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Many of our generation’s most pressing environmental science problems are wicked problems, which means they cannot be cleanly isolated and solved with a single ‘correct’ answer (e.g., Rittel 1973; Wirz 2021). The NSF AI Institute for Research on Trustworthy AI in Weather, Climate, and Coastal Oceanography (AI2ES) seeks to address such problems by developing synergistic approaches with a team of scientists from three disciplines: environmental science (including atmospheric, ocean, and other physical sciences), AI, and social science including risk communication. As part of our work, we developed a novel approach to summer school, held from June 27-30, 2022. The goal of this summer school was to teach a new generation of environmental scientists how to cross disciplines and develop approaches that integrate all three disciplinary perspectives and approaches in order to solve environmental science problems. In addition to a lecture series that focused on the synthesis of AI, environmental science, and risk communication, this year’s summer school included a unique Trust-a-thon component where participants gained hands-on experience applying both risk communication and explainable AI techniques to pre-trained ML models. We had 677 participants from 63 countries register and attend online. Lecture topics included trust and trustworthiness (Day 1), explainability and interpretability (Day 2), data and workflows (Day 3), and uncertainty quantification (Day 4). For the Trust-a-thon we developed challenge problems for three different application domains: (1) severe storms, (2) tropical cyclones, and (3) space weather. Each domain had associated user persona to guide user-centered development.

There is clear evidence that the earth's climate is changing, largely from anthropogenic causes. Flooding and tropical cyclones have clear impacts on human health in the United States at present, and projections of their health impacts in the future will help inform climate policy, yet to date there have been few quantitative climate health impact projections.Despite a wealth of studies characterizing health impacts of floods and tropical cyclones, many are better suited for qualitative, rather than quantitative, projections of climate change health impacts. However, a growing number have features that will facilitate their use in quantitative projections, features we highlight here. Further, while it can be difficult to project how exposures to flood and tropical cyclone hazards will change in the future, climate science continues to advance in its capabilities to capture changes in these exposures, including capturing regional variation. Developments in climate epidemiology and climate science are opening new possibilities in projecting the health impacts of floods and tropical cyclones under a changing climate.

Tropical cyclones impact human health, sometimes catastrophically. Epidemiological research characterizes these health impacts and uncovers pathways between storm hazards and health, helping to mitigate the health impacts of future storms. These studies, however, require researchers to identify people and areas exposed to tropical cyclones, which is often challenging. Here we review approaches, tools, and data products that can be useful in this exposure assessment.Epidemiological studies have used various operational measures to characterize exposure to tropical cyclones, including measures of physical hazards (e.g., wind, rain, flooding), measures related to human impacts (e.g., damage, stressors from the storm), and proxy measures of distance from the storm's central track. The choice of metric depends on the research question asked by the study, but there are numerous resources available that can help in capturing any of these metrics of exposure. Each has strengths and weaknesses that may influence their utility for a specific study. Here we have highlighted key tools and data products that can be useful for exposure assessment for tropical cyclone epidemiology. These results can guide epidemiologists as they design studies to explore how tropical cyclones influence human health.

Strategic preparedness has been shown to reduce the adverse health impacts of hurricanes and tropical storms, referred to collectively as tropical cyclones (TCs), but its protective impact could be enhanced by a more comprehensive and rigorous characterization of TC epidemiology. To generate the insights and tools necessary for high-precision TC preparedness, we develop and apply a novel Bayesian machine learning approach that standardizes estimation of historic TC health impacts, discovers common patterns and sources of heterogeneity in those health impacts, and enables identification of communities at highest health risk for future TCs. The model integrates (1) a causal inference component to quantify the immediate health impacts of recent historic TCs at high spatial resolution and (2) a predictive component that captures how TC meteorological features and socioeconomic/demographic characteristics of impacted communities are associated with health impacts. We apply it to a rich data platform containing detailed historic TC exposure information and Medicare claims data. The health outcomes used in our analyses are all-cause mortality and cardiovascular- and respiratory-related hospitalizations. We report a high degree of heterogeneity in the acute health impacts of historic TCs at both the TC level and the community level, with substantial increases in respiratory hospitalizations, on average, during a two-week period surrounding TCs. TC sustained windspeeds are found to be the primary driver of increased mortality and respiratory risk. Our modeling approach has broader utility for predicting the health impacts of many types of extreme climate events.

