Fertility preservation in female cancer patients : psychological impact and introduction of an online decision aid

The aim of the research project presented with this cumulative dissertation was to get a deeper insight into psychological aspects of young female cancer patients concerning fertility preservation (FP) and the development of an online decision aid (DA). A mixed-method approach was applied to the first part of the research project with an online survey and focus groups. Objectives were to assess the significance of fertility and fertility-related knowledge in these patients, their attitude towards FP, their decisional conflict and helpful support tools. Article 1 “Knowledge about and attitude towards fertility preservation in young female cancer patients: a cross-sectional, binational survey” and article 2 “Young female cancer patients’ decisional conflict about fertility preservation – results of an online survey” comprise results of the online survey about fertility issues, which was completed by 155 former female cancer patients from German and English speaking countries. Summarizing the findings, knowledge about FP was limited but positive attitudes towards FP significantly outweighed negative attitudes. Decisional conflict was considerable, especially with regard to missing information and support. However, decisional conflict was significantly lower in patients who discussed the risk of infertility with a health professional, who underwent a FP procedure and in patients who had a university level education. To enrich these quantitative data, four focus groups with 12 female cancer survivors were conducted, which are described in article 3 “Decision-making about fertility preservation – qualitative data on young cancer patients’ attitudes and needs”. Results confirmed previously gained data. The significance of fertility was high and attitude towards FP positive. Religious and ethical reservations were not negligible. Patients wished for more support and specific tools would be appreciated. These results lead to the conclusion that greater emphasis should be placed on counselling opportunities as well as on the provision of adequate information and supporting material. It is hypothesized that this may be a possible strategy to lower decisional conflict and improve fertility-related knowledge. Therefore, as second part of the research project, we developed an online DA for female cancer patients concerning their decision whether to opt for FP or not. Article 4 “Fertility preservation in young female cancer patients – development and pilot testing of an online decision aid” describes the development of the DA and the pilot study, which was conducted to get first data on the effectiveness and acceptability of the DA. The study was a prospective consecutive study with 40 female cancer patients. Data showed that the DA was considered helpful for decision-making and recommendable by nearly all participants. Knowledge about FP was high regarding FP techniques women went for. Mean decisional conflict was moderate whereas 20% showed scores above the threshold for high decisional conflict. A current randomized controlled trial is ongoing to confirm these data. Our research project has demonstrated that distress and burden due to the decision making process is considerable. Therefore, a deeper insight into psychological aspects of patients who have to make their decisions on FP is an important goal for research aiming to provide support in this challenging situation. In order to allow patients to make an informed choice, referring patients to fertility counselling is inevitable. The here presented DA enriches existing health service offers for young cancer patients by providing additional support for patients as well as professionals

Prescription strength ibuprofen interferes with prophylactic adaptations to heavy exercise

Purpose: This proof of concept study was designed to assess the influence of prescription-strength Ibuprofen (IBU) on the repeated bout effect (RBE) of heavy exercise. METHODS: Eight males (23 ± 4 yrs) with no recent history of lower-body resistance training completed two separate testing phases separated by a seven-day washout period. Each phase consisted of two sessions of single-legged resistance exercise (RE), performed on the same leg, separated by ten days. One RE trial included 10 sets of 10 repetitions of maximal unilateral eccentric leg extensions at 120% 1RM. Each phase was characterized by a distinct treatment of either 800mg IBU or placebo (PLA), which subjects consumed 45 minutes prior to RE and in 8h increments for 72h. A randomly counterbalanced, crossover design was utilized so each subject received both treatments. Muscle recovery variables (soreness, muscle function, plasma creatine kinase) were measured 24 and 72 hours following each RE session. Magnitude-based inferences were used to evaluate all outcomes. RESULTS: The increase in ascending and descending muscle soreness 24h after the second session of RE (RE2) was ‘likely’ less with PLA compared to IBU. Specifically, the reduction in ascending muscle soreness with PLA (RE1: 43mm to RE2: 27mm) was absent with IBU (RE1: 39mm to RE2: 39mm). A similar response was observed for descending muscle soreness. Furthermore, the impairment in total work performed 72h after RE2 was ‘likely’ attenuated with PLA (RE1: 598J to RE2: 13.1J), but not IBU (RE1: 335.1J to RE2: 343J). Decreases in work performed in the first five reps followed a similar pattern. Finally, the impact of IBU on all muscle strength and CK measurements were ‘unclear’. CONCLUSIONS: In general, IBU consumption appeared to interfere with the RBE, compared to PLA. Follow-up work is needed to confirm these findings but these preliminary data suggest that prescription-strength dosing of IBU following skeletal muscle trauma may need to be reconsidered

