Introduction: Over the last decade MM diagnosis and therapy have greatly improved; notably due to an increasing number of “novel agents” (NA; e.g. PIs, IMiDs, mAbs, HDAC-, PD1/PD-L1-inhibitors). ...Anti-MM-therapy has gained complexity; orientation towards “state of the art” chemotherapy (CTx) protocols and international guidelines, as well as their continuous evaluation is highly important. According to the international literature, analyses of CTx management and particularly the use of novel substances have mainly been performed in the context of clinical trials (CT), therefore in a selected minority of patients (pts). In order to determine, whether guideline recommendations on MM therapy are thoroughly implemented in- and outside CT settings, we performed a real-world data analysis on clinical MM practice patterns. Substance use was analyzed in view of treatment lines and evaluated for “MM-pathway conformity”.
Methods: We performed a detailed analysis of 287 myeloma pts treated at our University Medical Center, part of the DSMM study group in 2014/15. The pt cohort was defined using the hospital pharmacy and tumor documentation (TBD) databases. TBD analysis enabled the detailed acquisition of pt characteristics, such as age at initial diagnosis (ID), gender, Durie and Salmon (D&S) and International Staging System stage (ISS). Status of transplantation (Tx), comorbidity (via Revised Myeloma Comorbidity Index R-MCI), CT data, treatment line/cycle and the year of CTx application were collected using electronic medical records, TBD and CTx management tools. Basic data on therapy composition was collected for the years 2005 to 2017, separating two treatment periods for 1st, 2nd and 3rd-line therapy of 2005-2012 and 2013-2017. This cut-off was carefully chosen to discriminate best between NA- and non-NA-based regimens, and between first generation PI- (bortezomib (BOR) and IMiD-use (thalidomide (THAL), lenalidomide (LEN)) and second generation NA.
Results: Pt characteristics were representative for tertiary centers with a median age of 63 years (27-89), 54% were 60-79 and 14% >80 years old. The male:female gender ratio was 58%:42% and ISS predominantly advanced (II/III:62%). Pts showed substantial comorbidities and were classified as fit, intermediate-fit and frail according to R-MCI in 33%, 56% and 11%, respectively. Of interest, 33% of pts could be enrolled in CTs and 88% received 1st line treatment at our center. 275 pts received 1st-line, 149 pts 2nd-line and 97 pts 3rd-line treatment (Fig.1). As expected, numbers of pts decreased with subsequent lines of treatment, albeit the median time to 2nd line therapy due to progression amounted to 2 years. As depicted in Fig.1, 1st line conventional CTx (cCTx) alone was rare and substantially declined over time from 12% 2005-2012 to 1% in 2013-2017. 200 pts (73%) were treated with BOR in 1st line, 63 of 106 reinduced pts received BOR in 2nd or 3rd line. IMiD 2nd and 3rd line treatment was also common within different regimens and the combination of 2 NA of both PI+IMiD increased over time (BOR+THAL, BOR+LEN). The use of second generation NA in 2nd and 3rd line treatment notably increased in 2013 to 2017 in line with their approval. Our analysis revealed that 44% of second generation NA protocols were administered outside CT settings, mainly due to tight inclusion and wide CT exclusion criteria. Maintenance was performed in 57% of pts, predominantly with LEN (60%) and within DSMM CT protocols.
Conclusion: Our analyses demonstrate that NA combinations are used predominantly today, whereas the use of cCTx alone is substantially declining. While BOR plays an important role in induction, LEN was subsequently used for maintenance and in outpatient-regimens. BOR-reinduction as a validated treatment option is also reflecting the substantial amount of BOR-based protocols worldwide. A significant percentage of second generation NA are administered outside CT settings, representing the fast and effective implementation of guideline recommendations into the real-world clinical practice at our and other MM centers. Currently, we are assessing the percentage of pts discussed in our weekly MM tumorboard, the evidence level of therapeutic interventions, PFS and OS. Results will be shown at the meeting, including the comparison of our data with others in a detailed review of the literature.
