Collaborative advance care planning in palliative care: a randomised controlled trial.

OBJECTIVE: An effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore, a new conceptual model combining a psycho-oncological approach with structured ACP was developed. The effectiveness and efficiency of this new concept of collaborative ACP (col-ACP) is evaluated in the present randomised controlled trial in patients with palliative cancer. METHODS: 277 patients with palliative cancer and their relatives were randomised into three groups (1) collaborative ACP (col-ACP) consisting of a psycho-oncological approach addressing barriers to EOL conversations followed by a standardised ACP procedure, (2) supportive intervention (active control) and (3) standard medical care. RESULTS: Patients in the col-ACP group completed advance directives (p<0.01) and healthcare proxies (p<0.01) significantly more often. Additionally, they felt better planned ahead for their future treatment (p<0.01) and were significantly more confident that their relatives were aware of their treatment wishes (p=0.03). In fact, their goals of care were known and highly fulfilled. However, patients' and caregivers' quality of life, patients' stress, depression and peace did not differ between the groups. CONCLUSIONS: The new, well-received, concept of col-ACP improves readiness and access to ACP and results in more consistent EOL care. Further, even if no direct influence on quality of life could be proven, it supports patients in planning their treatment, making autonomous decisions and regaining self-efficacy in the face of life-limiting cancer. Therefore, a closer interlocking and information exchange between psycho-oncological and ACP services seems to be reasonable. TRIAL REGISTRATION NUMBER: NCT03387436.

Impact of the Corona Pandemic on Cervical Cancer Screening Assessment.

BACKGROUND/AIM: The global impact of the COVID-19 pandemic resulted in disruptions to healthcare systems throughout the world. The numbers of cytology examinations, human papillomavirus (HPV) tests, and women referred for colposcopy decreased in many countries. There have been no reports on cervical cancer screening in Germany. This study aimed to describe changes in the numbers of colposcopies, cytology examinations, HPV tests, and histological results during the pandemic compared to the pre-pandemic years in order to evaluate the impact of the COVID-19 pandemic on cervical cancer screening. PATIENTS AND METHODS: The numbers of colposcopies, cytology examinations, HPV tests, and histologic results were analyzed retrospectively for the period January 2018 to December 2022. The 2 years period before the pandemic (2018 and 2019) were compared with the 3 years period of the pandemic (2020-2022). RESULTS: In total, 6,518 colposcopies were performed in 5,579 women. The numbers of colposcopies, cytology examinations, and high-risk HPV (hrHPV) tests increased during the pandemic years. The number of biopsies per year taken was stable (range=450-554). The relative numbers of cervical intraepithelial neoplasia (CIN) III/HSIL findings were stable, while the numbers of cervical cancers identified increased slightly from 15 (6.6%) in 2018 to 22 (7.4%) in 2022. CONCLUSION: Increases in numbers of women examined and colposcopies were observed in the years 2021 and 2022 during the pandemic, in comparison to the preceding years. These also led to increases in the figures for cytology, hrHPV, histology, and operations. The onset of the pandemic occurred in the same year as a newly organized screening program started in Germany. The increases might therefore be due to the newly organized screening system.

Rethinking parameters of "success" in breaking bad news conversations from patient's perspective: the successful delivery process model.

PURPOSE: Studies that focus on improving the difficult process of breaking bad news in oncology should include the patient perspective and be guided by appropriate outcome measures. Endpoints such as "patient satisfaction" fall short to capture the complex nature of breaking bad news (BBN) conversations. However, this is true of many studies. The present study attempts to develop a framework model from a new, patient-centered perspective, which can be applied equally in clinical practice and in education. METHODS: Semi-structured in-depth interviews with twelve cancer patients were conducted. Transcripts were analyzed by "qualitative content analysis" following Mayring. Outcomes were further extrapolated in interpretational steps, and a model of "success" from patients view in BBN was developed. RESULTS: Two central needs of the patients could be identified: understanding and feelings. Their fulfillment depends on two groups of variables: first, structural characteristics, such as the inevitable shock, individuality, and processability; second, strongly influenceable variables, such as relationship, transfer of knowledge, and atmosphere. From these results, a framework model for successful breaking of bad news from the patient's perspective was developed: The successful delivery process model (SDP model). CONCLUSION: As a basic model for the framework for breaking bad news from the patient's perspective, the SDP model can be applied to many different situations in oncology and help to frame the difficult conversations by tailoring the BBN conversations on determinants that favorably influence the process in a patient centered manner. In this sense, the model can be useful in clinical practice as well as in education.