Körperliche Aktivität bei Patienten in stationärer psychiatrischer Behandlung

Ausgangslage: Psychische Erkrankungen stehen in Verbindung mit verminderter körperlicher Aktivität und somit mit einem überdurchschnittlichen kardiovaskulären Risiko (Martin et al., 2001). Obwohl die breiten gesundheitsfördernden Wirkungen von körperlicher Aktivität seit längerem diskutiert werden und der Bevölkerung bekannt sind, scheint die Nutzung der Angebote im psychiatrischen Setting spärlich. Die vorliegende Arbeit untersucht, ob die Teilnahme an Sport- und Trainingsprogrammen im Rahmen einer stationären psychiatrischen Behandlung einen Beitrag zur Vorhersage der Erreichung der Bewegungsempfehlungen gemäss CDC leisten kann. Methode: Das Bewegungsverhalten von insgesamt 116 Patienten mit einer psychischen Störung gemäss ICD-10 wurde während einer Woche objektiv unter Verwendung eines Akzelerometer-Geräts untersucht. Zudem wurde das Bewegungsverhalten der Probanden subjektiv durch einen Fragebogen (SIMPAQ) sowohl zu Beginn der Studie als auch am Ende der Studie erfasst. Die Schwere der Depression wurde via Beck-Depression-Inventar (BDI) bestimmt und die kognitive Leistungsfähigkeit durch den Montreal Cognitive Assessment Test (MOCA) eruiert. Mittels binären logistischen Regressionsanalysen (logistic regression) wurde berechnet, inwiefern die Teilnahme an Sport- und Trainingsprogrammen im Rahmen einer stationären psychiatrischen Behandlung einen Beitrag zur Vorhersage des Erreichens der Bewegungsempfehlungen gemäss CDC leisten kann. Resultate: Es konnte ein signifikanter Zusammenhang zwischen der Teilnahme an den Sport- und Trainingsprogrammen sowie der Erreichung der Bewegungsempfehlungen gemäss CDC festgestellt werden (p= 0.025). Schlussfolgerung: Patienten welche ≥60 Minuten pro Woche körperliche Aktivität in Form von Sport- und Trainingsprogrammen oder in Form von selbst betriebener körperlicher Aktivität ausüben, weisen eine grössere Chance auf, die Bewegungsempfehlungen gemäss CDC zu erreichen, als Personen, die sich weniger als 60 Minuten pro Woche bewegen

Ethologic and Economic Examination of Aviary Housing for Commercial Laying Flocks

The authors report that the results of their research indicate that appropriate housing is necessary for intensively kept hens and that the housing has to correspond to the vital needs and natures of the animals

Reduction of patient specific quality assurance through plan complexity metrics for VMAT plans with an open-source TPS script

PURPOSE Volumetric modulated arc therapy (VMAT) is a widespread technique for the delivery of normo-fractionated radiation therapy (NFRT) and stereotactic body radiation therapy (SBRT). It is associated with a significant hardware burden requiring dose rate modulation, collimator movement and gantry rotation synchronisation. Patient specific quality assurance (PSQA) guarantees that the linacs can precisely and accurately deliver the planned dose. However, PSQA requires a significant time allocation and class solutions to reduce this while guaranteeing the deliverability of the plans should be investigated. METHODS In this study, an in-house developed Eclipse Scripting API (ESAPI) script was used to extract five independent plan complexity metrics from N = 667 VMAT treatment fields. The correlation between metrics and portal dosimetry measurements was investigated with Pearson correlation, box plot analysis and receiver operating characteristic curves, which were used to defined the best performing metric and its threshold. RESULTS The incidence of fields failing the clinical PSQA criteria of 3%/2mm (NFRT) and 3%/1.5mm (SBRT) was low (N = 1). The mean MLC opening was the metric with the highest correlation with the portal dosimetry data and among the best in discriminating the requirement of PSQA. The thresholds of 16.12 mm (NFRT) and 7.96 mm (SBRT) corresponded to true positive rates higher than 90%. CONCLUSIONS This work presents a quantitative approach to reduce the time allocation for PSQA by identifying the most complex plans demanding a dedicated measurement. The proposed method requires PSQA for approximately 10% of the plans. The ESAPI script is distributed open-source to ease the investigation and implementation at other institutions

