A digital global map of irrigated areas : an update for Asia

The Land and Water Development Division of the Food and Agriculture Organization of the United Nations and the Johann Wolfgang Goethe University, Frankfurt am Main, Germany, are cooperating in the development of a global irrigation-mapping facility. This report describes an update of the Digital Global Map of Irrigated Areas for the continent of Asia. For this update, an inventory of subnational irrigation statistics for the continent was compiled. The reference year for the statistics is 2000. Adding up the irrigated areas per country as documented in the report gives a total of 188.5 million ha for the entire continent. The total number of subnational units used in the inventory is 4 428. In order to distribute the irrigation statistics per subnational unit, digital spatial data layers and printed maps were used. Irrigation maps were derived from project reports, irrigation subsector studies, and books related to irrigation and drainage. These maps were digitized and compared with satellite images of many regions. In areas without spatial information on irrigated areas, additional information was used to locate areas where irrigation is likely, such as land-cover and land-use maps that indicate agricultural areas or areas with crops that are usually grown under irrigation. Contents 1. Working Report I: Generation of a map of administrative units compatible with statistics used to update the Digital Global Map of Irrigated Areas in Asia 2. Working Report II: The inventory of subnational irrigation statistics for the Asian part of the Digital Global Map of Irrigated Areas 3. Working Report III: Geospatial information used to locate irrigated areas within the subnational units in the Asian part of the Digital Global Map of Irrigated Areas 4. Working Report IV: Update of the Digital Global Map of Irrigated Areas in Asia, Results Map

A digital global map of artificially drained agricultural areas : documentation

Artificial drainage of agricultural land, for example with ditches or drainage tubes, is used to avoid water logging and to manage high groundwater tables. Among other impacts it influences the nutrient balances by increasing leaching losses and by decreasing denitrification. To simulate terrestrial transport of nitrogen on the global scale, a digital global map of artificially drained agricultural areas was developed. The map depicts the percentage of each 5’ by 5’ grid cell that is equipped for artificial drainage. Information on artificial drainage in countries or sub-national units was mainly derived from international inventories. Distribution to grid cells was based, for most countries, on the "Global Croplands Dataset" of Ramankutty et al. (1998) and the "Digital Global Map of Irrigation Areas" of Siebert et al. (2005). For some European countries the CORINE land cover dataset was used instead of the both datasets mentioned above. Maps with outlines of artificially drained areas were available for 6 countries. The global drainage area on the map is 167 Mio hectares. For only 11 out of the 116 countries with information on artificial drainage areas, sub-national information could be taken into account. Due to this coarse spatial resolution of the data sources, we recommended to use the map of artificially drained areas only for continental to global scale assessments. This documentation describes the dataset, the data sources and the map generation, and it discusses the data uncertainty.Landwirtschaftliche Drainagen, z.B. durch Gräben oder unterirdische Dränrohre, werden angewandt um hohe Grundwasserstände zu kontrollieren und damit einhergehende Vernässung und Versalzung des Bodens zu vermeiden. Neben anderen Faktoren beeinflussen Drainagen die Nährstoffbilanz durch Erhöhung der Stickstoffauswaschung sowie Veringerung von Denitrifikation. Um den terrestrischen Stickstofftransport simulieren zu können, wurde ein globaler Datensatz der landwirtschaftlichen Dränageflächen in einer Auflösung von 5' x 5' erstellt. Die Karte zeigt den Anteil der Zellflächen mit künstlicher Drainage. Daten zu Drainageflächen in Ländern sowie subnationalen Einheiten wurden mit globalen Datensätzen zur Verteilung der landwirtschaftlichen Flächen (Ramankutty et al., 1998) sowie zur Verteilung bewässerter Flächen (Siebert et al., 2005) kombiniert. Für 11 Länder konnten subnationale Statistiken zur Dränagefläche verwendet werden. Karten mit Umrissen der Dränageflächen standen für sechs Länder zur Verfügung. Insgesamt wurden global 167 Mio ha Fläche als landwirtschaftliche Dränageflächen ausgewiesen. Auf Grund der geringen Auflösung der Eingangsdaten wird die Verwendung des Datensatzes nur für globale oder kontinentale Studien empfohlen. Dieser Bericht beschreibt den Datensatz selbst, die Methodik zur Erzeugung des Datensatzes sowie die Informationsquellen und diskutiert die Unsicherheit

