Die Bedeutung einer detaillierten geriatrischen Funktionsbeurteilung älterer Krebspatienten

Für ältere Krebspatienten ist der Erhalt oder die Wiedererlangung ihrer Fähigkeit, sich selbst zu versorgen, von großer Wichtigkeit. Welche Instrumente sind geeignet, um dies zu messen? In der geriatrischen und onkologischen Versorgung sind verschiedene Instrumente zur Beurteilung des funktionellen Status etabliert, die jedoch in der Vergangenheit nur unzureichend miteinander verglichen wurden. Patienten und Methoden: Im Rahmen einer prospektiven Kohortenstudie haben wir 483 Patienten eingeschlossen, 198 ältere Patienten mit Krebs, 156 jüngere Patienten mit Krebs und 129 ältere Patienten mit gutartigen Erkrankungen. Der Funktionsstatus wurde anhand des Eastern Cooperative Oncology Group Performance-Status (ECOG-PS), der Aktivitäten des täglichen Lebens (ADL) und der instrumentellen Aktivitäten des täglichen Lebens (IADL) beurteilt. Die Ergebnisse wurden dahingehend verglichen, Patienten mit Einschränkungen im funktionellen Status zu erfassen. Zusammenfassung: Die relative Häufigkeit von Krebspatienten mit Einschränkungen bei ECOG-PS, ADL und IADL stieg von 25,7 %, 13,5 % und 17,9 % bei den unter 60-Jährigen auf 50,0 %, 47,1 % und 66,7 % bei den 80-Jährigen und älteren. Die Ergebnisse bei älteren Patienten mit Krebs waren mit denen bei älteren Patienten mit gutartigen Erkrankungen vergleichbar. Bei älteren Krebspatienten wiesen 20,7 % der Patienten mit gutem ECOG-PS Einschränkungen bei den Aktivitäten des täglichen Lebens (ADL) und 21,6 % bei den instrumentellen Aktivitäten des täglichen Lebens (IADL) auf. Von den Patienten ohne Einschränkungen bei den Aktivitäten des täglichen Lebens (ADL) hatten 34,7 % einen schlechten ECOG-PS, und von den Patienten ohne Einschränkungen bei den instrumentellen Aktivitäten des täglichen Lebens (IADL) hatten 26,0 % einen schlechten ECOG-PS. Der Behandlungsansatz (kurativ vs. palliativ) ist signifikant mit funktionellen Einschränkungen verbunden

Weighting factor elicitation for sustainability assessment of energy technologies

In this paper, an approach for sustainability assessment of innovative energy technologies is expanded by multi-criteria decision analysis (MCDA) methods to aggregate indicator results and support decision-making. One of the most important steps for MCDA is to determine weighting factors for individual indicators. Thus, a workshop was performed to elicit weighting factors for sustainability assessments of energy technologies from developers of such technologies and energy system modellers from academia. These stakeholders expressed their preferences with respect to sustainability criteria using the Simple Multi Attribute Rating Technique (SMART). A triple bottom line approach of sustainable development was used as the basis for the aggregation of indicator results. This approach is based on Life Cycle Costing, Life Cycle Assessment and social indicators. Obtained weighting factors were applied to an integrative sustainability assessment with the aggregation method Preference Ranking Organization METHod for Enrichment of Evaluations (PROMETHEE). Hydrogen-based mobility as an important technology to foster decarbonization in the transport sector is used as a case study for the application of the derived weighting factors. A conventional vehicle, powered by fossil fuel, is compared with a fuel cell electric vehicle (FCEV) for the year 2050. Different options (pipeline, compressed gaseous hydrogen, liquid hydrogen, liquid organic hydrogen carrier) are discussed for the supply of hydrogen. The results for this weighting factor set are compared with an equal weighting scenario of the three sustainability dimensions and indicators within one sustainability dimension. The FCEV, using pipelines for hydrogen supply, came out first in the assessment as well as in all sensitivity analyses

Client Concealment and Disclosure of Secrets in Outpatient Psychotherapy

This study investigated client motivations for concealing versus disclosing secrets in therapy as well as how this negotiation process relates to therapeutic process and outcome. About half of the participants had both revealed a secret and were concealing a secret in therapy. Disclosed secrets were most likely to be related to relationships and were disclosed because the clients felt they could trust their therapists and because they thought they could benefit from sharing the secret. Concealed secrets were most likely to be sexual in nature and to be concealed due to shame or embarrassment. Clients initially experienced comparable levels of negative and positive emotions when they first disclosed their secret. However, over time, their feelings about the disclosure became more positive and less negative. Concealment was negatively related to the real relationship

Preface:Recognizing management in LCM

The Life Cycle Management conference 2013 took place in Göteborg, Sweden in August that year. During some very sunny days, nearly 450 presentations took place in front of more than 600 conference goers, leading to uncountable numbers of meetings, conversations, and reflections. A group that brought together different facets of management and policy-making research in relation to LCM was created as conference special issue editors. The group identified a need for systematized descriptions and analyses of life cycle-related practices in industry and in society at large. Preferably, the research should be grounded in the social and management sciences. The intention with the special issue was advancing LCM research, with an emphasis on the 'M' for management. The special issue includes 7 papers developed from the conference presentations. The combination of life cycles and management enables many kinds of LCM research. Novel terminology and perspectives to LCM research introduced by the included papers convey some of this diversity. Studies with a product chain perspective to LCM offer a complementing contrast to the study of corporate LCM. Advancement of LCM research can thus be achieved by expanding from the company perspective towards, looking deeper into the interactions of multiple actors. Also, critical perspectives have been shown to be valuable for the legitimacy and credibility of LCA and its practitioners. These studies show how deeper studies in the social sciences offer paths for the further advancement of LCM

