Physische und psychische sowie sozial-emotionale Effekte konventioneller Krebstherapien auf Brustkrebspatientinnen

Im Mittelpunkt dieser kumulativ angefertigten Forschungsarbeit stehen vier prospektive Beobachtungsstudien, die die physischen und psychischen sowie sozial-emotionalen Effekte konventioneller Krebstherapien (Operation, Chemotherapie, Radiotherapie und Hormontherapie) auf Brustkrebspatientinnen in frühen Krebsstadien von der Diagnose über die Behandlung hinweg untersuchen. In der ersten Studie wird die feinmotorische Geschicklichkeit inklusive der Hand- und Fingerfunktion überprüft. Die zweite Studie beschäftigt sich mit individuellen Veränderungen physischer Leistungsfähigkeit und Aktivität, bioelektrischem Phasenwinkel, Symptomen krebsbedingter Fatigue, Angst und Depressivität sowie dem Auftreten von Risikoparametern. Im Fokus der dritten Studie stehen patientenberichtete Endpunkte der gesundheitsbezogenen Lebensqualität und der wahrgenommenen kognitiven Funktion. Ein biopsychosoziales Profil einschließlich klinischer Charakteristika, physischer Leistungsfähigkeit, Phasenwinkel, Angst, Depressivität, Fatigue-Symptomatik sowie gesundheitsbezogener Lebensqualität wird in einer vierten Studie erstellt.:In Kapitel 1 der vorliegenden kumulativen Dissertationsschrift erfolgt die Herleitung der dieser Arbeit zugrunde liegenden wissenschaftlichen Untersuchungen. In Kapitel 2 werden theoretische Grundlagen zur Brustkrebserkrankung erläutert, um dem Leser einen besseren Einblick in die Thematik zu bieten und das Verständnis der eigenen Beiträge zu fördern. Die Publikationen selbst können dem Anhang entnommen werden und stehen als Veröffentlichungen nach Peer-Review-Verfahren in internationalen Fachzeitschriften zur Verfügung. In Kapitel 3 wird das methodische Vorgehen zum Ablauf, Umsetzung und Analyse der Studien beschrieben. In Kapitel 4 werden die einzelnen Studien zur Übersicht zusammengefasst und die wichtigsten Ergebnisse präsentiert. Anschließend erfolgt die Diskussion der gewonnenen Erkenntnisse zu physischen und psychischen sowie sozial-emotionalen Effekten konventioneller Krebstherapien auf Brustkrebspatientinnen (Kapitel 5). Den Abschluss bildet eine kurze Zusammenfassung der Untersuchungen (Kapitel 6)

Optimal federal co-regulation of renewable energy deployment

In federal countries the allocation of renewable energy (RE) deployment is simultaneously regulated by national and subnational governments. We analyze the efficiency of federal coregulation when different types of policy instruments - price and quantity - are assigned to government levels. Using an analytical model with two regulatory levels, we specify conditions that ensure first-best allocation of RE deployment in equilibrium. These efficiency conditions refer to how the financial burden of the national RE support scheme should be shared among subnational jurisdictions. Under realistic assumptions national price-based regulation is efficient if burden shares are proportional to population shares, regardless of the subnational policy instrument. Contrary, under national quantity-based regulation efficiency conditions depend on the subnational policy instrument. While with subnational price-based regulation burden shares should be oriented towards first-best RE deployment shares, with subnational quantity-based regulation burden shares should be oriented towards population shares

Analysing gap dynamics in forest canopies with landscape metrics based on multi-temporal airborne laser scanning surveys - A pilot study

For a long time gaps or openings in the forest canopy have been of considerable interest to forest ecologists and to forest managers. In the context of disturbances induced by climate change, canopy gap dynamics are of particular interest, since they can indicate imminent damage to forest resources and irreversible trends such as forest decline. Here, statistical significance is crucial for establishing whether any imminent large-scale threat to the sustainability of forest resources exists. In order to be able to assess significance, we applied the Boolean model, a null or reference model from random set statistics. The Boolean model served as a theoretical benchmark for testing the significance of the observed trends in forest canopy gap dynamics. As a pilot study we analysed airborne laser scan (ALS) data collected in the Krycklan catchment area (Northern Sweden) in 2006 and 2015. The data were analysed using eight different landscape metrics. Despite the moderate resolution of our ALS data the landscape metrics have proved to be useful tools for monitoring canopy gap dynamics of forest ecosystems. The Boolean model has been successful in ascertaining statistical significance and the model parameters indi-cated important trends. In the Krycklan catchment area, there was no significant trend of canopy gap dynamics indicating any harmful development between 2006 and 2015. On the contrary, we found evidence for gaps closing in and gap locations becoming more random whilst the canopy cover increased between the two survey years