Development and validation of the global map of irrigation areas

A new version of a digital global map of irrigation areas was developed by combining irrigation statistics for 10 825 sub-national statistical units and geo-spatial information on the location and extent of irrigation schemes. The map shows the percentage of each 5 arc minute by 5 arc minute cell that was equipped for irrigation around the year 2000. It is thus an important data set for global studies related to water and land use. This paper describes the data set and the mapping methodology and gives, for the first time, an estimate of the map quality at the scale of countries, world regions and the globe. Two indicators of map quality were developed for this purpose, and the map was compared to irrigated areas as derived from two remote sensing based global land cover inventories

Physiologically based pharmacokinetic modeling of tacrolimus for food-drug and CYP3A drug-drug-gene interaction predictions

The immunosuppressant and narrow therapeutic index drug tacrolimus is metabolized mainly via cytochrome P450 (CYP) 3A4 and CYP3A5. For its pharmacokinetics (PK), high inter- and intra-individual variability can be observed. Underlying causes include the effect of food intake on tacrolimus absorption as well as genetic polymorphism in the CYP3A5 gene. Furthermore, tacrolimus is highly susceptible to drug–drug interactions, acting as a victim drug when coadministered with CYP3A perpetrators. This work describes the development of a whole-body physiologically based pharmacokinetic model for tacrolimus as well as its application for investigation and prediction of (i) the impact of food intake on tacrolimus PK (food–drug interactions [FDIs]) and (ii) drug–drug(−gene) interactions (DD[G]Is) involving the CYP3A perpetrator drugs voriconazole, itraconazole, and rifampicin. The model was built in PK-Sim® Version 10 using a total of 37 whole blood concentration–time profiles of tacrolimus (training and test) compiled from 911 healthy individuals covering the administration of tacrolimus as intravenous infusions as well as immediate-release and extended-release capsules. Metabolism was incorporated via CYP3A4 and CYP3A5, with varying activities implemented for different CYP3A5 genotypes and study populations. The good predictive model performance is demonstrated for the examined food effect studies with 6/6 predicted FDI area under the curve determined between first and last concentration measurements (AUClast) and 6/6 predicted FDI maximum whole blood concentration (Cmax) ratios within twofold of the respective observed ratios. In addition, 7/7 predicted DD(G)I AUClast and 6/7 predicted DD(G)I Cmax ratios were within twofold of their observed values. Potential applications of the final model include model-informed drug discovery and development or the support of model-informed precision dosing

Semi-automated detection and analysis of glide-snow events using satellite-based remote sensing and terrestrial photography