Propagation of THz radiation in air over a broad range of atmospheric temperature and humidity conditions.

As the need for higher data rates for communication increases, the terahertz (THz) band has drawn considerable attention. This spectral region promises a much wider bandwidth and the transmission of large amounts of data at high speeds. However, there are still challenges that need to be addressed before the THz telecommunications technology hits the consumer market. One of the recurring concerns is that THz radiation is greatly absorbed by atmospheric water-vapor. Although many studies have presented the attenuation of THz signals under different atmospheric conditions, these results analyze specific temperature or humidity values, leaving the need for a more comprehensive analysis over a wider range of climate conditions. In this work, we present the first study of the attenuation of THz radiation over a broad range of temperatures and humidity values. It is worth noticing that all of our measurements have been undertaken at atmospheric pressure unlike many previous studies where the pressure was not kept constant for various temperatures. Furthermore, we extend our analysis beyond the impact of absolute humidity on the bit error rate in THz communications. We also discuss the refractivity of the atmosphere, examining its variations across different temperatures and humidity levels. THz propagation is studied using two different measurement systems, a long-path THz time-domain spectrometer as well as a quasi-optic setup with vector network analyze. We also compare the results with the ITU-R P.676-13 propagation model. We conclude that the attenuation at the absorption peaks increases linearly with water content and has no dependence on the temperature, while the refractive index, away from absorption lines, namely at 300 GHz shows a sub-linear increase with humidity.

Tuning Interlayer Exciton Emission with TMD Alloys in van der Waals Heterobilayers of Mo0.5W0.5Se2 and Its Binary Counterparts.

Semiconductor heterostructures have been the backbone of developments in electronic and optoelectronic devices. One class of structures of interest is the so-called type II band alignment, in which optically excited electrons and holes relax into different material layers. The unique properties observed in two-dimensional transition metal dichalcogenides and the possibility to engineer van der Waals heterostructures make them candidates for future high-tech devices. In these structures, electronic, optical, and magnetic properties can be tuned through the interlayer coupling, thereby opening avenues for developing new functional materials. We report the possibility of explicitly tuning the emission of interlayer exciton energies in the binary-ternary heterobilayer of Mo0.5W0.5Se2 with MoSe2 and WSe2. The respective interlayer energies of 1.516 eV and 1.490 eV were observed from low-temperature photoluminescence measurements for the MoSe2- and WSe2- based heterostructures, respectively. These interlayer emission energies are above those reported for MoSe2/WSe2 (≃1.30-1.45 eV). Consequently, binary-ternary heterostructure systems offer an extended energy range and tailored emission energies not accessible with the binary counterparts. Moreover, even though Mo0.5W0.5Se2 and MoSe2 have almost similar optical gaps, their band offsets are different, resulting in charge transfer between the monolayers following the optical excitation. Thus, confirming TMDs alloys can be used to tune the band-offsets, which adds another design parameter for application-specific optoelectronic devices.

Determining weathering-induced heterogeneous oxidation profiles of polyethylene, polypropylene and polystyrene using laser-induced breakdown spectroscopy.

Weathering-induced polymer degradation is typically heterogeneous which plays an integral part in fragmentation. Despite that, the current selection of techniques to investigate such heterogeneities, especially beneath the sample surface, is sparse. We introduce Laser-induced Breakdown Spectroscopy (LIBS) as an analytical tool and evaluate its performance for depth profiling. Three types of polymers were selected (polyethylene, polypropylene, and polystyrene) that were aged under controlled conditions. We demonstrate that LIBS can detect heterogeneous oxidation on the surface and inside the samples. The results reveal that different oxidation behaviors are linked to the sample's lattice structure and the subsequent formation of microcracks. This implies that LIBS is beneficial to give additional insights into the weathering and degradation behavior of environmentally relevant plastics.

Cytology and HPV Co-Testing for Detection of Vaginal Intraepithelial Neoplasia: A Retrospective Study.

(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n = 86), VaIN I/vLSIL (n = 116), VaIN II/vHSIL (n = 41), VaIN III/vHSIL (n = 33), and carcinoma (n = 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II/III/vHSIL threefold. The detection rate for VaIN III/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II/III/vHSIL.

Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program.

Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.

Terahertz Spectroscopy for Non-Destructive Solid-State Investigation of Norfloxacin in Paper Tablets after Wet Granulation.

