[Living Actively with Cancer - Recommendations for a Healthy Life Style: Needs Assessment and Design of Multimedia Patient Information]. / "Aktiv leben mit Krebs ­ Tipps für einen gesunden Lebensstil" ­ Bedarfserfassung und Entwicklung einer multimedialen Patienteninformation.

The positive effects of a healthy lifestyle on the holistic physical condition and quality of life of cancer survivors is scientifically proven. The National Comprehensive Cancer Network (NCCN) Guidelines for Survivorship specifically highlight the need for support in these areas. The lack of specialised offers for cancer patients in predominantly rural areas, however, represents a high level of assistance needed in terms of the development and implementation of a healthy lifestyle. Following a needs assessment, our aim was to conceptualise and design an easily accessible multi-media patient information system on the basis of a social-cognitive process model on health behaviour (Health Action Process Approach - HAPA). A higher level of health literacy represents, inter alia, the basis for informed choice and, as such, forms an important resource for the aftercare of cancer patients. Further studies are recommended on the acceptance, use and effects of patient information with regard to intended longer-term changes of health behaviour.

Impact of invasive Lantana camara on maize and cassava growth in East Usambara, Tanzania.

The impacts of invasive alien plant species on native plants are generally well documented, but little is known about the mechanisms underlying their impacts on crop growth. A better understanding of immediate as well as legacy effects and of direct and indirect impacts of invasive alien plant species is essential for an improved management of invaded cropland. We investigated how Lantana camara impacts the growth of two subsistence crops (maize and cassava) through competition for resources, allelopathy and the indirect plant-plant interactions. We carried out two pot experiments using soils from invaded abandoned, invaded cultivated and non-invaded cultivated crop fields. In the first experiment maize and cassava were grown alone or together with L. camara and half of the pots were treated with activated carbon to suppress allelochemicals. The effect of the soil microbial community on L. camara-crop interactions was assessed in a second experiment using autoclaved soil with 5% of soil from the three soil types. We found that L. camara reduced the growth of maize by 29%, but cassava was not affected. We did not find evidence of allelopathic effects of L. camara. Inoculation of autoclaved soil with microorganisms from all soil types increased biomass of cassava and reduced the growth of maize. Because L. camara only caused impacts when growing simultaneously with maize, the results suggest that removal of L. camara will immediately mitigate its negative impacts on maize.

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs.

Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.

Restoration of degraded grasslands, but not invasion by Prosopis juliflora, avoids trade-offs between climate change mitigation and other ecosystem services.

Grassland degradation and the concomitant loss of soil organic carbon is widespread in tropical arid and semi-arid regions of the world. Afforestation of degraded grassland, sometimes by using invasive alien trees, has been put forward as a legitimate climate change mitigation strategy. However, even in cases where tree encroachment of degraded grasslands leads to increased soil organic carbon, it may come at a high cost since the restoration of grassland-characteristic biodiversity and ecosystem services will be blocked. We assessed how invasion by Prosopis juliflora and restoration of degraded grasslands in a semi-arid region in Baringo, Kenya affected soil organic carbon, biodiversity and fodder availability. Thirty years of grassland restoration replenished soil organic carbon to 1 m depth at a rate of 1.4% per year and restored herbaceous biomass to levels of pristine grasslands, while plant biodiversity remained low. Invasion of degraded grasslands by P. juliflora increased soil organic carbon primarily in the upper 30 cm and suppressed herbaceous vegetation. We argue that, in contrast to encroachment by invasive alien trees, restoration of grasslands in tropical semi-arid regions can both serve as a measure for climate change mitigation and help restore key ecosystem services important for pastoralists and agro-pastoralist communities.

Implications of land use/land cover dynamics and Prosopis invasion on ecosystem service values in Afar Region, Ethiopia.

Land use/land cover (LULC) dynamics and the resulting changes in ecosystems, as well as the services they provide, are a consequence of human activities and environmental drivers, such as invasive alien plant species. This study assessed the changes in LULC and ecosystem service values (ESVs) in the Afar National Regional State, Ethiopia, which experiences a rapid invasion by the alien tree Prosopis juliflora (Swartz DC). Landsat satellite data of 1986, 2000 and 2017 were used in Random Forest algorithm to assess LULC changes in the last 31 years, to calculate net changes for different LULC types and the associated changes in ESVs. Kappa accuracies of 88% and higher were obtained for the three LULC classifications. Post-classification change analyses for the period between 1986 and 2017 revealed a positive net change for Prosopis invaded areas, cropland, salt flats, settlements and waterbodies. The rate of Prosopis invasion was estimated at 31,127 ha per year. Negative net changes were found for grassland, bareland, bush-shrub-woodland, and natural forests. According to the local community representatives, the four most important drivers of LULC dynamics were climate change, frequent droughts, invasive species and weak traditional law. Based on two different ESVs estimations, the ecosystem changes caused by LULC changes resulted in an average loss of ESVs in the study area of about US$ 602 million (range US$ 112 to 1091 million) over the last 31 years. With an increase in area by 965,000 ha, Prosopis-invaded land was the highest net change during the study period, followed by grassland (-599,000 ha), bareland (-329,000 ha) and bush-shrub-woodland (-327,000 ha). Our study provides evidence that LULC changes in the Afar Region have led to a significant loss in ESVs, with serious consequences for the livelihoods of the rural people.

