so überambitionierte Therapiemaßnahmen am Lebensende zu unterbinden und rückläufige Prozentzahlen bei dem QI „Durchführen einer tumorspezifischen Therapie in den letzten 14 Lebenstagen“ zu erhalten.
Ob die Screening-gestützte palliativmedizinische Mitbetreuung eine Möglichkeit dafür darstellen könnte, konnte mit unserer Studie nicht eindeutig geklärt werden. Es sind weitere Studien bezüglich dieser Thematik nötig.
It is the aim of this thesis to present a visual body weight estimation, which is suitable for medical applications. A typical scenario where the estimation of the body weight is essential, is the emergency treatment of stroke patients: In case of an ischemic stroke, the patient has to receive a body weight adapted drug, to solve a blood clot in a vessel. The accuracy of the estimated weight influences the outcome of the therapy directly. However, the treatment has to start as early as possible after the arrival at a trauma room, to provide sufficient treatment. Weighing a patient takes time, and the patient has to be moved. Furthermore, patients are often not able to communicate a value for their body weight due to their stroke symptoms. Therefore, it is state of the art that physicians guess the body weight. A patient receiving a too low dose has an increased risk that the blood clot does not dissolve and brain tissue is permanently damaged. Today, about one-third gets an insufficient dosage. In contrast to that, an overdose can cause bleedings and further complications. Physicians are aware of this issue, but a reliable alternative is missing.
The thesis presents state-of-the-art principles and devices for the measurement and estimation of body weight in the context of medical applications. While scales are common and available at a hospital, the process of weighing takes too long and can hardly be integrated into the process of stroke treatment. Sensor systems and algorithms are presented in the section for related work and provide an overview of different approaches.
The here presented system -- called Libra3D -- consists of a computer installed in a real trauma room, as well as visual sensors integrated into the ceiling. For the estimation of the body weight, the patient is on a stretcher which is placed in the field of view of the sensors. The three sensors -- two RGB-D and a thermal camera -- are calibrated intrinsically and extrinsically. Also, algorithms for sensor fusion are presented to align the data from all sensors which is the base for a reliable segmentation of the patient.
A combination of state-of-the-art image and point cloud algorithms is used to localize the patient on the stretcher. The challenges in the scenario with the patient on the bed is the dynamic environment, including other people or medical devices in the field of view.
After the successful segmentation, a set of hand-crafted features is extracted from the patient's point cloud. These features rely on geometric and statistical values and provide a robust input to a subsequent machine learning approach. The final estimation is done with a previously trained artificial neural network.
The experiment section offers different configurations of the previously extracted feature vector. Additionally, the here presented approach is compared to state-of-the-art methods; the patient's own assessment, the physician's guess, and an anthropometric estimation. Besides the patient's own estimation, Libra3D outperforms all state-of-the-art estimation methods: 95 percent of all patients are estimated with a relative error of less than 10 percent to ground truth body weight. It takes only a minimal amount of time for the measurement, and the approach can easily be integrated into the treatment of stroke patients, while physicians are not hindered.
Furthermore, the section for experiments demonstrates two additional applications: The extracted features can also be used to estimate the body weight of people standing, or even walking in front of a 3D camera. Also, it is possible to determine or classify the BMI of a subject on a stretcher. A potential application for this approach is the reduction of the radiation dose of patients being exposed to X-rays during a CT examination.
During the time of this thesis, several data sets were recorded. These data sets contain the ground truth body weight, as well as the data from the sensors. They are available for the collaboration in the field of body weight estimation for medical applications.
Previous research showed that full body ownership illusions in virtual reality (VR) can be robustly induced by providing congruent visual stimulation, and that congruent tactile experiences provide a dispensable extension to an already established phenomenon. Here we show that visuo-tactile congruency indeed does not add to already high measures for body ownership on explicit measures, but does modulate movement behavior when walking in the laboratory. Specifically, participants who took ownership over a more corpulent virtual body with intact visuo-tactile congruency increased safety distances towards the laboratory's walls compared to participants who experienced the same illusion with deteriorated visuo-tactile congruency. This effect is in line with the body schema more readily adapting to a more corpulent body after receiving congruent tactile information. We conclude that the action-oriented, unconscious body schema relies more heavily on tactile information compared to more explicit aspects of body ownership.
In contrast to the plasma membrane, the vacuole membrane has not yet been associated with electrical excitation of plants. Here, we show that mesophyll vacuoles from Arabidopsis sense and control the membrane potential essentially via the K\(^+\)-permeable TPC1 and TPK channels. Electrical stimuli elicit transient depolarization of the vacuole membrane that can last for seconds. Electrical excitability is suppressed by increased vacuolar Ca\(^{2+}\) levels. In comparison to wild type, vacuoles from the fou2 mutant, harboring TPC1 channels insensitive to luminal Ca\(^{2+}\), can be excited fully by even weak electrical stimuli. The TPC1-loss-of-function mutant tpc1-2 does not respond to electrical stimulation at all, and the loss of TPK1/TPK3-mediated K\(^{+}\) transport affects the duration of TPC1-dependent membrane depolarization. In combination with mathematical modeling, these results show that the vacuolar K\(^+\)-conducting TPC1 and TPK1/TPK3 channels act in concert to provide for Ca\(^{2+}\)- and voltage-induced electrical excitability to the central organelle of plant cells.