Zusammenfassung Fragestellung Assoziation zwischen Bildungsstand (BldS) der Eltern und diabetesbezogenen Outcomes bei Kindern mit Typ-1-Diabetes in Deutschland und Vergleich mit deren sozioökonomischem Status (SES). Material und Methode 1781 Kinder und Jugendliche mit Typ-1-Diabetes mellitus unter 18 Jahren aus 13 deutschen Diabeteszentren wurden von Juni 2013 bis Juni 2014 in die Studie eingeschlossen und Assoziationen des familiären BldS mit verschiedenen Diabetesoutcomes analysiert. Die Analyse wurde als Sekundäranalyse anhand des Datensatzes der DIAS-Studie durchgeführt. Diese hatte Assoziationen eines niedrigen SES (gemessen mit einem Index aus BldS, beruflicher Stellung und Haushaltseinkommen der Eltern) mit ungünstigen Diabetes- und Versorgungsoutcomes ermittelt. Die vorliegende Sekundäranalyse untersuchte Assoziationen derselben Outcomes mit dem BldS der Eltern, um zu prüfen, ob sich der BldS als vereinfachter Indikator für die Routinemessung des SES eignet.Die Daten wurden mittels der DPV-Software (Diabetes-Patienten-Verlaufsdokumentation) erfasst, die Analysen erfolgten je nach Verteilungscharakteristika der Outcomes mittels linearer, logistischer, negativ-binomialer oder Poisson-Modellen unter Adjustierung für Alter, Geschlecht, Diabetesdauer, jeweils mit und ohne zusätzliche Adjustierung für Migrationshintergrund. Ergebnisse Niedriger familiärer BldS war im Vergleich zu mittlerem/hohem BldS mit einer schlechteren glykämischen Einstellung (HbA1c) (8,1 % versus 7,8 %, p Zusammenfassung Der BldS der Eltern ist ein bedeutsamer Prädiktor für Gesundheits- und Versorgungsoutcomes bei Kindern mit Typ-1-Diabetes und sollte in der personalisierten Diabetestherapie von Kindern und Jugendlichen mehr Berücksichtigung erfahren. Als kurzer und leicht zu erhebender Indikator bildet er einen guten Näherungswert für die Routineerhebung der individuellen Stellung der Patientinnen und Patienten in der Sozialhierarchie in Diabetes-Standarddokumentationen.

Die psychoonkologische Versorgung von Tumorpatienten ist in der onkologischen Medizin zunehmend etabliert, nicht zuletzt durch die Implementierung der S3-Leitlinie. Daruber hinaus gibt es bei der psychoonkologischen Versorgung von Patienten mit akuten Leukamien einige spezifische Besonderheiten zu berucksichtigen. In diesem Artikel werden Aspekte aufgezeigt, die Arzte und Psychoonkologen bei der Unterstutzung der Patienten beachten sollten.

Objective To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. Methods A total of 1829 subjects

Development of quality of life in patients undergoing allogeneic stem cell transplantation with regard to anxiety, depression and resilience

Authenticity has recently become a popular term in science education. A study focusing on authenticity in the sense of making chemistry lessons better resemble chemistry practice is carried out at the University of Cologne in the Institute of Chemical Education, where prospective chemistry teachers are trained. In the long run an innovative module shall be developed, which challenges teacher students’ pre-conceptions about characteristics of chemistry practice and supports them in translating their conceptions into authentic learning environments. This paper presents the first part of the project in which course elements to stimulate reflection on students’ attitudes were evaluated. Moreover the students were given an opportunity for teacher students to create a practical activity for pupils in order to detect aspects in which the students need more support, for example possible ways for this transformation or more experience with inquiry-based learning.

Undertreatment of the older patients with AML can explain, in part, their inferior outcome when compared with that in younger patients. In analogy to the benefit of patients under the age of 60 years from high-dose AraC there are dosage related therapeutic effects in the patients over 60 years in particular for daunorubicin in the induction treatment, and for maintenance versus no maintenance in the post-remission treatment. Utilizing these effects can partly overcome the mostly unfavorable disease biology in older age AML, whereas the role of risk factors involved is not completely understood and the concept of dose–response needs to be requestioned. We recommend an adequate dosage of 60mg/(m 2 day) daunorubicin for 3 days in a combination with standard dose AraC and 6-thioguanine given for induction and consolidation and followed by a prolonged monthly maintenance chemotherapy. Further improvements in supportive care may help delivering additional anti-leukemic cytotoxicity. As a novel approach, reduced toxicity preparative regimens may open up allogeneic transplantation for older patients with AML. Other new options like MDR modulators, antibody targeted therapies and tyrosine kinase inhibitors are under clinical investigation. A questionnaire study in patients with AML showed that according to patients' self-assessment intensive and prolonged treatment did not result in decreasing quality of life. This finding did not vary by age under or above 60 years. Given the actual median age in this disease being more than 60 years the adequate management of older age AML remains as the major challenge.

Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high-dose cytosine arabinoside (Ara-C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over-representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara-C and 6-thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients' self-assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.

Background Allogeneic stem cell transplantation (alloSCT) is the preferred option of postremission therapy for high-risk patients suffering from acute myeloid leukemia (AML). Therefore, monitoring life satisfaction (LS) of long-term survivors following alloSCT is becoming increasingly important for oncologists. The aim of the study was to evaluate individual survivor priority of various general and health-related domains of life and their satisfaction with these domains. Furthermore, we investigated the impact of general and health-related LS on resilience, anxiety, depression and quality of life in AML survivors following alloSCT. Methods Forty-one AML survivors (median age at time of assessment = 49.0 years) who had undergone alloSCT (median time since transplantation = 3.1 years) were enrolled in the study. Psychosocial parameters were assessed using the following instruments: FLZM (Questions on Life Satisfaction), EORTC QLQ-C30, HADS (Hospital Anxiety and Depression Scale) and the RS-25 (Resilience Scale-25 items). Correlation analyses were computed to reveal the associations between the different questionnaires. Results Independence from help or care, well-regulated living conditions and financial security contributed positively to LS, whereas being off work due to health-reasons and dissatisfaction with physical aspects were negatively associated to the subjective feelings of overall satisfaction. Moreover, a high quality of life was strongly positively correlated with LS (Spearman’s rho general LS: 0.643 and health-related LS: 0.726, both p

The purpose of this investigation was to determine how the position of tibial rotation effects the EMG activity of the medial and lateral hamstrings during low-force isometric knee flexion contractions. Forty-five subjects (ages 18-35) with no history of lower extremity injury or disease volunteered for this study. While lying prone, and with surface EMG electrodes secured to the bellies of their right medial (semitendinous and semimembranosus) and lateral (long head of the biceps femoris) hamstring muscles, each subject held the knee in 45° of flexion for 8 s against 5% of their body weight. This was performed three times in each of the positions of neutral tibial rotation, external tibial rotation, and internal tibial rotation. The root-mean-square (RMS) of the EMG activity from these muscles was determined for each of the contractions. A repeated measures ANOVA was used to compare the RMS values of the two muscle groups in the three positions. The average RMS values (in microvolts [mV]) obtained were (means and standard deviation): medial hamstrings in external rotation: 50.74 ± 23.11; in neutral: 65.57 ± 25.35; in internal rotation: 70.73 ± 31.86; lateral hamstrings in external rotation: 66.08 ± 46.99; in neutral: 46.18 ± 39.34; in internal rotation: 27.68 ± 17.86. A statistically significant interaction was found between tibial rotation and hamstring muscle (p < 0.0001). These results are consistent with the presumed function of these muscles in that EMG activity in the medial hamstrings increased when the tibia was rotated internally, whereas the lateral hamstring EMG activity increased when the tibia was rotated externally.

After undergoing allogeneic stem cell transplantation (alloSCT), patients adapt in very different ways to their taxing situation. Some patients cope very well; others almost seem to fail. Psychosocial variables are important factors for successful reintegration. Besides quality of life, resilience may help to understand the variance in individual differences in adaptation after alloSCT.A pilot study at the University Hospital Muenster, Germany, assessed resilience in patients after alloSCT. The sample included 75 patients (leukemia, lymphoma, myeloma, aplastic anemia) aged 20-76 years. The instruments Resilience Scale RS-25, Hospital Anxiety and Depression Scale, General Self-efficacy Scale, and EORTC QLQ-C30 were used.Resilience is positively correlated with quality of life (Spearman's rho 0.587) and social functioning (0.472), negatively with anxiety (-0.491) and depression (-0.577). Dividing the sample at the median resilience score of 144 reveals that high-resilience patients report less anxiety (p = 0.008) and depression (p 0.001); higher physical (p = 0.041), emotional (p = 0.030), and social functioning (p = 0.003); and a better quality of life (p 0.001) than low-resilience patients. No effects on resilience were found for age, gender, and primary disease entity. The high correlation of resilience and self-efficacy (r = 0.698) shows the strong relationship between the two concepts. Our results indicate a potential influence of the time span from alloSCT on patients' resilience.Resilience should be considered as a protective psychosocial factor for patients after alloSCT. A high degree of resilience can help patients to adapt to their situation and to resume their everyday life.