Performances of machine learning algorithms for mapping fractional cover of an invasive plant species in a dryland ecosystem.

In recent years, an increasing number of distribution maps of invasive alien plant species (IAPS) have been published using different machine learning algorithms (MLAs). However, for designing spatially explicit management strategies, distribution maps should include information on the local cover/abundance of the IAPS. This study compares the performances of five MLAs: gradient boosting machine in two different implementations, random forest, support vector machine and deep learning neural network, one ensemble model and a generalized linear model; thereby identifying the best-performing ones in mapping the fractional cover/abundance and distribution of IPAS, in this case called Prosopis juliflora (SW. DC.). Field level Prosopis cover and spatial datasets of seventeen biophysical and anthropogenic variables were collected, processed, and used to train and validate the algorithms so as to generate fractional cover maps of Prosopis in the dryland ecosystem of the Afar Region, Ethiopia. Out of the seven tested algorithms, random forest performed the best with an accuracy of 92% and sensitivity and specificity >0.89. The next best-performing algorithms were the ensemble model and gradient boosting machine with an accuracy of 89% and 88%, respectively. The other tested algorithms achieved comparably low performances. The strong explanatory variables for Prosopis distributions in all models were NDVI, elevation, distance to villages and distance to rivers; rainfall, temperature, near-infrared and red reflectance, whereas topographic variables, except for elevation, did not contribute much to the current distribution of Prosopis. According to the random forest model, a total of 1.173 million ha (12.33% of the study region) was found to be invaded by Prosopis to varying degrees of cover. Our findings demonstrate that MLAs can be successfully used to develop fractional cover maps of plant species, particularly IAPS so as to design targeted and spatially explicit management strategies.

Modelling the current fractional cover of an invasive alien plant and drivers of its invasion in a dryland ecosystem.

The development of spatially differentiated management strategies against invasive alien plant species requires a detailed understanding of their current distribution and of the level of invasion across the invaded range. The objectives of this study were to estimate the current fractional cover gradient of invasive trees of the genus Prosopis in the Afar Region, Ethiopia, and to identify drivers of its invasion. We used seventeen explanatory variables describing Landsat 8 image reflectance, topography, climate and landscape structures to model the current cover of Prosopis across the invaded range using the random forest (RF) algorithm. Validation of the RF algorithm confirmed high model performance with an accuracy of 92% and a Kappa-coefficient of 0.8. We found that, within 35 years after its introduction, Prosopis has invaded approximately 1.17 million ha at different cover levels in the Afar Region (12.3% of the surface). Normalized difference vegetation index (NDVI) and elevation showed the highest explanatory power among the 17 variables, in terms of both the invader's overall distribution as well as areas with high cover. Villages and linear landscape structures (rivers and roads) were found to be more important drivers of future Prosopis invasion than environmental variables, such as climate and topography, suggesting that Prosopis is likely to continue spreading and increasing in abundance in the case study area if left uncontrolled. We discuss how information on the fractional cover and the drivers of invasion can help in developing spatially-explicit management recommendations against a target invasive plant species.

Uptake of Gynecological Cancer Screening and Performance of Breast Self-Examination Among 50-Year-Old Migrant and Non-migrant Women in Germany: Results of a Cross-Sectional Study (InEMa).

Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer.

Knowledge about mammography screening in Germany by education and migrant status ­ results of a cross-sectional study (InEMa)

Background: The population-based mammography screening program (MSP) is aimed to reduce breast cancer mortality, to detect breast cancer at an early stage, and to allow for less invasive treatment. However, it also has some potential harms, such as overdiagnosis and overtreatment. Therefore, it is necessary that women receive sufficient and balanced information to enable informed decision-making. We examined knowledge about benefits and harms of the MSP in Germany among first-time invitees of different socio-demographic backgrounds. Methods: This observational study assessed knowledge about benefits and harms of the MSP among women who were invited to the MSP for the first time by six multiple choice items, using a postal survey. We investigated (i) single items of knowledge, (ii) the distribution of sufficient knowledge stratified by education, migration status and invitation, and (iii) possible determinants of sufficient knowledge by analyzing Odds Ratios (ORs) using bivariate and multivariate logistic regression. Results: In total, 5397 women included in the analyses. 46.1% of the study population had sufficient knowledge about benefits and harms of the MSP. However, women with low educational level and migration background had higher proportions of insufficient knowledge and used most frequently the option "don't know". Women had the most difficulties answering the numeric question and the question about the target group correctly. Results from the logistic regression showed that the odds of having sufficient knowledge were higher among well-educated women (OR 3.84, 95%CI 3.24­4.55), among women who already received the MSP invitation (OR 1.38, 95%CI 1.20­1.59) and lowest among Turkish women (OR 0.14, 95%CI 0.07­0.25). Conclusions: Women with low education and migration background need adapted information regarding benefits and harms of the MSP and are important target groups for further developing the information material about mammography screening to reduce disparities in knowledge and enable informed decision-making (AU)