(1) Background: Amorphous drug systems are an intensively studied approach to overcome the insufficient bioavailability of poorly soluble drugs. Here, paper tablets were studied, which were made from cellulose-based paper matrices loaded with norfloxacin. Moreover, wet granulation was introduced as an additional processing step for improving the flowability of the solids, which is necessary when considering production on an industrial scale. (2) Methods: The possible impact of the wet granulation on the crystallinity of norfloxacin was studied by examining granulated and non-granulated samples. Crystallinity investigations were performed using X-ray powder diffraction (XRD) and terahertz time-domain spectroscopy (THz TDS). (3) Results: THz TDS allowed for a more straightforward crystallinity assessment than XRD. Moreover, using THz TDS, it was possible to detect minor changes in the crystallinity of the API after the granulation, whereas this was not possible with the XRD analysis. (4) Conclusions: THz TDS results indicate a partial crystallization of norfloxacin due to the wet granulation. Depending on the formulation, THz TDS can serve as a beneficial and advantageous tool to determine the crystallinity of an API.

Mobile-BAT-A Novel Ultra-Low Power Wildlife Tracking System.

We introduce a novel ultra-low power system for tracking animal movements over long periods with an unprecedented high-temporal-resolution. The localization principle is based on the detection of cellular base stations using a miniaturized software-defined radio, weighing 2.0 g, including the battery, and having a size equivalent to two stacked 1-euro cent coins. Therefore, the system is small and lightweight enough to be deployed on small, wide-ranging, or migrating animals, such as European bats, for movement analysis with an unprecedented spatiotemporal resolution. The position estimation relies on a post-processing probabilistic RF pattern-matching method based on the acquired base stations and power levels. In several field tests, the system has been successfully verified, and a run-time of close to one year has been demonstrated.

Management of Cervical Intraepithelial Neoplasia in Pregnant Women.

BACKGROUND/AIM: The aims of the present study were to evaluate the accuracy of colposcopic findings, investigate the way in which untreated cervical intraepithelial neoplasia (CIN) 2/3 develops during pregnancy, and identify factors associated with regression, persistence, or progression rates. PATIENTS AND METHODS: In a tertiary gynecology and obstetrics department, 655 pregnant women were seen for colposcopy. The most common reason for referral was abnormal cytology findings. The follow-up findings were analyzed retrospectively on the basis of colposcopic findings and cytological and histological tests. RESULTS: The rate of accuracy for major colposcopic findings was 89.2%. Among the colposcopic findings considered "suspicious for invasion" were invasive carcinoma in 42.9% and CIN 3 in 57.1%. The persistence of CIN 3 postpartum was 80% and the rate of progression 4.1%. The rate of regression for CIN 3 was 21.9%. For CIN 2, the rate of persistence was 37.5%, with a regression rate of 31.3%. The rate of regression was higher after vaginal delivery in comparison with caesarean section. CONCLUSION: The accuracy rate of colposcopy is comparatively high, at 89.2%. This might be because pregnant women are seen by more experienced examiners in our dysplasia unit. The rate of progression is comparable with that in other studies. Vaginal delivery increases the regression rate. The newborns' birth weight or birth week did not affect the rates of regression or persistence.

Gestational and Non-gestational Trophoblastic Neoplasia. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 032/049, April 2022).

Purpose The aim was to develop and update a guideline which would improve the quality of care offered to women with gestational and non-gestational trophoblastic disease, a group of diseases characterized by their rarity and biological heterogeneity. Methods In accordance with the method used to compile S2k-guidelines, the guideline authors carried out a search of the literature (MEDLINE) for the period 1/2020 to 12/2021 and evaluated the recent literature. No key questions were formulated. No structured literature search with methodical evaluation and assessment of the level of evidence was carried out. The text of the precursor version of the guideline from 2019 was updated based on the most recent literature, and new statements and recommendations were drafted. Recommendations The updated guideline contains recommendations for the diagnosis and therapy of women with hydatidiform mole (partial and complete moles), gestational trophoblastic neoplasia after pregnancy or without prior pregnancy, persistent trophoblastic disease after molar pregnancy, invasive moles, choriocarcinoma, placental site nodules, placental site trophoblastic tumor, hyperplasia at the implantation site und epithelioid trophoblastic tumor. Separate chapters cover the determination and assessment of human chorionic gonadotropin (hCG), histopathological evaluation of specimens, and the appropriate molecular pathological and immunohistochemical diagnostic procedures. Separate chapters on immunotherapy, surgical therapy, multiple pregnancies with simultaneous trophoblastic disease, and pregnancy after trophoblastic disease were formulated, and the corresponding recommendations agreed upon.

