225 research outputs found
Erfassung des psychokognitiven Statusâ von Patienten mit einer onkologischen Erkrankung mithilfe des ALGA-c-Fragebogens
Einleitung Einer personalisierten Medizin kommt heutzutage eine immer gröĂere Bedeutung zu. Ein wichtiger Bestandteil einer personalisierten Medizin liegt in der StĂ€rkung der Ressourcen des einzelnen Patienten (patient empowerment). Durch die Erhebung des psychokognitiven Status eines Patienten soll es den behandelnden Ărzten ermöglicht werden, den Patienten besser zu verstehen und dadurch auch so mit ihm zu kommunizieren, dass man auf seine BedĂŒrfnisse gezielter eingehen kann. Dies ermöglicht u.a. gemeinsam mit ihm Entscheidungen in Bezug auf seine Erkrankung zu treffen (shared decision making). Um diese Ziele zu erreichen wurde 2012 das von der EU-geförderte Projekt zur personalisierten Medizin (p-medicine) ins Leben gerufen. Der ALGA-Fragebogen wurde dabei entwickelt, mit dessen Hilfe der psychokognitive Zustand des Patienten erfasst werden kann. Der Fragebogen ist online frei zugĂ€nglich. Die personenbezogene Auswertung dieses Fragebogens wird dem behandelnden Arzt mit EinverstĂ€ndnis des Patienten zur VerfĂŒgung gestellt. Ziel dieser Arbeit war die Erfassung des psychokognitiven Status von erwachsenen Patienten/innen mit einer Tumorerkrankung mithilfe des ALGA-Fragebogens. Material und Methoden Der Fragebogen wurde bereits in Mailand an Menschen ohne Tumorerkrankung validiert und bei Brustkrebspatienten evaluiert. Eine Evaluierung des Fragebogens an Menschen ohne Tumorerkrankung fand ebenfalls am UniversitĂ€tsklinikum des Saarlandes statt, auf den diese Arbeit aufbaut. Der Fragebogen besteht aus insgesamt 109 Fragen. Neben den demographischen Daten erfasst ein Teil des Fragebogens den psychokognitiven Status des Patienten und eine Evaluation des Fragebogens durch den bzw. die Patienten/in. Im psychokognitiven Teil gibt es insgesamt 7 Oberkategorien, die wiederum in 20 Unterkategorien aufgeteilt werden. Die Auswertung erfolgte vorwiegend unter den Aspekten: Geschlecht, Altersgruppe und Diagnosegruppe. Ergebnisse Insgesamt wurden 1394 Fragebögen verteilt, wovon 307 Fragebögen zurĂŒckkamen. Dies entspricht einer RĂŒcklaufquote von 22,76%. Mit 56% waren die Studienteilnehmer etwas hĂ€ufiger mĂ€nnlich. Ăltere Patienten/innen (ĂŒber 60 Jahre) machen den gröĂten Anteil an der gesamten Kohorte aus. Die Diagnosestellung lag im Mittel 3 Jahre zurĂŒck. Es war zu erkennen, dass die RĂŒcklaufquote neben der TumorentitĂ€t am stĂ€rksten von der Akzeptanz des Fragebogens innerhalb einer Einrichtung abhing. Im Vergleich zu den Referenzwerten aus der Vorarbeit stieg der Mittelwert aller Items bis auf die Kategorien Emotionale UnterstĂŒtzung, ErinnerungsfĂ€higkeit, Cognitive Closure, Persönlichkeit und Risikobereitschaft bei den hier untersuchten Tumorpatienten/innen an. Ăber alle 20 Unterkategorien zeigte sich, dass Frauen, 40-49-jĂ€hrige Patienten/innen und Menschen mit der Diagnose eines Bronchialkarzinoms ĂŒberdurchschnittlich hĂ€ufig VerĂ€nderungen im psychokognitiven Status gegenĂŒber dem Normalkollektiv aufwiesen, was als Hinweis auf eine deutliche Belastung durch die Tumorerkrankung zu sehen ist. Besonders niedrige Werte innerhalb aller Unterkategorien zeigte sich in der gesamten Studienkohorte nur bei den urologischen und nephrologischen Karzinomen. Diskussion Mithilfe des ALGA-Fragebogens kann der psychokognitive Status von Tumorpatienten/innen erhoben werden und es konnte gezeigt werden, dass sich dieser von Gesunden unterscheidet. Im Vergleich zu anderen Arbeitsgruppen fanden sich Ăbereinstimmungen als auch Unterschiede. So zeigten sich in dieser Analyse bei Brustkrebspatientinnen mehr sexuelle Probleme als in der Literatur berichtet. Ăhnliches fand sich beim psychologischen Zustand von Brustkrebspatientinnen, der in dieser Studie besser ist, als in der Literatur beschrieben. Weiterhin wird in der Literatur eher ein junges Alter als belastendes Merkmal fĂŒr eine psychische Erkrankung angesehen. Durch hohe Standardabweichungen in allen Unterkategorien kann allerdings in keinem Tumorkollektiv eine generelle Empfehlung fĂŒr einzelne Patienten abgeleitet werden. Dies unterstreicht die Notwendigkeit einer personalisierten Medizin auch in der psychologischen Betreuung von Tumorpatienten/innen.Introduction