External Validation of Three Prognostic Scores for Brain Metastasis Velocity in Patients Treated with Intracranial Stereotactic Radiotherapy

BACKGROUND AND INTRODUCTION Brain metastasis velocity (BMV) has been proposed as a prognostic factor for overall survival (OS) in patients with brain metastases (BMs). In this study, we conducted an external validation and comparative assessment of the performance of all three BMV scores. MATERIALS AND METHODS Patients treated with intracranial stereotactic radiotherapy (SRT) for BM at a single center between 2014 and 2018 were identified. Where possible, all three BMV scores were calculated. Log-rank tests and linear, logistic and Cox regression analysis were used for validation and predictor identification of OS. RESULTS For 333 of 384 brain metastasis patients, at least one BMV score could be calculated. In a sub-group of 187 patients, "classic" BMV was validated as categorical (p<0.0001) and continuous variable (HR 1.02; 95% CI 1.02-1.03; p<0.0001). In a sub-group of 284 patients, "initial" BMV was validated as categorical variable (high-risk vs. low-risk; p<0.01), but not as continuous variable (HR 1.02; 95% CI 0.99-1.04; p=0.224). "Volume-based" BMV could not be validated in a sub-group of 104 patients. On multivariable Cox regression analysis, iBMV (HR 1.85; 95% CI 1.01-3.38; p<0.05) and cBMV (HR 2.32; 95% CI 1.15 4.68; p<0.05) were predictors for OS for intermediate-risk patients after first SRT and first DBFs, respectively. cBMV proved to be the dominant predictor for OS for high-risk patients (HR 2.99; 95% CI 1.30-6.91; p<0.05). CONCLUSION This study externally validated cBMV and iBMV as prognostic scores for OS in patients treated with SRT for BMs whereas validation of vBMV was not achieved

Kapitel 3. Sozioökonomische und klimatische Treiber der Änderung der Landnutzung in Österreich

Dieses Kapitel beschäftigt sich mit den klimatischen, ökologischen und sozioökonomischen treibenden Kräften, welche die Landnutzung in Österreich in der Vergangenheit und der Gegenwart maßgeblich bestimmt haben und die zukünftigen Entwicklungen beeinflussen werden. Es behandelt die in der Vergangenheit beobachteten und in der Zukunft erwarteten treibenden Kräfte von Landnutzungsänderungen in der Landwirtschaft (Abschn. 3.2), der Forstwirtschaft (Abschn. 3.3) und der Siedlungs- und Infrastrukturentwicklung (Abschn. 3.4). Abschließend werden die möglichen und erwarteten Auswirkungen dieser treibenden Kräfte auf die Bereitstellung der Ökosystemleistungen (ÖSL) beschrieben (Abschn. 3.5). Der Abbau von Mineralien wie Schotter oder Metalle wird aus Platzgründen nicht in diesem Kapitel behandelt, wenngleich es unumstritten ist, dass es sich auch dabei um landnutzungsrelevante Aktivitäten handelt. Kap. 3 unterscheidet zwischen natürlichen und anthropogenen Faktoren und wie sich diese auf die Landnutzung ausgewirkt haben und auswirken. Die sozioökonomischen Auswirkungen berücksichtigen dabei allerdings nicht die möglichen Anpassungs- oder Minderungsstrategien der einzelnen Sektoren, da diese in den Kap. 4 und 5 gesondert dargestellt werden