Temperature dependence of the dielectric function of dehydrated biological samples in the THz band.

Terahertz technology has demonstrated enormous potential for the analysis of biological systems and the diagnosis of some medical conditions, given its high sensitivity to detect water content. In previously published papers, effective medium theories are used to extract the water content from the terahertz measurements. When the dielectric functions of water and dehydrated bio-material are well known, the volumetric fraction of water can be left as the only free parameter in those effective medium theory models. While water complex permittivity is very well known, the dielectric functions of dehydrated tissues are normally measured for each individual application. In previous studies, it has been traditionally assumed that, unlike water, the dielectric function of the dehydrated tissues is temperature independent, measuring it only at room temperature. Yet, this is an aspect that has not been discussed and that is relevant in order to get THz technology closer to clinical and in-the-field applications. In this work, we present the characterization of the complex permittivity of dehydrated tissues; each studied at temperatures ranging from 20°C to 36.5°C. We studied samples of different organism classifications to have a wider confirmation of the results. We find that, in each case, the dielectric function changes of dehydrated tissues caused by temperature are smaller than for water across the same temperature interval. Yet, the changes in the dielectric function of the dehydrated tissue are not negligible and should, in many cases, be taken into account for the processing of terahertz signals that interact with biological tissues. While this study gives a first introduction into the probable relevancy of temperature-dependent optical behavior of biological samples, this work only focuses on the experimental proof for this relationship and will, therefore, not give a deeper analysis of how the underlying models have to be modified.

How weather triggers the emergence of bats from their subterranean hibernacula.

Hibernation is one of the most important behaviours of bats of the temperate zone. During winter, when little food or liquid water is available, hibernation in torpor lowers metabolic costs. However, the timing of emergence from hibernation is crucial for the resumption of the reproductive process in spring. Here, we investigate the spring emergence of six bat species or pairs of bat species of the genera Myotis and Plecotus at five hibernation sites in Central Europe over 5 years. Using generalized additive Poisson models (GAPMs), we analyze the influence of weather conditions (air and soil temperature, atmospheric pressure, atmospheric pressure trend, rain, wind, and cloud cover) as predictors of bat activity and separate these extrinsic triggers from residual motivation to emerge from hibernation (extrinsic factors not studied; intrinsic motivation). Although bats in a subterranean hibernaculum are more or less cut off from the outside world, all species showed weather dependence, albeit to varying degrees, with air temperature outside the hibernaculum having a significant positive effect in all species. The residual, potentially intrinsic motivation of species to emerge from their hibernacula corresponds to their general ecological adaptation, such as trophic specialization and roosting preferences. It allows the definition of three functional groups (high, medium and low residual activity groups) according to the degree of weather dependence of spring activity. A better knowledge of the interplay of extrinsic triggers and residual motivation (e.g., internal zeitgebers) for spring emergence will help to understand the flexibility of a species to adapt to a changing world.

Extra-axonal contribution to double diffusion encoding-based pore size estimates in the corticospinal tract.

OBJECTIVE: To study the origin of compartment size overestimation in double diffusion encoding MRI (DDE) in vivo experiments in the human corticospinal tract. Here, the extracellular space is hypothesized to be the origin of the DDE signal. By exploiting the DDE sensitivity to pore shape, it could be possible to identify the origin of the measured signal. The signal difference between parallel and perpendicular diffusion gradient orientation can indicate if a compartment is regular or eccentric in shape. As extracellular space can be considered an eccentric compartment, a positive difference would mean a high contribution to the compartment size estimates. MATERIALS AND METHODS: Computer simulations using MISST and in vivo experiments in eight healthy volunteers were performed. DDE experiments using a double spin-echo preparation with eight perpendicular directions were measured in vivo. The difference between parallel and perpendicular gradient orientations was analyzed using a Wilcoxon signed-rank test and a Mann-Whitney U test. RESULTS: Simulations and MR experiments showed a statistically significant difference between parallel and perpendicular diffusion gradient orientation signals ([Formula: see text]). CONCLUSION: The results suggest that the DDE-based size estimate may be considerably influenced by the extra-axonal compartment. However, the experimental results are also consistent with purely intra-axonal contributions in combination with a large fiber orientation dispersion.

Polyvinylpyrrolidone as co-inhibitor of crystallization of nifedipine in paper tablets.