Inspired by Nature: Hydrogels as Versatile Tools for Vascular Engineering

Significance: Diseases related to vascular malfunction, hyper-vascularization, or lack of vascularization are among the leading causes of morbidity and mortality. Engineered, vascularized tissues as well as angiogenic growth factor-releasing hydrogels could replace defective tissues. Further, treatments and testing of novel vascular therapeutics will benefit significantly from models that allow for the study of vascularized tissues under physiological relevant in vitro conditions. Recent Advances: Inspired by fibrin, the provisional matrix during wound healing, naturally derived and synthetic hydrogel scaffolds have been developed for vascular engineering. Today, engineers and biologists use commercially available hydrogels to pre-vascularize tissues, to control the delivery of angiogenic growth factors, and to establish vascular diseases models. Critical Issue: For clinical translation, pre-vascularized tissue constructs must be sufficiently large and stable to substitute function-relevant tissue defects and integrate with host vascular perfusion. Moreover, the continuous integration of knowhow from basic vascular biology with innovative, tailorable materials and advanced manufacturing technologies is key to achieving near-physiological tissue models and new treatments to control vascularization. Future Directions: For transplantation, engineered tissues must comprise hierarchically organized vascular trees of different caliber and function. The development of novel vascularization-promoting or -inhibiting therapeutics will benefit from physiologically relevant vessel models. In addition, tissue models representing treatment-relevant vascular tissue functions will increase the capacity to screen for therapeutic compounds and will significantly reduce the need for animals for their validation

Ethologic and Economic Examination of Aviary Housing for Commercial Laying Flocks

The result of our work shows that appropriate housing is necessary for intensively kept hens and that the housing has to correspond to the vital needs and the nature of the animals. This is important for two reasons: a) the innate needs of the birds must be satisfied; b) for the proper development of the animal and successful egg production. The housing facilities should allow the following functional cycles without restrictions: Social organization: the structuring of a group or unit of animals. Locomotion: walking, running, fluttering, flying. Feeding behavior: search for food and water, food and water pecking, ground scratching, scraping. Comfort behavior: plumage care, stretching, dust bathing. Resting behavior: standing, sleeping. Sexual behavior: egg laying, nest building behavior. Each one of these functional cycles requires its own area in the hen house. The hen house has to be arranged in order to accommodate the needs of the animals

Latex on Glass: an Appropriate Model for Cartilage-Lubrication Studies?

Latex versus glass has frequently been used as a model system for the investigation of natural lubrication mechanisms, despite its significant differences from articular cartilage pairings. The differences in surface chemistry account for its different behavior in terms of protein adsorption and lubrication. While cartilage is well known for its protein resistance, most proteins present in synovial fluid can non-specifically adsorb onto latex or glass. We have investigated latex-versus-glass lubrication by means of pin-on-disk tribometry in the presence of synovial-fluid proteins and glycoproteins, focusing on the influence of the glass-cleaning procedure on friction. In order to simulate the effects of possible contamination of glass in previous studies, both hydrophilic and hydrophobic glass substrates were tested. Albumin was shown to impair lubrication (in comparison to PBS) when latex was slid against both types of glass surface, whereas bovine synovial fluid (BSF) and alpha-1-acid glycoprotein (AGP) impaired the lubrication of latex versus hydrophilic glass and improved the lubrication of latex versus hydrophobic glass. Protein adsorption on the surfaces was monitored by means of fluorescence imaging and optical waveguide lightmode spectroscopy (OWLS), which revealed a faster and greater amount of adsorption of AGP on hydrophobic surfaces than on hydrophilic ones. The influence of surface chemistry on the friction behavior of BSF and on the adsorption of AGP suggests that it plays a role in determining the relative amounts of adsorbed synovial fluid proteins. When BSF is used as a lubricant in the latex-versus-hydrophobic-glass system, more of the AGP, relative to albumin, appears to adsorb on both surfaces, counteracting the negative effect of albumin on friction. It therefore seems that latex on glass, while displaying nominal similarities to cartilage on cartilage under certain conditions, is not a useful model system. Moreover, surface contamination of the glass can play a major role in determining the result