Climate warming has the potential to disrupt plant-pollinator interactions or to increase competition of co-flowering plants for pollinators, due to species-specific phenological responses to temperature. However, studies focusing on the effect of temperature on solitary bee emergence and the flowering onset of their food plants under natural conditions are still rare. We studied the effect of temperature on the phenology of the two spring bees Osmia cornuta and Osmia bicornis, by placing bee cocoons on eleven grasslands differing in mean site temperature. On seven grasslands, we additionally studied the effect of temperature on the phenology of the red-list plant Pulsatilla vulgaris, which was the first flowering plant, and of co-flowering plants with later flowering. With a warming of 0.1°C, the abundance-weighted mean emergence of O. cornuta males advanced by 0.4 days. Females of both species did not shift their emergence. Warmer temperatures advanced the abundance-weighted mean flowering of P. vulgaris by 1.3 days per 0.1°C increase, but did not shift flowering onset of co-flowering plants. Competition for pollinators between P. vulgaris and co-flowering plants does not increase within the studied temperature range. We demonstrate that temperature advances plant flowering more strongly than bee emergence suggesting an increased risk of pollinator limitation for the first flowers of P. vulgaris.
Summary
Introduction. Rapid and uncontrolled industrialisation and urbanisation in most developing countries are resulting in land, air and water pollution at rates that the natural environment cannot fully renew. These contemporary environmental issues have attracted local, national and international attention. The problem of urban garbage management is associated with rapid population growth in developing countries. These are pertinent environmental crises of sustainability and sanitation in Sub-Saharan Africa and other Third World countries. Despite efforts of the various tiers of government (the case of Nigeria with three tiers: Federal, State and Local governments) in managing solid waste in urban centres, it is still overflowing open dumpsites, litters streets and encroaches into water bodies. These affect the quality of urban living conditions and the natural environment.
Sub-Saharan and other developing countries are experiencing an upsurge in the accumulation and the diversity of waste including E-waste, waste agricultural biomass and waste plastics. The need for effective, sustainable and efficient management of waste through the application of 3Rs principle (Reduce, Reuse, and Recycle) is an essential element for promoting sustainable patterns of consumption and production. This study examined waste management in Imo State, Nigeria as an aspect correlated to the sustainability of its environment.
Materials and methods. To analyse waste management as a correlate of environmental sustainability in Sub-Saharan Africa, Imo State, in eastern Nigeria was chosen as a study area. Issues about waste handling and its impact on the environment in Imo have been reported since its creation in 1976; passing through the State with the cleanest State capital in 1980 to a ‘dunghill’ in 2013 and a ‘garbage capital’ on October 1, 2016. Within this State, three study sites were selected – Owerri metropolis (the State capital) Orlu and Okigwe towns. At these sites, households, commercial areas, accommodation and recreational establishments and schools, as well as dumpsites were investigated to ascertain the composition, quantity, distribution, handling patterns of waste in relation to the sustainability of the State’s environment. This was done conveniently but randomly through questionnaires, interviews, focus group discussions and non-participant observation; these were all heralded by a detailed deskwork. Data were entered using Microsoft Office Excel and were explored and analysed using the Statistical Package for Social Sciences - SPSS.
Data were made essentially of categorical variables and were analysed using descriptive statistics. The association between categorical variables was measured using Cramer’s V the Chi-Square that makes the power and the reliability of the test. Cramer’s V is a measure of association tests directly integrated with cross-tabulation. The Chi-Square test of equal proportions was used to compare proportions for significant differences at 0.05 levels. The statistical package - the Epi Info 6.04d was also used since a contingency table had to be created from several sub-outputs and determine the extent of association between the row and column categories.
The scale variable ‘quantity of waste generated’ was described using measures of central tendency. It was screened for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests for normality; in all context, the normality assumption was violated (P<0.05). Five null hypotheses were tested using Logistic Regression model. The explanatory power of individual conceptual component was calculated using the Cox & Snell R2 and that of individual indicators was also appraised using the Likelihood Ratio test.
In the context of this work, the significance of the variability explained by the model (baseline model) was appraised using the Omnibus Tests of Model Coefficients, the magnitude of this variability explained by the model using the Cox & Snell R2 and the effects of individual predictors using the Likelihood Ratio test.
Qualitatively, data from open-ended items, observations and interviews were analysed using the process of thematic analysis whereby concepts or ideas were grouped under umbrella terms or keywords. The results were presented using tables, charts, graphs, photos and maps.
