Building a high-resolution site index map using boosted regression trees: The Norwegian case

Accurate estimation of site productivity is essential for forest projections and scenario modelling. We present and evaluate models to predict site index (SI) and whether a site is productive (potential total stem volume production ≥ 1 m3·ha−1·year−1) in a wall-to-wall high-resolution (16 m × 16 m) SI map for Norway. We investigate whether remotely sensed data improve predictions. We also study the advantages and disadvantages of using boosted regression trees (BRT), a machine-learning algorithm, to create high-accuracy SI maps. We use climatic and topographical data, soil parent material, a land resource map, and depth to water, together with Sentinel-2 satellite images and airborne laser scanning metrics, as predictor variables. We use the SI observed at more than 10 000 National Forest Inventory (NFI) sample plots throughout Norway to fit BRT models and validate the models using 5822 independent temporary plots from the NFI. We benchmark our results against SI estimates from forest monitoring inventories. We find that the SI from BRT has root mean squared error (RMSE) ranging from 2.3 m (hardwoods) to 3.6 m (spruce) when tested against independent validation data from the NFI temporary plots. These RMSEs are similar or marginally better than an evaluation of SI estimates from operational forest management plans where SI normally stems from manual photo interpretation.publishedVersio

A century of national forest inventories - informing past, present and future decisions

In 2019, 100 years had elapsed since the first National Forest Inventory (NFI) was established in Norway. Motivated by a fear of over-exploitation of timber resources, NFIs today enable informed policy making by providing data vital to decision support at international, national, regional, and local scales. This Collection of articles celebrates the 100th anniversary of NFIs with a description of past, present, and future research aiming at improving the monitoring of forest and other terrestrial ecosystems.Non peer reviewe

Modeling soil carbon dynamics in northern forests: effects of spatial and temporal aggregation of climatic input data

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Framskrivninger for arealbrukssektoren – under FNs klimakonvensjon, Kyotoprotokollen og EUs rammeverk

I denne rapporten presenteres framskrivninger for opptak og utslipp fra arealbrukssektoren (eng. Land Use, Land-Use Change and Forestry; LULUCF) frem til 2100. Framskrivninger av opptak og utslipp av CO2 og andre klimagasser fra arealbrukssektoren er utført i tråd med metodikken brukt i klimagassregnskapet for Norge i 2019 (Miljødirektoratet mfl. 2019), og basert på data rapportert for 2010 – 2017 som referanseperiode. Framskrivningen for opptak og utslipp i skog er basert på tilsvarende metodikk som i referansebanen for forvaltede skogarealer (eng. Forest Reference Level, FRL), som publisert i National Forest Accounting Plan (Klima- og miljødepartementet 2019), men basert på nyeste tilgjengelige data og med implementert politikk. Framskrivningene er utført basert på rapporteringen under FNs klimakonvensjon og Kyotoprotokollen, samt EUs LULUCF-forordning.publishedVersio

PRO B: evaluating the effect of an alarm-based patient-reported outcome monitoring compared with usual care in metastatic breast cancer patients—study protocol for a randomised controlled trial

Background: Despite the progress of research and treatment for breast cancer, still up to 30% of the patients afflicted will develop distant disease. Elongation of survival and maintaining the quality of life (QoL) become pivotal issues guiding the treatment decisions. One possible approach to optimise survival and QoL is the use of patient-reported outcomes (PROs) to timely identify acute disease-related burden. We present the protocol of a trial that investigates the effect of real-time PRO data captured with electronic mobile devices on QoL in female breast cancer patients with metastatic disease. Methods: This study is a randomised, controlled trial with 1:1 randomisation between two arms. A total of 1000 patients will be recruited in 40 selected breast cancer centres. Patients in the intervention arm receive a weekly request via an app to complete the PRO survey. Symptoms will be assessed by study-specific optimised short forms based on the EORTC QLQ-C30 domains using items from the EORTC CAT item banks. In case of deteriorating PRO scores, an alarm is sent to the treating study centre as well as to the PRO B study office. Following the alarm, the treating breast cancer centre is required to contact the patient to inquire about the reported symptoms and to intervene, if necessary. The intervention is not specified and depends on the clinical need determined by the treating physician. Patients in the control arm are prompted by the app every 3 months to participate in the PRO survey, but their response will not trigger an alarm. The primary outcome is the fatigue level 6 months after enrolment. Secondary endpoints include among others hospitalisations, use of rescue services and overall QoL. Discussion: Within the PRO B intervention group, we expect lower fatigue levels 6 months after intervention start, higher levels of QoL, less unplanned hospitalisations and less emergency room visits compared to controls. In case of positive results, our approach would allow a fast and easy transfer into clinical practice due to the use of the already nationwide existing IT infrastructure of the German Cancer Society and the independent certification institute OnkoZert

Clinicians' knowledge and attitudes towards patient reported outcomes in colorectal cancer care - insights from qualitative interviews

IntroductionPatient-reported outcomes (PROs) can be used in cancer care to monitor patients' disease-related symptoms and functional status. However, successful implementation of such instruments is only possible if clinical staff are convinced of the clinical benefits. It is therefore crucial to investigate the attitudes of clinical staff to PROs in routine cancer care.MethodsSemi-structured, guideline-based interviews were held with 12 clinicians working in certified colorectal cancer centers in Germany who are taking part in an observational study on PROs (five surgeons, two oncologists, one psycho-oncologist, two oncological care nurses, one stoma therapist, and one physician assistant) in order to investigate firstly, how clinicians describe PRO instruments (wording); and secondly, the clinicians' general attitude toward PROs. A qualitative content analysis according to Kuckartz was performed.ResultsThe wording used to describe PROs was not consistent. Statements on attitudes toward PROs were very heterogeneous and were therefore categorized into (rather) positive and (rather) negative. The principal advantages of PROs mentioned by participants included broader, structured knowledge about patients and treatment, as well as relevance for patients. Subcategories for (rather) negative attitudes included statements expressing doubts about the questionnaires and no need for PROs.DiscussionThe clinicians participating mainly expressed fairly positive attitudes toward PROs. However, they had little knowledge about PROs in general and the interviews therefore mainly reflect their expectations and assumptions about them. These initial impressions may be regarded as providing a basis for future implementation strategies and for training of clinicians on how to use PROs in routine cancer care