Past and future impacts of land-use changes on ecosystem services in Austria

Environmental and socio-economic developments induce land-use changes with potentially negative impacts on human well-being. To counteract undesired developments, a profound understanding of the complex relationships between drivers, land use, and ecosystem services is needed. Yet, national studies examining extended time periods are still rare. Based on the Special Report on land use, land management and climate change by the Austrian Panel on Climate Change (APCC), we use the Driver-Pressure-State-Impact-Response (DPSIR) framework to (1) identify the main drivers of land-use change, (2) describe past and future land-use changes in Austria between 1950 and 2100, (3) report related impacts on ecosystem services, and (4) discuss management responses. Our findings indicate that socio-economic drivers (e.g., economic growth, political systems, and technological developments) have influenced past land-use changes the most. The intensification of agricultural land use and urban sprawl have primarily led to declining ecosystem services in the lowlands. In mountain regions, the abandonment of mountain grassland has prompted a shift from provisioning to regulating services. However, simulations indicate that accelerating climate change will surpass socio-economic drivers in significance towards the end of this century, particularly in intensively used agricultural areas. Although climate change-induced impacts on ecosystem services remain uncertain, it can be expected that the range of land-use management options will be restricted in the future. Consequently, policymaking should prioritize the development of integrated land-use planning to safeguard ecosystem services, accounting for future environmental and socio-economic uncertainties

Technische Zusammenfassung

Die Technische Zusammenfassung des APCC-Sonderberichts ″Landnutzung und Klimawandel in Österreich″ umfasst die Kernbotschaften der Kapitel 1–9. In ihr sind die Hauptaussagen zu den sozioökonomischen und klimatischen Treibern der Landnutzungsänderungen, zu den Auswirkungen von Landnutzung und -bewirtschaftung auf den Klimawandel, zu Minderungs- und Anpassungsoptionen im Kontext nachhaltiger Entwicklungsziele sowie zu Synergien, Zielkonflikten und Umsetzungsbarrieren von Klimamaßnahmen enthalten

Bubbles and Information: An Experiment

We study whether information about imminent future dividends can abate bubbles in experimental asset markets. Using the seminal design of Smith et al. (1988) we find that markets where traders are asymmetrically informed about future dividends have smaller, and shorter, bubbles than markets with symmetrically informed or uninformed traders. Hence, fundamental values are better reflected in market prices - implying higher market efficiency - when some traders know more than others about the future prospects of an asset. We also find that asymmetric information has a similar abating impact on bubbles as when uninformed traders accumulate experience, though for different reasons

Hat der Versicherungsstatus einen Einfluss auf die Appendektomiehäufigkeit?

We investigated the influence of insurance status on the frequency of negative appendectomy. Over 5 years 820 patients underwent surgery with the diagnosis of acute appendicitis. Private and semi-private rated patients had statistically significantly more appendectomies without inflammation in the pathological specimen than ward patients (p < 0.04). This difference arose only from a statistically highly significant difference in patients aged over 40 years (p < 0.001); there was no difference between patients aged under 40 years. Possible reasons for this phenomenon are discussed. The most important finding from our data seems that financial reasons are not at all a major factor influencing the surgeon's decision for operation

Outcomes of skin cancer excision in frail patients : a retrospective cohort study

Non-melanoma skin cancer (NMSC) is the most common cancer type and incidence increases with age. As a consequence, an increasing number of frail patients are being referred for consideration of skin cancer surgery. However, some of these patients may not live long enough to experience benefit from surgery, while being at risk of postoperative complications. To investigate the treatment burden of surgical excision of skin cancers in frail individuals. We conducted a single-center retrospective cohort study analyzing outcomes of skin cancer excision in frail versus non-frail patients. Eighty-eight patients were included. The complication rate was higher in frail versus non-frail patients: 12 (27.9%) versus 9 (18.8%), with 5 unplanned postoperative hospital attendances leading to 3 hospital admissions in the frail cohort. Nine patients in the frail group (21%) died within 6 months of their procedure versus no deaths in the non-frail group (p < 0.001 Fisher's Exact test), with no deaths attributed to skin cancer. Treatment-related complications and mortality are common in frail patients after surgical excision of skin lesions clinically suspicious for skin cancer. Careful consideration should be given, and patients should be adequately counseled about treatment risks and alternative management options, including active surveillance, in particular, if the lesions are expected to remain asymptomatic. [Abstract copyright: Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.