Gleitschneelawinen stellen Lawinenwarndienste und Sicherheitsverantwortliche, insbesondere von Verkehrsinfrastrukturen, jeden Winter vor große Herausforderungen. Eine Kombination aus teilweise lang andauernder Gefährdung, großen Unsicherheiten bei der Vorhersagbarkeit und fehlenden Möglichkeiten für Kontrollmaßnahmen ist hierfür die Ursache. Der Prozess des Schneegleitens und die sich daraus entwickelnden Gleitschneelawinen sind bisher relativ wenig untersucht worden. Der Winter 2011/12 hat eindrücklich die bestehenden Wissenslücken aufgezeigt. Ein ungewöhnlich trockener, sonniger und warmer Herbst 2011, gefolgt von einem schneereichen Frühwinter hatte vor allem auf der Alpennordseite zu einer außergewöhnlichen Gleitschneeaktivität mit vielen Sachschäden und Unfalllawinen geführt. In der Regel öffnen sich vor dem Abgang einer Gleitschneelawine sogenannte Gleitschneerisse in der Schneedecke, welche aufgrund der frei werdenden dunklen Geländeoberfläche meist gut sichtbar sind. Damit stellen Gleitschneelawinen die einzige Lawinenart dar, bei welcher der Gefahrenbereich vor dem Lawinenabgang prinzipiell erkennbar und damit genau lokalisierbar ist. Eine optische Erfassung und Überwachung der Entstehung und zeitlichen Entwicklung von Gleitschnee-Ereignissen, d. h. Gleitschneerissen und Gleitschneelawinen, bietet sich daher an. Eine neue Generation räumlich sehr hoch auflösender Satellitendaten eröffnet seit etwa Anfang des neuen Jahrtausends die Möglichkeit, die satellitenbasierte Fernerkundung bei Fragestellungen in der Lawinenforschung und für die operationelle Lawinenwarnung einsetzen zu können. In der vorliegenden Arbeit wurden erstmals unterschiedliche Ansätze für eine (halb-)automatische, satellitenbasierte Erfassung von Gleitschnee-Ereignissen untersucht. Eine großräumige Erfassung der Gleitschneeaktivität kann zum einen für die Einschätzung und Vorhersage des Gefahrenpotentials genutzt werden. Zum anderen kann sie dem Aufbau eines, bisher fehlenden, systematischen und flächendeckenden Datensatzes dienen, welcher als Grundlage für die verschiedensten Anwendungen in Forschung und Praxis benötigt wird. Die heute operierenden, räumlich sehr hoch auflösenden Satellitensysteme haben jedoch eine Wiederkehrfrequenz, die eine Verfolgung der kurzfristigen Entstehung und Entwicklung von Gleitschneerissen und eine hinreichend genaue Bestimmung des Abgangszeitpunktes von Gleitschneelawinen noch nicht zulassen. Um ein besseres Verständnis im Hinblick auf diese kurzfristig ablaufenden Prozesse zu erlangen und Fortschritte hinsichtlich einer zeitlich präzisen Gefahrenvorhersage und Warnung zu erzielen, wurden daher zudem zeitlich hoch aufgelöste fotografische Intervallaufnahmen von zwei Gleitschneehängen in den Wintern 2008/09 und 2011/12 vorgenommen und manuell ausgewertet. Grundlage für die satellitenbasierte Erfassung war ein 25 km² großer Ausschnitt einer Szene des räumlich sehr hoch auflösenden panchromatischen WorldView-1 Satelliten vom 28.04.2008 über dem Hochtal von St. Antönien in den östlichen Schweizer Alpen. Getestet wurden zwei unterschiedliche Ansätze für die automatische Erfassung von Gleitschnee-Ereignissen, welche neben dem Einbezug von spektralen Eigenschaften auch die Möglichkeit bieten, weitere erklärende Variablen, wie Gelände- oder Formparameter, zu berücksichtigen. Zum einen war dies ein pixelbasierter Ansatz, der hauptsächlich auf einer statistischen Modellierung mittels eines Generalisierten Additiven Modells (GAM), beruht. Zum anderen ein Ansatz, welcher auf einer objektorientierten Bildanalyse basiert. Die Ergebnisse zeigen, dass sowohl beim pixelbasierten als auch beim objektbasierten Klassifikationsansatz Gleitschnee-Ereignisse, welche sich innerhalb einer geschlossenen Schneedecke befinden und bei denen die dunkle Geländeoberfläche zu sehen ist, mit einer hohen Genauigkeit erfasst werden. Die (halb-)automatische Erfassung eignet sich damit besonders für Gebiete bzw. Situationen mit einzelnen Gleitschnee-Ereignissen innerhalb einer ansonsten geschlossenen Schneedecke und nur wenigen bis keinen sonstigen aperen Flächen. Die größte Herausforderung bei beiden getesteten Ansätzen ist die Trennung der schneefreien Gleitschnee-Ereignisflächen von sonstigen aperen Flächen. Insbesondere der Klassifikationsansatz auf Pixelebene mittels eines GAMs zeigt, dass eine Kombination aus spektralen und topographischen Variablen in der Lage ist, innerhalb der aperen Bereiche zu differenzieren. So wird beispielsweise bei einer 70-prozentigen Sensitivität ein Spezifitätsniveau von 71% erreicht und dies bei einer Detektierungsrate von 79% und einem durchschnittlich erfassten Flächenanteil pro Referenzpolygon von 51%. Der hohe Anteil an sonstigen aperen Flächen auf dem untersuchten Satellitenbildausschnitt, gerade in typischen Gleitschneehängen, stellt allerdings eine schwierige Ausgangssituation dar und führt bei hohen Sensitivitätsanteilen zu hohen Falsch-Positiv-Raten. Bessere Klassifikationsergebnisse sind in Zukunft in erster Linie über Fortschritte bei der Vorprozessierung und Ausmaskierung der Satellitendaten zu erwarten, wofür eine Fusion mit räumlich weniger hoch auflösenden, dafür aber multispektralen Sensoren notwendig ist. Im Hinblick auf eine zukünftig anzustrebende kontinuierliche Überwachung der Gleitschneeaktivität, insbesondere der Rissentwicklung, verspricht der pixelbasierte Ansatz bessere Möglichkeiten. Die oftmals komplexen Gleitschnee-Ereignisformen werden beim pixelbasierten im Vergleich zum objektbasierten Ansatz, bei welchem die Objektformen stärker generalisiert werden, deutlich präziser erfasst. Damit besteht prinzipiell die Möglichkeit auch geringfügige Veränderungen zwischen zwei Aufnahmezeitpunkten, z. B. eine Risserweiterung, erfassen zu können. Die Auswertung der fotografischen Intervallaufnahmen ergab einen hohen Anteil an beobachteten Gleitschneelawinenabgängen ohne (erkennbare) Rissöffnung und mit nur sehr kurzer Rissüberdauerung (< 1h) von zusammen 67,5% aller registrierten Lawinen. Nur für die verbleibenden gut 30% der Gleitschneelawinen mit einer längeren Zeitverzögerung erscheint eine Beobachtung der Rissentwicklung möglich und sinnvoll. Insbesondere bei der Gleitschneelawinenaktivität aber auch bei den Rissöffnungen wurde ein deutlicher Tagesgang festgestellt – dies auch nach erfolgter Aufteilung der Datensätze in „Hochwinter-“ und „Frühjahrsperioden“. Etwa 10% aller Gleitschneelawinen ereigneten sich, ohne dass vorher an der Anrisskrone ein Riss zu erkennen war, direkt oberhalb eines vorausgegangenen Gleitschnee-Ereignisses. Auch weitere Beobachtungen von Gleitschneerissöffnungen