Different Approaches for Case-Mix Adjustment of Patient-Reported Outcomes to Compare Healthcare Providers-Methodological Results of a Systematic Review

Simple Summary Patient-reported outcomes need to be reported with case-mix adjustment in order to allow fair comparison between healthcare providers. This systematic review identified different approaches to case-mix adjustment, with wide variation between the various approaches. Patient-reported outcomes (PROs) are increasingly being used to compare the quality of outcomes between different healthcare providers (medical practices, hospitals, rehabilitation facilities). However, such comparisons can only be fair if differences in the case-mix between different types of provider are taken into account. This can be achieved with adequate statistical case-mix adjustment (CMA). To date, there is a lack of overview studies on current CMA methods for PROs. The aim of this study was to investigate which approaches are currently used to report and examine PROs for case-mix-adjusted comparison between providers. A systematic MEDLINE literature search was conducted (February 2021). The results were examined by two reviewers. Articles were included if they compared (a) different healthcare providers using (b) case-mix-adjusted (c) patient-reported outcomes (all AND conditions). From 640 hits obtained, 11 articles were included in the analysis. A wide variety of patient characteristics were used as adjustors, and baseline PRO scores and basic sociodemographic and clinical information were included in all models. Overall, the adjustment models used vary considerably. This evaluation is an initial attempt to systematically investigate different CMA approaches for PROs. As a standardized approach has not yet been established, we suggest creating a consensus-based methodological guideline for case-mix adjustment of PROs

Cancer rehabilitation support by cancer counselling centres (CARES): study protocol of a quasi-experimental feasibility study

Introduction While maintaining or restoring work ability after a cancer diagnosis is an essential aim of the rehabilitation process for working-age patients, problems can arise during the return to work (RTW) or when retaining work. Counselling could provide support for patients with or after cancer with employment-related questions (eg, questions related to RTW and work retention). Outpatient psychosocial cancer counselling centres in Germany offer counselling on work-related questions; however, resources for this are limited. This protocol presents a feasibility study of an intensified needs-based counselling intervention that supports those seeking employment-related advice.Methods and analysis The CARES (cancer rehabilitation support by cancer counselling centres) project is a feasibility study for a newly developed counselling intervention. The intervention is being developed as part of the project and piloted in about 20 outpatient cancer counselling centres. The CARES study has a quasi-experimental pre–post design with a control cohort. First, patients who undergo regular counselling are recruited. Second, after the counsellors have been trained for the newly developed intervention, participants for the intervention group are recruited from the cancer counselling centres. Quantitative and formative evaluations will be performed in accordance with the existing guidelines. The quantitative evaluation comprises three patient surveys (at the beginning of the counselling process, 3 months into the counselling process and, for the intervention group, at the end of the counselling process) and routine data of the counselling process. The formative evaluation includes interviews with patients, counsellors and other stakeholders, as well as participatory observations of counselling sessions.Ethics and dissemination Approval has been obtained from the ethics committee of the Medical Faculty of the University Bonn (061/22; 09.04.2022). A data protection concept ensures adherence to data protection regulations for the handled data. The dissemination strategies include discussing the results with the cancer counselling centres.Trial registration number German Clinical Trials Register (DRKS00028121); Pre-results

Prevalence and determinants of anxiety and depression in long-term breast cancer survivors

Background There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. Methods Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. Results Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. Conclusions Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed

Individual courses and determinants of fear of cancer recurrence in long-term breast cancer survivors with and without recurrence

Objective This study investigated the prevalence, individual courses, and determinants of fear of cancer recurrence (FoR) in long-term breast cancer survivors (BCSs) with and without recurrence. Methods A total of 184 breast cancer survivors were surveyed at four measurement time points: during hospitalization (T1), 10 weeks (T2), 40 weeks (T3), and 5-6 years (T4) after hospital discharge. Descriptive statistics, chi-square tests, and logistic regression were performed. Results Respondents were females and 57 years old, on average. At T1, T3, and T4, 54.8%, 31.6%, and 29.7% of BCSs, respectively, were classified as having dysfunctional levels of FoR. Dysfunctional FoR decreased from T1 to T3 (chi(2)(1) = 17.11, p = 0.000; N = 163) and remained stable afterwards. Eight subgroups of individual courses of FoR over time could be described: (1) constant functional FoR; (2) constant dysfunctional FoR; (3) improving from dysfunctional to functional FoR from T1 to T3; (4) improving from dysfunctional to functional FoR from T3 to T4; (5) worsening from functional to dysfunctional FoR from T1 to T3; (6) worsening from functional to dysfunctional FoR from T3 to T4; (7) dysfunctional FoR at T1 and T4, and functional FoR in between; and (8) functional FoR at T1 and T4, and dysfunctional FoR in between. Logistic regression analysis revealed that being divorced/widowed, showing high levels of fatigue, being treated by chemotherapy, and having low confidence in treatment were associated with dysfunctional FoR 5 to 6 years after diagnosis (Nagelkerkes' Pseudo-R2 = 0.648). Conclusions The findings reveal that FoR is a significant issue in long-term BCSs and has the potential to become a persistent psychological strain. We emphasize the need for increased awareness of FoR among BCSs and the need for support programs