OBJECTIVE: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. RESEARCH DESIGN AND METHODS: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. RESULTS: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. CONCLUSIONS: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

Background The impact on quality of life of allogeneic stem cell transplantation or conventional chemotherapy in patients with acute myeloid leukemia remains unclear, mainly because of a lack of studies with long-term follow-up. The German AML-Intergroup, therefore, initiated a survey on quality of life of patients with a relapse-free survival of at least 5 years after first-line treatment. Design and Methods The EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics was used. The questionnaire was returned by 419 of 818 patients (51.2%) identified by six study groups. The patients’ median age at diagnosis was 42 years, and the median follow-up period was 8 years. One hundred and seventy patients were treated with stem cell transplantation (121 allogenic, 49 autologous) in first complete remission; the other 249 patients were treated with conventional chemotherapy. Results The ECOG activity index revealed normal activity in 45% vs. 60% of the patients in the allogeneic stem cell transplantation vs. conventional chemotherapy groups, respectively and disabled person status in 60% vs. 35%. All QLQ-C30 functions, except physical functioning and pain, were poorer in allogeneic stem cell transplantation patients. Problems in leisure-time activities, social life, and financial management, sexual limitations and adverse effects were significantly more frequent in patients after allogeneic stem cell transplantation than after conventional chemotherapy. Multivariate logistic regression models on global health status revealed concomitant disease, age >45 years, and allogeneic stem cell transplantation as significant risk factors. Conclusions These results indicate that, compared to conventional chemotherapy, allogeneic stem cell transplantation has a significantly worse long-term impact on quality of life. This needs to be considered when treatment options are discussed.

The German Lung Cancer Cooperative Group (GLCCG) is assessing the impact of chemoradiation in addition to chemotherapy in the neoadjuvant treatment of stage III NSCLC. After three cycles of cisplatin/etoposide patients receive either hyperfractionated radiotherapy (RT) with concurrent carboplatin/vindesine and then surgery (arm A) versus surgery and then conventional RT (arm B). Quality of life (QL) was assessed throughout therapy using the EORTC QLQ-C30 and EORTC QLQ-LC 13. Of 126 eligible patients, 54 completed treatment. For patients in both treatment arms physical functioning decreased, whereas dyspnoea, fatigue and pain increased from beginning to the end of treatment. For self-assessed QL no statistically significant effect was found in or between the two treatment arms. The combined modality approach with preoperative radio/chemotherapy proves to be feasible in treating locally advanced NSCLC patients without decreasing their subjective QL.

Intensification of treatment for AML resulted in a substantial improvement in longterm prognosis. As intensive therapy might be associated with high morbidity and most patients with AML eventually relapse, quality of life (QL) of patients has become an important parameter to be assessed. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group (Munster). QL has been analyzed throughout therapy at 12 different time points by using the EORTC-QLQ C 30 questionnaire. Patients’ coping strategies were assessed by the Freiburg Questionnaire on Coping with Illness, patients’ individual perception of their disease and therapy by a semi-structured interview. 101 patients were enrolled in the protocol. For those patients having completed the courses of inpatient treatment (n=37), Physical functioning (p

The paper provides an overview on the 11th scientific conference of the European Society for Psycho-Oncology (ESPO), which took place in June 2001, at Heidelberg, Germany. The main topics discussed during the conference were: (1) the state of the art of research on the effects of psychological interventions in cancer patients; (2) psychosocial aspects in the new field of cancer genetics; (3) recent developments in Quality of Life research; (4) Psycho-Oncology from an European perspective; and (5) children and cancer. The conference gave an impressive picture of the many achievements Psycho-Oncology in Europe has accomplished during the last years, in the clinical and scientific domain. With recent biomedical innovations Psycho-Oncology is facing new challenges. Despite these achievements limitations have become apparent. Identifying these limitations, future aims can be outlined. Among these, there is the need for methodological refinement, as well as for proof of clinical relevance of research results, in order to narrow the gap between research and practice.