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Engelhardt:German Cancer Aid (#11424): Other: Educational Grant; Janssen Cilag GmbH: Other: Educational Grant; Celgene GmbH: Other: Educational Grant; Amgen GmbH: Other: Educational Grant.
With land planning, socioeconomics and natural systems as foundations, this book combines urban planning and ecological science in examining urban regions. Writing for graduate students, academic ...researchers, planners, conservationists and policy makers, and with the use of informative urban-region color maps, Richard Forman analyzes 38 urban regions from 32 nations, including London, Chicago, Ottawa, Brasilia, Cairo, Seoul, Bangkok, Canberra, and a major case study of the Greater Barcelona region. Alternative patterns of urbanization spread (including sprawl) are evaluated from the perspective of nature and people, stating land-use principles extracted from landscape ecology, transportation and hydrology. Good, bad and interesting spatial patterns for creating sustainable land mosaics are pinpointed, and urban regions are considered in broader contexts, from climate change to biodiversity loss, disasters and sense of place.
Inspiring deep emotion, landscape carries many meanings. This book follows the development of several threads of the concept of landscape as they have evolved across disciplines and across countries, ...leading to the European Landscape Convention and the designation of cultural landscapes as World Heritage Sites. The book introduces the key notions of landscape, such as landscape as meaning, as picture, as scale, as scenery and as place. It also considers the various factors which influence the way in which landscape is perceived now and in the past, with all of the senses. Finally, it looks of the various ways of protecting, managing and enhancing the landscape, taking into account a future of climate change. Beautifully illustrated and including 'capsules' in each section which provide fascinating insights into subjects from reading pictures, to mapping and GIS, through a discussion of the range of types of landscape to issues such as eco-museums, this book provides an excellent introductory overview for any students with an interest in the landscape around us.
Peter Howard is a geographer who studied at Newcastle and later at Exeter. He taught landscape ideas to students of art and design, and later ran degree courses in landscape and heritage, at Plymouth University. He is now Visiting Professor of Cultural Landscapes at Bournemouth, and is editor of the Landscape Research journal.
Contents: Preface; Introduction; Part 1 What is Landscape?: Landscape as culture; Landscape as picture; Capsule 1: reading pictures; Landscape as scale; European round table; Capsule 2: abroad is different; Capsule 3: Mediterranean landscapes; Landscapes of the other senses; Capsule 4: travel. Part 2 How is Landscape Perceived?: Landscape as a common heritage; Capsule 5: maps; Capsule 6: participation; Our personal landscapes; Capsule 7: woodland and forest; Capsule 8: coast; National landscape; Capsule 9: mountains; Capsule 10: moor, marsh, heath and fen; Class; Capsule 11: rivers and lakes; Capsule 12: farms and farmland; Insiders and experts; Capsule 13: villages; Capsule 14: towns; Whose landscape when?; Where is this place? Part 3 What is the Future?: Protecting landscapes; Managing landscape; Capsule 15: industrial landscape; Enhancing the landscape; Trends for the future; Index.