A Tobacco Homolog of DCN1 is Involved in Cellular Reprogramming and in Developmental Transitions

Plant proteomes show remarkable plasticity in reaction to environmental challenges and during developmental transitions. Some of this adaptability comes from ubiquitin-mediated protein destruction regulated by cullin-RING E3 ubiquitin ligases (CRLs). CRLs are activated through modification of the cullin subunit with the ubiquitin-like protein RUB/NEDD8 by an E3 ligase called defective in cullin neddylation 1 (DCN1). Here we show that tobacco DCN1 binds ubiquitin and RUB/NEDD8, and associates with cullin. When knocked down by RNAi, tobacco pollen formation stopped and zygotic embryogenesis was blocked around the globular stage. Additionally, we found that RNAi of DCN1 inhibited the stress-triggered reprogramming of cultured microspores from their intrinsic gametophytic mode of development to an embryogenic state. This stress-induced developmental switch is a known feature in many important crops and leads ultimately to the formation of haploid embryos and plants. Compensating the RNAi effect by re-transformation with a promoter-silencing construct restored pollen development and zygotic embryogenesis, as well as the ability for stress-induced formation of embryogenic microspores. Overexpression of DCN1, however, accelerated pollen tube growth and increased the potential for microspore reprogramming. These results demonstrate that the biochemical function of DCN1 is conserved in plants and that its activity is specifically required for transitions during pollen development and embryogenesis, and for pollen tube tip growth

Diachronic dynamics of Middle English phonotactics provide evidence for analogy effects among lexical and morphonotactic consonant clusters

Consonant clusters that rarely occur lexically (i.e. within morphemes) may function as complexity markers when they span a morpheme boundary, i.e. when they occur morphonotactically. In this study we observe patterns in the diachronic dynamics of Middle English which hint at mutually beneficial effects between morphonotactic and lexical clusters. We suggest that the patterns revealed can be explained by frequency-based analogy effects in language acquisition

Prospective assessment of energy technologies: a comprehensive approach for sustainability assessment

Background: A further increase in renewable energy supply is needed to substitute fossil fuels and combat climate change. Each energy source and respective technologies have specific techno-economic and environmental characteristics as well as social implications. This paper presents a comprehensive approach for prospective sustainability assessment of energy technologies developed within the Helmholtz Initiative “Energy System 2050” (ES2050).Methods: The “ES2050 approach” comprises environmental, economic, and social assessment. It includes established life cycle based economic and environmental indicators, and social indicators derived from a normative concept of sustainable development. The elaborated social indicators, i.e. patent growth rate, acceptance, and domestic value added, address three different socio-technical areas, i.e. innovation (patents), public perception (acceptance), and public welfare (value added).Results: The implementation of the “ES2050 approach” is presented exemplarily and different sustainability indicators and respective results are discussed based on three emerging technologies and corresponding case studies: (1) synthetic biofuels for mobility; (2) hydrogen from wind power for mobility; and (3) batteries for stationary energy storage. For synthetic biofuel, the environmental advantages over fossil gasoline are most apparent for the impact categories Climate Change and Ionizing Radiation—human health. Domestic value added accounts for 66% for synthetic biofuel compared to 13% for fossil gasoline. All hydrogen supply options can be considered to become near to economic competitiveness with fossil fuels in the long term. Survey participants regard Explosion Hazard as the most pressing concern about hydrogen fuel stations. For Li-ion batteries, the results for patent growth rate indicate that they enter their maturity phase.Conclusions: The “ES2050 approach” enables a consistent prospective sustainability assessment of (emerging) energy technologies, supporting technology developers, decision-makers in politics, industry, and society with knowledge for further evaluation, steering, and governance. The approach presented is considered rather a starting point than a blueprint for the comprehensive assessment of renewable energy technologies though, especially for the suggested social indicators, their significance and their embedding in context scenarios for prospective assessments

Peripheral Ventricular Assist Devices in Interventional Cardiology: The Impella® Micro-Axial Pump

Coronary artery disease (CAD) presents an ever-growing burden on health systems especially in the Western world. While percutaneous coronary intervention (PCI) is feasible in increasingly complex CAD, certain patient groups possess a high risk for major cardiac adverse events (MACE) during PCI. Poor outcome is associated with significantly depressed left ventricular function, complexity of relevant lesions, and increasing incidence of pre-existing cerebrovascular comorbidities and poor pre-interventional status. However, these risk factors also translate into a high peri-operative risk for coronary artery bypass graft (CABG) rendering some of these patients inoperable. Peripheral ventricular assist devices (pVADs) are temporarily inserted axial or centrifugal pumps that support ventricular output during PCI. The Impella® micro-axial device (Abiomed, Danvers, Massachusetts, USA) is an easily implantable pVAD that may improve patient outcome during PCI in high-risk patients (termed “protected PCI”) and in patients with cardiogenic shock (CS). pVADs in general and the Impella® system in particular play important roles in interventional cardiology and its indications and use will likely expand in the future. This chapter outlines in detail the indications, applications, and future trends concerning the Impella® system. Practical advice is given on the correct implantation of the device