Quality of life (QL) was evaluated in 101 patients with AML undergoing intensive and prolonged treatment at 12 sequential time points by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C 30 questionnaire and the profile of mood states scale (POMS). For those patients having completed the course of inpatient treatment (n=37), QL improved from the beginning of chemotherapy to the end of inpatient treatment. Patients who subsequently went off protocol did not differ significantly in their self-assessed QL when compared with patients who completed therapy. Fatigue was more closely related to QL than nausea/emesis or appetite loss, but did not correlate with hemoglobin levels.

Intensification of treatment for AML resulted in a substantial improvement in longterm prognosis (Buchner 1997). As intensive therapy might be associated with high morbidity and most patients with AML eventually relapse, quality of life (QL) of patients has become an important parameter to be assessed. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group.

Intensification of treatment for acute myeloid leukemia (AML) in adult patients resulted in a substantial improvement in long-term prognosis. Therefore, the assessment of quality of life (QL) of patients undergoing treatment is of growing interest. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group (Munster, Germany). The EORTC QLQ-C 30 questionnaire was used to analyze QL throughout therapy, evaluating defined specific parameters at 12 different time-points. Sixty-one patients were recruited within the first 30 months of the study. Those 28 patients who have completed the course of inpatient treatment (n=28) are evaluated for changes in the conceptually distinct QL domains: Physical Functioning (P

In oncology, quality of life (QL) has become an essential criterion for evaluating the effects of therapy in clinical trials. So far, in adult patients suffering from acute leukemia assessment of QL has not been considered possible due to poor prognosis and the acute course of the disease. Advances in chemotheraphy significantly prolong survival of patients with acute myeloid leukemia (AML) and may cure a significant percentage (25%-30%) of patients. Therefore, the assessment of QL of patients undergoing chemotherapy is of growing interest. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML Cooperative Group (Munster).

Abstract 2088 Introduction: Quality of life (QoL) plays a very important role for the assessment of oncological treatment outcome. For the assessment of therapy strategies both survival time and quality of survival regarding physical and emotional conditions are of interest. The present cross sectional study evaluated the impact of resilience, life satisfaction, anxiety and depression on the global health status of patients having received an allogeneic stem cell transplantation (HSCT). Design and Methods: 80 eligible patients from 26 German cancer centres fulfilling the following criteria were contacted: 1. Treatment within the AMLCG 99 trial for acute myeloid leukemia (AML). Patients were randomized to receive either standard-dose Cytarabine containing TAD or high-dose Cytarabine containing HAM-HAM induction therapy, followed by TAD consolidation and HSCT when having no low-risk cytogenetics and an available family donor or high-risk cytogenetics and an unrelated donor. 2. HSCT in first complete remission at least 6 months before the questionnaire. 3. Outpatient setting at the time of the questionnaire. The multi-part questionnaire included general informations about age, gender, marital and employment status as well as validated scaled questionnaire parts. These include the QLQ-C30, the Resilience Scale RS-25, the Hospital Anxiety and Depression Scale (HADS) and a questionnaire about general and health-related life satisfaction (FLZ). To ensure standardized analyses of the data, scales were summarized based on well-established scoring principles or rather linear transformed, so that scores ranged from 0 to 100. Global health status was defined as the primary objective of quality of life assessment. Results: Overall, 41 of 80 patients (51%) completed the questionnaire and were evaluable. Thus 41 patients (18 male, 23 females) aged between 23 and 66 (median 49) years at the time of data collection were included in the analysis. 66% were treated with de novo AML, 24% with secondary AML from MDS and 5% of the evaluable patients had MDS and t-AML, respectively. Median time between HSCT and questionnaire was 3.1 years (range, 8 months to 7 years). 26 patients (63%) received an HSCT from a related donor and 15 (37%) from an unrelated donor. Patients' self-assessed high quality of life was associated with an improved resilience (r=0.538, p Conclusion: The results suggest that quality of life after HSCT for AML correlates with patients' subjective assessment of emotional and physical conditions. For an effective evaluation of the quality of life assessment and the interaction with clinical parameters in AML patients, specific QoL instruments should be applied and different comparable studies should be combined in order to obtain more reliable results. Disclosures: No relevant conflicts of interest to declare.