How do large-scale agricultural investments affect land use and the environment on the western slopes of Mount Kenya? Empirical evidence based on small-scale farmers' perceptions and remote sensing.

Africa has been heavily targeted by large-scale agricultural investments (LAIs) throughout the last decade, with scarcely known impacts on local social-ecological systems. In Kenya, a large number of LAIs were made in the region northwest of Mount Kenya. These large-scale farms produce vegetables and flowers mainly for European markets. However, land use in the region remains dominated by small-scale crop and livestock farms with less than 1 ha of land each, who produce both for their own subsistence and for the local markets. We interviewed 100 small-scale farmers living near five different LAIs to elicit their perceptions of the impacts that these LAIs have on their land use and the overall environment. Furthermore, we analyzed remotely sensed land cover and land use data to assess land use change in the vicinity of the five LAIs. While land use change did not follow a clear trend, a number of small-scale farmers did adapt their crop management to environmental changes such as a reduced river water flows and increased pests, which they attributed to the presence of LAIs. Despite the high number of open conflicts between small-scale land users and LAIs around the issue of river water abstraction, the main environmental impact, felt by almost half of the interviewed land users, was air pollution with agrochemicals sprayed on the LAIs' land. Even though only a low percentage of local land users and their household members were directly involved with LAIs, a large majority of respondents favored the presence of LAIs nearby, as they are believed to contribute to the region's overall economic development.

Identification and classification of structural soil conservation measures based on very high resolution stereo satellite data.

Land degradation affects large areas of land around the globe, with grave consequences for those living off the land. Major efforts are being made to implement soil and water conservation measures that counteract soil erosion and help secure vital ecosystem services. However, where and to what extent such measures have been implemented is often not well documented. Knowledge about this could help to identify areas where soil and water conservation measures are successfully supporting sustainable land management, as well as areas requiring urgent rehabilitation of conservation structures such as terraces and bunds. This study explores the potential of the latest satellite-based remote sensing technology for use in assessing and monitoring the extent of existing soil and water conservation structures. We used a set of very high resolution stereo Geoeye-1 satellite data, from which we derived a detailed digital surface model as well as a set of other spectral, terrain, texture, and filtered information layers. We developed and applied an object-based classification approach, working on two segmentation levels. On the coarser level, the aim was to delimit certain landscape zones. Information about these landscape zones is useful in distinguishing different types of soil and water conservation structures, as each zone contains certain specific types of structures. On the finer level, the goal was to extract and identify different types of linear soil and water conservation structures. The classification rules were based mainly on spectral, textural, shape, and topographic properties, and included object relationships. This approach enabled us to identify and separate from other classes the majority (78.5%) of terraces and bunds, as well as most hillside terraces (81.25%). Omission and commission errors are similar to those obtained by the few existing studies focusing on the same research objective but using different types of remotely sensed data. Based on our results, we estimate that the construction of the conservation structures in our study area in Eritrea required over 300,000 person-days of work, which underlines the huge efforts involved in soil and water conservation.

Physical condition, nutritional status, fatigue, and quality of life in oncological out-patients.

OBJECTIVE: Early detection of limited physical activity and nutritional deficiencies in cancer survivors could contribute to early treatment and preservation of quality of life. The aim of this study is to describe the association of physical condition and nutritional status with fatigue and quality of life in oncological out-patients. METHODS: Data in this descriptive study was collected on bioelectrical impedance analysis, postural stability (stability index), body mass index, Karnofsky Index, quality of life (Short-Form 36-Item Health Survey) and fatigue (multidimensional fatigue inventory-20) in a consecutive sample of 203 oncological out-patients. Phase angle was calculated from bioelectrical impedance analysis. Values were intercorrelated and compared to appropriate standard values. RESULTS: Phase angle and stability index outcomes were far below the values of a healthy population of similar age (p < 0.001). Quality of life was significantly lower than in the normal population (p < 0.001), and the level of fatigue was significantly higher (p < 0.001). Phase angle correlated with Karnofsky Index (p = 0.002) and Short-Form 36-Item Health Survey Summary physical function (p < 0.001). Furthermore, multidimensional fatigue inventory-20 scales 'physical fatigue' and 'reduced activity' were significantly associated with phase angle (p = 0.04, p = 0.005). Stability indices correlated with Short-Form 36-Item Health Survey physical function. CONCLUSION: The physical condition and the nutritional status are key components determining the individual quality of life of oncological out-patients. These variables also showed an association with the manifestation of fatigue. Results highlight the need for interdisciplinary cooperation to detect physical, nutritional and psychological deficiencies in oncological out-patients.