Findings and discussions. The total findings and analyses indicated that proper waste handling in Imo State, Nigeria has a positive impact on the environment. This was assessed by the community’s awareness of waste management via sources like the radio and the TV, their education on waste management and schools’ integration of environmental education in their program. Although most community members perceived the State’s environment as compared to it about 10 years’ back has worsened, where they were conscious of proper waste handling measures, the environment was described to be better. This influence of environmental awareness and education on environmental sustainability appraised using Logistic Regression Model, portrayed a significant variability (Omnibus Tests of Model Coefficients: χ2=42.742; P=0.014), inferring that environmental awareness and education significantly predict environmental sustainability.
The findings also revealed that organic waste generation spearheaded amongst other waste types like paper, plastic, E-waste, metal, textile and glass. While waste pickers always sorted paper, plastics, aluminium and metal, some of them also sorted out textile and glass. Statistically (P<0.05), in situations where waste was least generated (i.e., 1-2kg per day), community members maintained that the environmental quality was better in comparison to 10 years’ back. Waste items like broken glass and textile as well as the remains of E-waste after the extraction of copper and brass were not sorted for and these contributed more to environmental degradation.
Similarly, the influence of wealth on environmental sustainability was appraised using Logistic Regression Model including development index related indicators like education, occupation, income and the ability to pay for waste disposal. Harmonising the outcome, farmers, who were mostly the least educated claimed to notice more environmental improvement. In addition, those who did not agree to pay for waste disposal who were mostly those with low income (less than 200,000 Naira, i.e. about 620 Euros monthly) perceived environmental improvement more than those with income above 200,000 Naira. This irony can be attributed to the fact that those with low educational backing lack the capacity to appreciate environmental sustainability pointers well as compared to those with a broader educational background with critical thinking.
The employment and poverty reduction opportunities pertaining to waste management on environmental sustainability was appraised using qualitative thematic analysis. All community members involved in sorting, buying and selling of waste items had no second job. They attested that the money earned from their activities sustained their livelihood and families. Some expressed love for the job, especially as they were their own masters. Waste picking and trading in waste items are offering employment opportunities to many communities around the world. For instance, in the waste recycling, waste composting, waste-to-energy plants and die Stadtreiniger in Würzburg city. The workers in these enterprises have jobs as a result of waste.
Waste disposal influence on environmental sustainability was appraised using the Binary Logistic Regression Model and the variability explained by the model was significant. The validity was also supported by the Wald statistics (P<0.05), which indicates the effect of the predictors is significant. Environmental sustainability was greatly reliant on indicators like the frequency at which community members emptied their waste containers; how/where waste is disposed of, availability of disposal site or public bin near the house, etc. Imolites who asserted to have public waste bins or disposal sites near their houses maintained that the quality of the State’s environment had worsened as such containers/disposal sites were always stinking as well as had animals and smoke around them. Imolites around disposal sites complained of traits like diarrhoea, catarrh, insect bites, malaria, smoke and polluted air.
Conclusions. The liaison between poor waste management strategies and the sustainability of the Imo State environment was considered likely as statistically significant ineffectiveness, lack of awareness, poverty, insufficient and unrealistic waste management measures were found in this study area. In these situations, the environment was said to have not improved. Such inadequacies in the handling of generated waste did not only expose the citizenry to health dangers but also gave rise to streets and roads characterized by filth and many unattended disposal sites unleashing horrible odour to the environment and attracting wild animals. This situation is not only prevalent in Imo State, Nigeria but in many Sub-Saharan cities.
Future Perspectives. To improve the environment in Sub-Saharan Africa, it is imperative to practice an inclusive and integrated sustainable waste management system. The waste quantity in this region is fast growing, especially food/organic waste. The region should aim at waste management laws and waste reduction strategies, which will help save and produce more food that it really needs. Waste management should be dissociated from epidemic outbreaks like cholera, typhoid, Lassa fever and malaria, whose vectors thrive in filthy environments. Water channels and water bodies should not be waste disposal channels or waste disposal sites.
A series of photoactivatable CO‐releasing molecules (PhotoCORMs) was prepared from manganese pentacarbonyl bromide and 1H‐benzimidazol‐2‐ylmethyl‐(N‐phenyl)amine ligands (L) bearing different electron‐donating and electron‐withdrawing groups R = H, 4‐CH\(_3\), 4‐OCH\(_3\), 4‐Cl, 4‐NO\(_2\), 2‐, 3‐, and 4‐COOCH\(_3\) on the phenyl substituent to give octahedral manganese(I) complexes of the general formula [MnBr(CO)\(_3\)(L)]. Aerated DMSO solutions of the compounds are stable in the dark for 16 h with no CO release. However, the compounds rapidly release CO upon illumination at 412–525 nm, depending on the substitution pattern. Its influence on the photophysical and photochemical properties was systematically explored using UV/Vis spectroscopy and CO release measurements with a commercial gas sensor system. In the nitro‐substituted compound, the electronically excited state switched from benzimidazole‐ to phenyl‐centered, leading to a markedly different photochemical behavior of this visible‐light activated PhotoCORM.