Paternal antisocial behavior and sons' cognitive ability : a population-based quasiexperimental study

Parents’ antisocial behavior is associated with developmental risks for the offspring but effects on cognitive ability are unknown. We used linked Swedish register data for a large sample of adolescent men (N = 1,177,173) and their parents to estimate associations between fathers’ criminal convictions and sons’ cognitive ability assessed at compulsory military conscription. Mechanisms behind the association were tested in children-of-siblings models across three types of sibling fathers (half-siblings, full-siblings, and monozygotic twins) with increasing genetic relatedness, and in quantitative genetic models. Fathers’ convictions associated with lower cognitive ability in sons (any crime: Cohen’s d = -.28; violent crimes: Cohen’s d = -.49). Adjusting for more genetic factors gradually reduced and eventually eliminated the association. Nuclear family environmental factors did not contribute to the association. Our results suggest that the association between paternal antisocial behavior and offspring cognitive ability is not causal but mostly due to underlying genetic factors.The Alfred Kordelin FoundationThe Swedish Research CouncilThe Swedish Research Council for Health, Working Life and WelfareAccepte

Konzeption und Entwicklung eines trinokularen Endoskops zur robusten Oberflächenerfassung in der minimalinvasiven Chirurgie

Die minimalinvasive Chirurgie ist eine besonders anspruchsvolle Aufgabe für den Chirurgen, da die Operation ausschließlich über Endoskope und stangenartige, filigrane Instrumente erfolgt. Computerassistierte Stereo-Endoskopiesysteme erleichtern die Tiefenwahrnehmung und unterstützen bei verschiedensten Anwendungen wie z.B. der Resektion eines Nierentumors durch Augmented Reality. Eine wesentliche Aufgabe ist die robuste dreidimensionale Erfassung der beobachteten Oberfläche der Organe. Aufgrund starker Reflexionen durch die endoskopische Lichtquelle, homogener Texturen und weicher, sich bewegender Geometrien ist eine zuverlässige Oberflächenerfassung sehr herausfordernd und stellt noch ein ungelöstes Problem dar. In dieser Arbeit wird deshalb ein neuartiges miniaturisiertes Dreikamerasystem als Demonstrator für ein trinokulares Endoskop sowie ein Algorithmus zur Dreibildauswertung mit semi-globaler Optimierung entwickelt. Durch synthetische und reale Messdaten werden theoretische Überlegungen anhand von drei Hypothesen geprüft. Im Vergleich zu einer stereoskopischen Auswertung wird untersucht, ob eine Dreibildauswertung robustere Ergebnisse liefert, kleinere Referenz- und Suchfenster ermöglicht und eine rechenzeitaufwendige semi-globale Optimierung ersetzt. Es stellt sich heraus, dass die ersten beiden Annahmen grundsätzlich zutreffen, eine semi-globale Optimierung aber nur bedingt ersetzt werden kann. Weiterhin werden die Fehlereinflüsse durch Reflexionen näher spezifiziert und durch gekreuzte Polarisationsfilter sehr effektiv unterdrückt. Das vorgestellte Dreikamera-Endoskop und angepasste Auswerteverfahren tragen wesentlich zur Verbesserung der computerassistierten Endoskopie bei und bringen die Forschungen in diesem Gebiet einen Schritt voran.Minimally invasive surgery is a quite challenging task to the surgeon due to operation through an endoscope and sensitive telescopic instruments exclusively. Computer assisted stereo endoscopic systems eases depth perception and supports several tasks such as dissection of a renal tumour by augmented reality. An essential procedure is robust surface reconstruction of the observed organs. Due to strong reflections from the endoscopic light source, homogeneous textures and weak deforming geometries robust surface reconstruction becomes quite challenging and is not solved successfully yet. Therefore, in this work a novel miniaturised three camera endoscope is introduced and an algorithm for three image analysis and semi-global optimisation is implemented. Synthetic and real experimental measurements are conducted to evaluate theoretical assumptions and review three hypotheses. In contrast to stereo analysis, it is examined whether three image analysis leads to more robust results, allows for smaller matching window sizes and replaces a time-consuming semiglobal matching algorithm. The investigations show that the first two assumptions can generally be confirmed, but the semi-global matching is necessary in some cases. Additionally, errors by reflections are examined in more detail and are suppressed efficiently by crossed polarising filters. The novel three camera endoscope and customized image analysis algorithm gives a great benefit to computer assisted endoscopy and brings research a step closer to more reliable assistant systems