Large-Scale Land Acquisition and Its Effects on the Water Balance in Investor and Host Countries.

This study examines the validity of the assumption that international large-scale land acquisition (LSLA) is motivated by the desire to secure control over water resources, which is commonly referred to as 'water grabbing'. This assumption was repeatedly expressed in recent years, ascribing the said motivation to the Gulf States in particular. However, it must be considered of hypothetical nature, as the few global studies conducted so far focused primarily on the effects of LSLA on host countries or on trade in virtual water. In this study, we analyse the effects of 475 intended or concluded land deals recorded in the Land Matrix database on the water balance in both host and investor countries. We also examine how these effects relate to water stress and how they contribute to global trade in virtual water. The analysis shows that implementation of the LSLAs in our sample would result in global water savings based on virtual water trade. At the level of individual LSLA host countries, however, water use intensity would increase, particularly in 15 sub-Saharan states. From an investor country perspective, the analysis reveals that countries often suspected of using LSLA to relieve pressure on their domestic water resources--such as China, India, and all Gulf States except Saudi Arabia--invest in agricultural activities abroad that are less water-intensive compared to their average domestic crop production. Conversely, large investor countries such as the United States, Saudi Arabia, Singapore, and Japan are disproportionately externalizing crop water consumption through their international land investments. Statistical analyses also show that host countries with abundant water resources are not per se favoured targets of LSLA. Indeed, further analysis reveals that land investments originating in water-stressed countries have only a weak tendency to target areas with a smaller water risk.

Estimating population and livestock density of mobile pastoralists and sedentary settlements in the south-eastern Lake Chad area.

Mobile pastoralists provide major contributions to the gross domestic product in Chad, but little information is available regarding their demography. The Lake Chad area population is increasing, resulting in competition for scarce land and water resources. For the first time, the density of people and animals from mobile and sedentary populations was assessed using randomly defined sampling areas. Four sampling rounds were conducted over two years in the same areas to show population density dynamics. We identified 42 villages of sedentary communities in the sampling zones; 11 (in 2010) and 16 (in 2011) mobile pastoralist camps at the beginning of the dry season and 34 (in 2011) and 30 (in 2012) camps at the end of the dry season. A mean of 64.0 people per km2 (95% confidence interval, 20.3-107.8) were estimated to live in sedentary villages. In the mobile communities, we found 5.9 people per km2 at the beginning and 17.5 people per km2 at the end of the dry season. We recorded per km2 on average 21.0 cattle and 31.6 small ruminants in the sedentary villages and 66.1 cattle and 102.5 small ruminants in the mobile communities, which amounts to a mean of 86.6 tropical livestock units during the dry season. These numbers exceed, by up to five times, the published carrying capacities for similar Sahelian zones. Our results underline the need for a new institutional framework. Improved land use management must equally consider the needs of mobile communities and sedentary populations.

Functional morphology, biomechanics and biomimetic potential of stem-branch connections in Dracaena reflexa and Freycinetia insignis.

Branching in plants is one of the most important assets for developing large arborescent growth forms with complex crowns. While the form and development of branching in gymnosperms and dicotyledonous trees is widely understood, very little is known about branching patterns and the structure of branch-stem-junctions in arborescent monocotyledons. For a better and quantitative understanding of the functional morphology of branch-stem-junctions in arborescent monocotyledons, we investigated the two species Dracaena reflexa and Freycinetia insignis. While D. reflexa is able to develop large arborescent forms with conspicuous crowns by anomalous secondary growth, F. insignis remains relatively small and is only capable of primary growth. Biomechanical investigations were performed by applying vertical loads up to rupture to lateral branches of both species. This allows the analysis of the fracture mechanics and the determination of the maximal force, stress and strain at rupture as well as the fracture toughness. Functional morphology was correlated with the mechanical behaviour of these plants and compared to data of other dicotyledonous trees. The high energy absorption found in the rupture process of lateral branches of D. reflexa and F. insignis makes them promising biological concept generators with a high potential for biomimetic implementation, i.e., for the development of branched fibre-reinforced technical composites. A wide range of constructional elements with branched (sub-)structures can be optimised by using solutions inspired by plant ramifications, e.g., in automotive and aerospace engineering, architecture, sports equipment and prosthetic manufacturing.