These days the importance of personalized healthcare continues to increase considerably. The reinforcement of resources for the individual patient (patient empowerment) is one of the major goals of personalized healthcare. Surveying the psycho-cognitive state of the patient is supposed to improve the communication, allowing the doctor to respond to the patientâs needs more effectively. It allows shared decision making regarding the disease and its treatment. In order to achieve these goals, the EU-funded project 'p-medicine' (personalized medicine) was launched in 2012. In the process the ALGA-questionnaire has been designed and, amongst other things, it serves as a tool to measure the psycho-cognitive state of patients. This questionnaire is available online and for free. Requiring the informed consent of the patient the individual evaluation of the questionnaire is provided to the treating doctor. The goal of this project was to gather data regarding the psycho-cognitive state of adults with cancer using the ALGA-questionnaire. Material and Research Methods The questionnaire has already been validated in Milan by including participants that do not suffer any tumour diseas and was evaluated in breast cancer patients. Another evaluation took place at the Saarland University also not including tumour patients, it serves as a basis for this research. The questionnaire includes 109 questions. Besides collecting demographic data, other parts include gathering information about the psycho-cognitive state of the patient and an evaluation of the questionnaire by the patient himself or herself. The part examining the psycho-cognition consists of seven main categories which are split into 20 more subcategories. This analysis focuses primarily on these aspects: gender, age group and diagnosis group. Results A total of 1394 questionnaires were handed out, whereof 307 were returned, which equals a response rate of 22.76%. Slightly more male, 56%, than female participants took part in the study. Older patients (above 60 years) are the largest part of the whole cohort. On average the diseases were diagnosed three years earlier. Besides the tumour entity, the response rate was highly depending on the approval of the questionnaire inside an institution or clinics. In comparison to the reference values the average values of all items of the examined participants increased, except for the categories emotional support, memory attention, cognitive closure, personality and risk. It was noticeable that, including all 20 subcategories, the frequency of the changing of the participants psycho-cognitive state was above average in following groups: women, 40 - 49-year-olds and participants who were diagnosed with a lung cancer. This observation mirrors the burden of the tumour disease. Exceptional low values regarding all subcategories were only seen within the group of urological and nephrological carcinomas. Discussion The ALGA-questionnaire is able measure the psycho-cognitive state of tumour patients. It is shown that this state differs from people without a medical condition. In comparison to the literature a lot of findings could be confirmed but also new ones are described. More sexual problems regarding breast cancer patients were noted than expected based on the literature. In addition, analyzing the psychological status of breast cancer patients showed better results in this study compared to the literature. Furthermore, in literature young age is still considered an important psychological factor coping with the disease. However, due to high standard deviations in each subcategory within every tumour entity it is not possible to make any recommendations for the treatment of individual patients. This emphasizes once more the necessity of a personalized healthcare approach in cancer patients including psychological support
Fractional Chern Insulators vs. Non-Magnetic States in Twisted Bilayer MoTe
Fractionally filled Chern bands with strong interactions may give rise to
fractional Chern insulator (FCI) states, the zero-field analogue of the
fractional quantum Hall effect. Recent experiments have demonstrated the
existence of FCIs in twisted bilayer MoTe without external magnetic fields
-- most robust at -- as well as Chern insulators (CIs) at .