Childhood family income, adolescent violent criminality and substance misuse : a quasi-experimental total population study

Background: Low socioeconomic status in childhood is a well-known predictor of subsequent criminal and substance misuse behaviors but the causal mechanisms are questioned. Aims: To investigate if the associations between childhood family income and subsequent adolescent criminality and substance misuse are explained by unobserved familial risk factors. Method: Swedish population-based quasi-experimental, family-based study following cohorts born 1989-1993 (ntotal=529,428; ncousins=262,816; nsiblings=217,035) from their 15th birthday up until the end of 2009. Results: Children of parents in the lowest income quintile experienced a seven-fold increased hazard rate of being convicted of violent criminality compared to peers in the highest quintile (HR=6.84, 95% CI: 6.28-7.44). This association was entirely accounted for by unobserved familial risk factors (HR=0.99; 95% CI: 0.46-2.13). Similar pattern of effects was found for substance misuse. Conclusions: There are no associations between childhood family income and subsequent violent criminality and substance misuse once unobserved familial risk factors are adjusted for.The Swedish Council for Working Life and Social ResearchThe Swedish Research CouncilThe National Institute of Child Health and Human DevelopmentAccepte

Multipath propagation simulator for V2X Communication Tests on Cars

Test and evaluation of wireless communication performance with cars can be done in many ways. One approach, for both vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) tests, is to use a multipath propagation simulator to achieve realistic signal environments for the different communication systems under test. Multipath propagation simulators have previously been shown to be useful for testing mobile handsets. Specific issues related to tests with cars are the large size of the test object and the disturbances it can cause. In this paper we experimentally study how different design parameters of the multipath propagation simulator affect the received signals. The analysis of the setup as well as the data is performed using the so-called “Design of Experiments” method

A school-based educational on-site vaccination intervention for adolescents in an urban area in Germany: feasibility and psychometric properties of instruments in a pilot study

Background: Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting. Methods: The study covered 863 students from 41 classes of four schools. The optimization and feasibility of access to schools, recruitment strategies, intervention, and assessment procedures were examined. The course and content of the educational unit were evaluated with a mixed-methods approach. A pre-post measurement design was tested for the vaccination rate in all schools. Additionally, at two schools, improvement in vaccination-related knowledge and perceived self-efficacy were measured by questionnaire pre-educational unit (n=287) and post-educational unit (n=293). The remaining two schools provided only postintervention data. Finally, we evaluated the psychometric properties (i.e., reliability, retest reliability, and change rates) of the questionnaire, applying Cronbach's alpha, factor analyses, generalized estimating equations and linear mixed models. Results: The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had M=2.84 (95% CI [2.69, 3.10]) correct answers before and M=4.45 (95% CI [4.26, 4.64]) after the class. Ranging from 1 to 4, the self-efficacy scale changed by 0.3 points (p <.001); Cronbach's alpha was 0.67 and 0.76 pre- and post-educational unit, respectively, and a one-factor solution was found. Content analysis of the five semistructured group interviews (n=12, 58.3% female) showed that all students found the length of the intervention to be appropriate. The teaching methods, including interactive and social media components, were perceived as very good. Conclusions: A school-based educational and on-site vaccination intervention appears to be feasible in terms of procedures and the adequacy of the instruments for the adolescent target group

Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up

Objective To investigate the impact of coexistent psychiatric morbidity on risk of suicide after a suicide attempt