und Gleitschneelawinen, welche offensichtlich durch vorausgegangene Gleitschnee-Ereignisse in der direkten Umgebung induziert wurden, lassen darauf schließen, dass in diesen Fällen die Stabilitätsverhältnisse im Hang eine entscheidende Rolle für die Auslösung spielen. Abschließend lässt sich festhalten, dass sich der satellitengestützte Ansatz zurzeit vor allem für den Aufbau großräumiger und langfristiger Erhebungen von Gleitschnee-Ereignissen eignet, welche u. a. eine Grundlage für die Weiterentwicklung der Erfassungsalgorithmen darstellen. Für bekannte Gleitschneehänge mit jährlich wiederkehrenden Ereignissen und konkreter Bedrohung für Infrastrukturen, stellt die terrestrische Hangbeobachtung mit Fotokameras zurzeit die beste Möglichkeit für eine kontinuierliche Überwachung dar. Um die Methode in Zukunft auch tatsächlich zur Gefahrenfrüherkennung und Warnung einsetzen zu können, ist eine automatisierte (Echtzeit-)Auswertung erforderlich. Eine der wichtigsten zu klärenden Fragestellungen zukünftiger Untersuchungen wird es jedoch sein müssen, ob eine Beobachtung der Gleitschneeaktivität (z. B. der Gleitraten) überhaupt eine verlässliche Gefahrenvorhersage zulässt und diese für temporäre Schutzmaßnahmen (z. B. Evakuierungen oder Sperrungen von Verkehrswegen) in der überwiegenden Anzahl der Fälle auch zeitlich ausreichend ist.Glide-snow avalanches are a recurring challenge for avalanche warning services and avalanche control programs because they are difficult to predict and hard to trigger artificially. Processes leading to snow gliding on the ground as well as the evolution of glide cracks and glide avalanches are still poorly understood. This lack of knowledge became apparent in win-ter 2011/12. An extremely dry and warm fall season followed by a snowy early winter season led to extraordinary glide-snow activity with much damage and accidents all over the north-ern Alps. The occurrence of glide avalanches is frequently indicated by glide cracks. Due to the strong contrast between the dark ground and the surrounding snow areas, these cracks are easy to detect in visual examination. This offers, in contrast to other types of avalanches, the possibility for an optical detection and monitoring of glide-snow events, i.e. glide cracks and glide avalanches. Since the beginning of this millennium a new generation of satellite sensors with very high spatial resolution has offered the possibility of using remote sensing approaches for avalanche research and warning issues. For the first time this work investigates different methods to automatically detect glide-snow events with space-borne remote sensing. An area-wide detection of glide-snow activity is important for avalanche forecasting and safety assessments. Further it could be used to systematically build up a dataset with a large cov-erage. Such a dataset is presently lacking yet is needed for many applications related to ava-lanche research and warning. However, satellite revisiting times are currently not adequate to monitor glide crack evolution in detail and to determine the time of release. To achieve a better knowledge of these short time scale processes, terrestrial and temporal high resolution time-lapse photography of two slopes that are known for glide-snow events were made dur-ing the winter seasons 2008/09 and 2011/12. A panchromatic image of the valley of St. Antönien (Eastern Swiss Alps) was used for the satellite based approach. The image was taken by the WorldView-1 sensor on April 28th 2008 and covered 25 km². Two different methods including spectral attributes as well as to-pographic parameters or parameters relating to the shape of objects were tested regarding their potential to automatically detect glide-snow events from the satellite image. The first approach was pixel-based and included statistical modeling using a generalized additive model (GAM). The second approach included an object-based image analyzing method. Re-sults showed that glide-snow events within completely snow-covered slopes were mapped with high accuracy by both approaches. However, the challenge for both classification ap-proaches was to separate aper glide-snow areas from other snow free areas in the pan-chromatic imagery. In particular the pixel-based approach showed that a differentiation of these two types of snow-free areas is generally possible. On a 70% sensitivity level a speci-ficity of 71% and a detection rate of 79% could be achieved. A prerequisite for better classifi-cation results in the future are improvements related to the preprocessing and masking of satellite images. These improvements can be achieved by data fusion with multispectral data. However, higher spectral resolution is frequently accompanied by a coarser spatial resolution. Compared to the object-based approach, the pixel-based approach allowed for a more precise detection of the shapes of the glide-snow events. It is thus considered the more appropriate method for multi-temporal change detection investigations in the future. The analyses of the images collected by the terrestrial time-lapse photography showed a high incidence of 67.5% of glide avalanches with no identifiable glide-cracks on a previous photo or only short time-lags (<1 h) between crack opening and subsequent avalanche. Fur-thermore the glide-snow activity had a clear diurnal cycle with most events occurring at noon. This diurnal cycle was observed independently of the type of snow gliding, i.e. for periods with a cold and dry (early and mid-winter conditions) as well as for periods with an isothermal and wet snowpack (spring conditions). Approximately every tenth glide avalanche occurred directly above and not below a previous glide-snow event. The surrounding stability condi-tions of the snowpack are thus considered important for the occurrence of these events. The study led to the conclusion that the satellite-based approach can be used for an area-wide baseline detection of glide-snow events. This baseline dataset can be used among other applications to develop and improve detection algorithms. For slopes that are known for a high annual glide-snow activity threatening infrastructure, terrestrial time-lapse photog-raphy offers the best monitoring possibilities. To use this method in future for an operational glide avalanche warning, an automatic real-time detection and analysis of glide-snow events is a prerequisite. However, one of the crucial questions to answer in future work is whether the monitored glide-snow activity is a reliable indicator to forecast, warn and initiate temporal protection measurements or not