Techniques to maintain drugs amorphous that would otherwise crystallize is an extensively studied approach to enhance the dissolution characteristics of poorly soluble drugs. However, their performance is limited by the low physical stability of the amorphous phase which can lead to recrystallization which in turn results in decreased solubility and bioavailability of the drug. In this work, the crystallinity of nifedipine loaded into a cellulose-based paper matrix, so called smartFilms, was determined by terahertz time-domain spectroscopy. By adding polyvinylpyrrolidone as an extra carrier, the capability of smartFilms to transfer nifedipine into its amorphous state improved. Moreover, the performance of the formulation to inhibit recrystallization of the amorphous drug over a period of six months increased. For formulations containing up to 10 w% drug loading and additional polyvinylpyrrolidone (nifedipine/polyvinylpyrrolidone: 4:1 mass ratio), nifedipine was found to be completely amorphous after six months of storage.

Cervical intraepithelial neoplasia grade 3: development during pregnancy and postpartum.

PURPOSE: The aims of the present study were to evaluate the development of untreated cervical intraepithelial neoplasia (CIN) 3 during pregnancy and to assess persistence, progression, and regression rates postpartum to identify factors associated with regression. METHODS: In a tertiary gynecology and obstetrics department, a total of 154 pregnant women with CIN 3 were treated in the dysplasia unit. The follow-up findings were analyzed retrospectively on the basis of histological, cytological, and human papillomavirus (HPV) testing of 154 pregnant women confirmed as having CIN 3 in colposcopically guided biopsies. RESULTS: The rates of persistence, regression, and progression of CIN 3 in these women were 76.1%, 20% and 3.2%, respectively. Data for the delivery mode was available for 126 women. The rate of regression was almost twice as high with vaginal delivery as with cesarean section, at 27.4 vs. 15.2%, whereas the rate of progression was lower with vaginal delivery, at 2.7 vs. 6.5%. CONCLUSION: The rate of persistence of CIN observed in this study is comparable to that reported in other studies. The study provides strong evidence for greater regression among women who have vaginal deliveries. Careful work-up is recommended postpartum for this group of women in order to rule out persistent CIN 3 or invasive disease.

Metabarcoding dietary analysis in the insectivorous bat Nyctalusleisleri and implications for conservation.

In this study, we aim to uncover diet preferences for the insectivorous bat Nyctalusleisleri (Leisler's bat, the lesser noctule) and to provide recommendations for conservation of the species, based on the analysis of prey source habitats. Using a novel guano trap, we sampled bat faeces at selected roosts in a forest in Germany and tested two mitochondrial markers (COI and 16S) and three primer pairs for the metabarcoding of bat faecal pellets. We found a total of 17 arthropod prey orders comprising 358 species in N.leisleri guano. The most diverse orders were Lepidoptera (126 species), Diptera (86 species) and Coleoptera (48 species), followed by Hemiptera (28 species), Trichoptera (16 species), Neuroptera (15 species) and Ephemeroptera (10 species), with Lepidoptera species dominating in spring and Diptera in summer. Based on the ecological requirements of the most abundant arthropod species found in the bat guano, we propose some recommendations for the conservation of N.leisleri that are relevant for other insectivorous bat species.

Layer separation mapping and consolidation evaluation of a fifteenth century panel painting using terahertz time-domain imaging.

Over time, artworks often sustain paint layer separation and air gaps within their internal structure due to storage conditions and past restoration efforts. Because of this, paint layer consolidation interventions are an essential activity for art conservators. However, it is difficult to determine the exact location and the extent of layer separation on a piece of art in a non-invasive way, and even more difficult to evaluate the success of a consolidation intervention. In this work, a fifteenth-century wood panel painting was analyzed using terahertz time-domain imaging before and after it was consolidated. Using the terahertz data, it was possible to determine the areas on the artwork in need of consolidation and aid the intervention. The analysis of the after data allowed for the control and determination of the success of the consolidation effort in a non-destructive manner.

Identifying plastics with photoluminescence spectroscopy and machine learning.

A quantitative understanding of the worldwide plastics distribution is required not only to assess the extent and possible impact of plastic litter on the environment but also to identify possible counter measures. A systematic collection of data characterizing amount and composition of plastics has to be based on two crucial components: (i) An experimental approach that is simple enough to be accessible worldwide and sensible enough to capture the diversity of plastics; (ii) An analysis pipeline that is able to extract the relevant parameters from the vast amount of experimental data. In this study, we demonstrate that such an approach could be realized by a combination of photoluminescence spectroscopy and a machine learning-based theoretical analysis. We show that appropriate combinations of classifiers with dimensional reduction algorithms are able to identify specific material properties from the spectroscopic data. The best combination is based on an unsupervised learning technique making our approach robust to alternations of the input data.