Managing agricultural landscapes to support biodiversity conservation requires profound structural changes worldwide. Often, discussions are centered on management at the field level. However, a wide ...and growing body of evidence calls for zooming out and targeting agricultural policies, research, and interventions at the landscape level to halt and reverse the decline in biodiversity, increase biodiversity-mediated ecosystem services in agricultural landscapes, and improve the resilience and adaptability of these ecosystems. We conducted the most comprehensive assessment to date on landscape complexity effects on nondomesticated terrestrial biodiversity through a meta-analysis of 1,134 effect sizes from 157 peer-reviewed articles. Increasing landscape complexity through changes in composition, configuration, or heterogeneity significatively and positively affects biodiversity. More complex landscapes host more biodiversity (richness, abundance, and evenness) with potential benefits to sustainable agricultural production and conservation, and effects are likely underestimated. The few articles that assessed the combined contribution of linear (e.g., hedgerows) and areal (e.g., woodlots) elements resulted in a near-doubling of the effect sizes (i.e., biodiversity level) compared to the dominant number of studies measuring these elements separately. Similarly, positive effects on biodiversity are stronger in articles monitoring biodiversity for at least 2 y compared to the dominant 1-y monitoring efforts. Besides, positive and stronger effects exist when monitoring occurs in nonoverlapping landscapes, highlighting the need for long-term and robustly designed monitoring efforts. Living in harmony with nature will require shifting paradigms toward valuing and promoting multifunctional agriculture at the farm and landscape levels with a research agenda that untangles complex agricultural landscapes’ contributions to people and nature under current and future conditions.
Aimed at prospective and new students, this book gives a comprehensive introduction to the nature and practise of landscape architecture, the professional skills required and the latest ...developments.After discussing the history of the profession, the book explains the design process through principles such as hierarchy, human scale, unity, harmony, asymmetry, color, form, and texture. It looks at how design is represented through both drawing and modeling, and through digital techniques such as CAD and the use of GIS (Geographic Information Systems). This is followed by an examination of project management and landscape management techniques. Finally, the book explores educational and employment opportunities and the future of the profession in the context of climate change and sustainability.Illustrated with international examples of completed projects, Landscape Architecture provides an invaluable, one-stop resource for anyone considering studying or a career in this field.
ZusammenfassungDer Beitrag erläutert zunächst einen breiten Kulturbegriff und die Transformationen des ländlichen Raums durch den globalen Kapitalismus, die den ländlichen Raum härter treffen als die ...Städte. Er skizziert die vermehrt auftretenden politisch gerahmten Kulturkämpfe und zeigt, wie Institutionen, Initiativen und Projekte Kultureller Bildung wie auch die Forschung zu Kultureller Bildung versuchen, nicht nur zu vermitteln, sondern neue Wege zu gehen.
Recipient of 2019 John Brinckerhoff Jackson Book Prize,
Foundation for Landscape Studies 2021 On the Brinck Book Award
Winner
"Burle Marx created a new and modern grammar for international
landscape ...design." -Lauro Cavalcanti, quoted in the New York
Times
"The real creator of the modern garden." -American Institute of
Architects
Presenting the first English translation of Burle Marx's
"depositions," this volume highlights the environmental advocacy of
a preeminent Brazilian landscape architect who advised and
challenged the country's military dictatorship. Roberto
Burle Marx (1909-1994) is internationally known as one of the
preeminent modernist landscape architects. He designed renowned
public landscapes in Brazil, beginning with small plazas in Recife
in the 1930s and culminating with large public parks in the early
1960s, most significantly the Parque do Flamengo in Rio de Janeiro.
Depositions explores a pivotal moment in Burle Marx's
career-the years in which he served as a member of the Federal
Cultural Council created by the military dictatorship in the
mid-1960s. Despite the inherent conflict and risk in working with
the military regime, Burle Marx boldly used his position to
advocate for the protection of the unique Brazilian landscape,
becoming a prophetic voice of caution against the regime's policies
of rapid development and resource exploitation.
Depositions presents the first English translation of
eighteen environmental position pieces that Burle Marx wrote for
the journal Cultura , a publication of the Brazilian
Ministry of Education and Culture, from 1967 through 1973.
Catherine Seavitt Nordenson introduces and contextualizes the
depositions by analyzing their historical and political contexts,
as well as by presenting pertinent examples of Burle Marx's earlier
public projects, which enables a comprehensive reading of the
texts. Addressing deforestation, the establishment of national
parks, the place of commemorative sculpture, and the unique history
of the Brazilian cultural landscape, Depositions offers
new insight into Burle Marx's outstanding landscape oeuvre and
elucidates his transition from prolific designer to prescient
counselor.
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