Physiologically‐based pharmacokinetic modeling of quinidine to establish a CYP3A4, P‐gp, and CYP2D6 drug–drug–gene interaction network

Abstract The antiarrhythmic agent quinidine is a potent inhibitor of cytochrome P450 (CYP) 2D6 and P‐glycoprotein (P‐gp) and is therefore recommended for use in clinical drug–drug interaction (DDI) studies. However, as quinidine is also a substrate of CYP3A4 and P‐gp, it is susceptible to DDIs involving these proteins. Physiologically‐based pharmacokinetic (PBPK) modeling can help to mechanistically assess the absorption, distribution, metabolism, and excretion processes of a drug and has proven its usefulness in predicting even complex interaction scenarios. The objectives of the presented work were to develop a PBPK model of quinidine and to integrate the model into a comprehensive drug–drug(–gene) interaction (DD(G)I) network with a diverse set of CYP3A4 and P‐gp perpetrators as well as CYP2D6 and P‐gp victims. The quinidine parent‐metabolite model including 3‐hydroxyquinidine was developed using pharmacokinetic profiles from clinical studies after intravenous and oral administration covering a broad dosing range (0.1–600 mg). The model covers efflux transport via P‐gp and metabolic transformation to either 3‐hydroxyquinidine or unspecified metabolites via CYP3A4. The 3‐hydroxyquinidine model includes further metabolism by CYP3A4 as well as an unspecific hepatic clearance. Model performance was assessed graphically and quantitatively with greater than 90% of predicted pharmacokinetic parameters within two‐fold of corresponding observed values. The model was successfully used to simulate various DD(G)I scenarios with greater than 90% of predicted DD(G)I pharmacokinetic parameter ratios within two‐fold prediction success limits. The presented network will be provided to the research community and can be extended to include further perpetrators, victims, and targets, to support investigations of DD(G)Is

Use of psycho-oncological services by prostate cancer patients: A multilevel analysis

