Az alvás és a kimerültség vizsgálata daganatos betegek körében = Investigation of sleep and fatigue in patients with cancer

Absztrakt: Bevezetés: A rosszindulatú daganat diagnózisa nagyobb distresszel jár, mint bármely más diagnózis. A daganatos betegségek jelentős pszichés terheléssel járnak, az egészségügyi személyzet kapacitása pedig korlátozott. Ezért kiemelten fontos a hatékony pszichológiai szűrési eljárások kidolgozása. Az alvás alapvető jelentőségű a pszichés működésben, a rossz alvásminőség ismert probléma a daganatos betegek esetén. Célkitűzés: A kutatás célja az alvásminőséget és a kimerültséget mérő vizuális analóg skálák alkalmazhatóságának vizsgálata. Módszer: Vizuális analóg skálákon mértük az alvás minőségét és a kimerültséget. Vizsgálatunkban szerepelt még az Athén Insomnia Skála, a Daganatos Kimerültség Skála és az Alvási Kondíció Indikátor is. A pszichés distressz mértékét az Általános Szorongás Zavar Kérdőívvel, a Beck Depresszió Kérdőívvel és a Rövidített Érzelemszabályozási Nehézségek Kérdőívvel mértük fel. A betegek által tapasztalt fájdalom és jól-lét mértékét a Fájdalom Arcai Skálával és a WHO Jól-lét Kérdőívével vizsgáltuk. Összesen 71 daganatos beteg vett részt a vizsgálatban. Eredmények: Az alvásminőség és a kimerültség – a vizuális és a többtételes skálákkal mérve is – szignifikáns összefüggést mutatott a distresszel (szorongás, depresszió, érzelemszabályozási nehézség) és a fájdalommal. A distressz és a fájdalom szignifikánsan alacsonyabb jól-léttel mutatott összefüggést. Következtetések: A jelen vizsgálat megerősíti, hogy az alvás minősége fontos tényező a daganatos betegek distressz-, fájdalom- és általános jól-lét szintjének alakulásában. Ez alátámasztja, hogy az alvásminőséget és a kimerültséget mérő vizuális analóg skálák alkalmasak – az alvásminőségen és a kimerültségen túl – a pszichológiai distressz szűrésére és a jól-lét szintjének becslésére is. Alkalmazásuk ajánlható a klinikai gyakorlatban onkopszichológiai szűrésre, az onkopszichológiai ellátás indikációjának megállapítására. Orv Hetil. 2018; 159(42): 1720–1726. | Abstract: Introduction: The diagnosis of cancer elicits greater distress than any other diagnosis. The prevalence of psychological difficulties is high in cancer, and resources of the medical staff are limited. The development of efficient screening measures is therefore of utmost importance. Sleep is vital to all psychological functioning and poor sleep is a known problem in cancer. Aim: The main goal of the present study was testing of visual analogue scales assessing sleep quality and fatigue. Method: Sleep quality and fatigue were assessed with visual analogue scales. The Sleep Condition Indicator, the Athens Insomnia Scale and the Cancer Fatigue Scale were also included. Psychological distress was assessed with the Generalized Anxiety Disorder Scale, the Beck Depression Inventory and the Brief Difficulties in Emotion Regulation Scale. Pain and well-being was measured with the Faces of Pain Scale and the WHO Well-being Scale, respectively. A total of 71 patients with cancer were enrolled in this study. Results: Insomnia and fatigue – measuring them with visual and several-item scales – showed high correlation with the measures of distress (anxiety, depression, emotion regulation difficulties) and pain. Distress and pain showed significant negative correlation with well-being. Conclusions: It has been affirmed that sleep quality is crucial in the changes of distress, pain and general well-being in cancer patients. It affirms that the visual analogue scales assessing sleep quality and fatigue – besides sleep quality and fatigue – are acceptable screening tools of distress and decreased well-being. Their use in clinical practice is recommended for screening in cancer patients and providing indications for onco-psychological treatment. Orv Hetil. 2018; 159(42): 1720–1726

Cryogenic Liquid Hydrogen (LH2) system for Refueling an Airplane, and Use for other Mobile or Stationary Applications

Liquid hydrogen (LH2) is used for energy supply for various stationary and mobile applications. Current political and economic developments show the need of storable, decentralized produced, green energy to ensure supply of fuel, heat and power for an adequate price. Hydrogen can be part of the solution for those global problems. Especially LH2 is promising as fuel for mobile applications. It is advantageous because of the high energy density, and therefore is used for space applications since decades. Currently, there are many activities, to transfer the LH2 technology to other applications, e.g. aerospace and trucks

Prevalence, outcomes and costs of a contemporary, multinational population with heart failure.

OBJECTIVE Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries. METHODS Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years. RESULTS The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases. CONCLUSIONS We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management

Soil seed bank responses to edge effects in temperate European forests

Aim The amount of forest edges is increasing globally due to forest fragmentation and land-use changes. However, edge effects on the soil seed bank of temperate forests are still poorly understood. Here, we assessed edge effects at contrasting spatial scales across Europe and quantified the extent to which edges can preserve the seeds of forest specialist plants. Location Temperate European deciduous forests along a 2,300-km latitudinal gradient. Time period 2018-2021. Major taxa studied Vascular plants. Methods Through a greenhouse germination experiment, we studied how edge effects alter the density, diversity, composition and functionality of forest soil seed banks in 90 plots along different latitudes, elevations and forest management types. We also assessed which environmental conditions drive the seed bank responses at the forest edge versus interior and looked at the relationship between the seed bank and the herb layer species richness. Results Overall, 10,108 seedlings of 250 species emerged from the soil seed bank. Seed density and species richness of generalists (species not only associated with forests) were higher at edges compared to interiors, with a negative influence of C : N ratio and litter quality. Conversely, forest specialist species richness did not decline from the interior to the edge. Also, edges were compositionally, but not functionally, different from interiors. The correlation between the seed bank and the herb layer species richness was positive and affected by microclimate. Main conclusions Our results underpin how edge effects shape species diversity and composition of soil seed banks in ancient forests, especially increasing the proportion of generalist species and thus potentially favouring a shift in community composition. However, the presence of many forest specialists suggests that soil seed banks still play a key role in understorey species persistence and could support the resilience of our fragmented forests

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007