Although the appearance of both of these states is theoretically natural in an
interacting topological system, experiments repeatedly observe nonmagnetic
states (lacking FCIs) at and , a puzzling result which has not
been fully theoretically explained. In this work, we perform Hartree-Fock and
exact diagonalization calculations to test whether the standard MoTe
moir\'e model with the (greatly varying) parameter values available in the
literature can reproduce the non-magnetic states at and in
unison with the FCI at and CI state at . We focus on the
experimentally relevant twist angles and, crucially, include remote bands. We
find that the parameters proposed in [Wang et al. (2023)] can nearly capture
the experimental phenomena at simultaneously, though
the predicted ground states at are still mostly fully-spin-polarized
and a larger dielectric constant than is typical of hexagonal
boron nitride (h-BN) substrate is required. Our results show
the importance of remote bands in identifying the competing magnetic orders and
lay the groundwork for further study of the realistic phase diagram.Comment: 16+32 pages, 10+28 figures, 2+1 table
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Trajectory and uniqueness of mutational signatures in yeast mutators.
The acquisition of mutations plays critical roles in adaptation, evolution, senescence, and tumorigenesis. Massive genome sequencing has allowed extraction of specific features of many mutational landscapes but it remains difficult to retrospectively determine the mechanistic origin(s), selective forces, and trajectories of transient or persistent mutations and genome rearrangements. Here, we conducted a prospective reciprocal approach to inactivate 13 single or multiple evolutionary conserved genes involved in distinct genome maintenance processes and characterize de novo mutations in 274 diploid Saccharomyces cerevisiae mutation accumulation lines. This approach revealed the diversity, complexity, and ultimate uniqueness of mutational landscapes, differently composed of base substitutions, small insertions/deletions (InDels), structural variants, and/or ploidy variations. Several landscapes parallel the repertoire of mutational signatures in human cancers while others are either novel or composites of subsignatures resulting from distinct DNA damage lesions. Notably, the increase of base substitutions in the homologous recombination-deficient Rad51 mutant, specifically dependent on the Polζ translesion polymerase, yields COSMIC signature 3 observed in BRCA1/BRCA2-mutant breast cancer tumors. Furthermore, "mutome" analyses in highly polymorphic diploids and single-cell bottleneck lineages revealed a diverse spectrum of loss-of-heterozygosity (LOH) signatures characterized by interstitial and terminal chromosomal events resulting from interhomolog mitotic cross-overs. Following the appearance of heterozygous mutations, the strong stimulation of LOHs in the rad27/FEN1 and tsa1/PRDX1 backgrounds leads to fixation of homozygous mutations or their loss along the lineage. Overall, these mutomes and their trajectories provide a mechanistic framework to understand the origin and dynamics of genome variations that accumulate during clonal evolution
Moir\'e Fractional Chern Insulators III: Hartree-Fock Phase Diagram, Magic Angle Regime for Chern Insulator States, the Role of the Moir\'e Potential and Goldstone Gaps in Rhombohedral Graphene Superlattices
We investigate in detail the displacement-field-tuned interacting
phase diagram of layer rhombohedral graphene aligned to hBN
(RG/hBN). Our calculations account for the 3D nature of the Coulomb
interaction, the inequivalent stacking orientations , the effects of
the filled valence bands, and the choice of `interaction scheme' for specifying
the many-body Hamiltonian. We show that the latter has a dramatic impact on the
Hartree-Fock phase boundaries and the properties of the phases, including for
pentalayers (R5G/hBN) with large displacement field where recent
experiments observed a Chern insulator at and fractional Chern
insulators for . In this large regime, the low-energy conduction
bands are polarized away from the aligned hBN layer, and are hence
well-described by the folded bands of moir\'eless rhombohedral graphene at the
non-interacting level. Despite this, the filled valence bands develop
moir\'e-periodic charge density variations which can generate an effective
moir\'e potential, thereby explicitly breaking the approximate continuous
translation symmetry in the conduction bands, and leading to contrasting
electronic topology in the ground state for the two stacking arrangements.
Within time-dependent Hartree-Fock theory, we further characterize the strength
of the moir\'e pinning potential in the Chern insulator phase by computing the
low-energy collective mode spectrum, where we identify competing
gapped pseudophonon and valley magnon excitations. Our results emphasize the
importance of careful examination of both the single-particle and interaction
model for a proper understanding of the correlated phases in RG/hBN
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