Background Cancer patients often suffer from psychological distress. Psycho-oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs). Methods Center-reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted. Results Model 1 showed that utilization of POS in PCCs is associated with patients' age (OR = 0.98; 95%-CI = 0.96-0.99; P < .001), number of comorbidities (1-2 vs 0, OR = 1.27; 95%-CI = 1.00-1.60; P=.048), disease staging (localized high-risk vs localized intermediate risk, OR = 1.41; 95%-CI = 1.14-1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%-CI = 0.10-0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%-CI = 0.02-0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%-CI = 0.03-0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%-CI = 0.02-0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high-risk vs localized intermediate risk, OR = 1.31; 95%-CI = 1.05-1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%-CI = 0.01-0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics. Conclusions Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects - for example, less need following radiotherapy - or because access to POS is more difficult for those receiving radiotherapy

Determinants of self-reported functional status (EPIC-26) in prostate cancer patients prior to treatment

Purpose!#!The self-reported functional status (sr-FS) of prostate cancer (PCa) patients varies substantially between patients and health-care providers before treatment. Information about this issue is important for evaluating comparisons between health-care providers and to assist in treatment decision-making. There have been few reports on correlates of pretherapeutic sr-FS. The objective of the article, therefore, is to describe clinical and sociodemographic correlates of pretherapeutic sr-FS, based on a subset of the TrueNTH Global Registry, a prospective cohort study.!##!Methods!#!A total of 3094 PCa patients receiving local treatment in 44 PCa centers in Germany were recruited between July 2016 and April 2018. Multilevel regression models were applied to predict five pretherapeutic sr-FS (EPIC-26) scores based on clinical characteristics (standard set suggested by the International Consortium for Health Outcomes Measurement), sociodemographic characteristics, and center characteristics.!##!Results!#!Impaired pretherapeutic sr-FS tended to be associated with lower educational level and poorer disease characteristics-except for 'urinary incontinence' which was only associated with age. Notably, age was a risk factor ('urinary incontinence,' 'urinary irritative/obstructive,' 'sexual') as well as a protective factor ('hormonal') for pretherapeutic sr-FS. Pretherapeutic sr-FS varies little across centers.!##!Conclusions!#!Pretherapeutic sr-FS varies by clinical patient characteristics and age as well as by socioeconomic status. The findings point out the benefit of collecting and considering socioeconomic information in addition to clinical and demographic patient characteristics for treatment decision-making and fair comparisons between health-care providers

Determinants of self-reported functional status (EPIC-26) in prostate cancer patients prior to treatment

Purpose The self-reported functional status (sr-FS) of prostate cancer (PCa) patients varies substantially between patients and health-care providers before treatment. Information about this issue is important for evaluating comparisons between health-care providers and to assist in treatment decision-making. There have been few reports on correlates of pretherapeutic sr-FS. The objective of the article, therefore, is to describe clinical and sociodemographic correlates of pretherapeutic sr-FS, based on a subset of the TrueNTH Global Registry, a prospective cohort study. Methods A total of 3094 PCa patients receiving local treatment in 44 PCa centers in Germany were recruited between July 2016 and April 2018. Multilevel regression models were applied to predict five pretherapeutic sr-FS (EPIC-26) scores based on clinical characteristics (standard set suggested by the International Consortium for Health Outcomes Measurement), sociodemographic characteristics, and center characteristics. Results Impaired pretherapeutic sr-FS tended to be associated with lower educational level and poorer disease characteristics-except for urinary incontinence which was only associated with age. Notably, age was a risk factor (urinary incontinence, urinary irritative/obstructive, sexual) as well as a protective factor (hormonal) for pretherapeutic sr-FS. Pretherapeutic sr-FS varies little across centers. Conclusions Pretherapeutic sr-FS varies by clinical patient characteristics and age as well as by socioeconomic status. The findings point out the benefit of collecting and considering socioeconomic information in addition to clinical and demographic patient characteristics for treatment decision-making and fair comparisons between health-care providers

Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer

Purpose The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE. Materials and methods Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, PCCs) between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen's d and MIDs. Results Adjusted domain scores at 12 months varied between sites, with IQRs of 66-78 (incontinence), 89-92 (irritative/obstructive function), and 20-29 (sexual function). Changes in domain scores after casemix adjustment for sites >= 1 MID were noted for the incontinence domain (six sites). Cohen's d ranged between - 0.07 (incontinence) and - 0.2 (sexual function), indicating a small to medium effect of casemix adjustment. Conclusions Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation