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Prof. Dr. Olaf Gefeller
Department of Medical Informatics, Biometry and Epidemiology; Friedrich-Alexander-University of Erlangen-Nuremberg

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Journal article
Published: 31 July 2021 in Children
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Seeking shade, the use of textile sun protection and sunscreen, and protecting one’s eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children’s age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p< 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.

ACS Style

Tatiana Görig; Corinna Södel; Annette Pfahlberg; Olaf Gefeller; Eckhard Breitbart; Katharina Diehl. Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants. Children 2021, 8, 668 .

AMA Style

Tatiana Görig, Corinna Södel, Annette Pfahlberg, Olaf Gefeller, Eckhard Breitbart, Katharina Diehl. Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants. Children. 2021; 8 (8):668.

Chicago/Turabian Style

Tatiana Görig; Corinna Södel; Annette Pfahlberg; Olaf Gefeller; Eckhard Breitbart; Katharina Diehl. 2021. "Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants." Children 8, no. 8: 668.

Journal article
Published: 10 June 2021 in Viruses
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SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.

ACS Style

Ralf Wagner; David Peterhoff; Stephanie Beileke; Felix Günther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus Stark; André Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette Pfahlberg; Iris Heid; Olaf Gefeller; Klaus Überla. Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020. Viruses 2021, 13, 1118 .

AMA Style

Ralf Wagner, David Peterhoff, Stephanie Beileke, Felix Günther, Melanie Berr, Sebastian Einhauser, Anja Schütz, Hans Niller, Philipp Steininger, Antje Knöll, Matthias Tenbusch, Clara Maier, Klaus Korn, Klaus Stark, André Gessner, Ralph Burkhardt, Michael Kabesch, Holger Schedl, Helmut Küchenhoff, Annette Pfahlberg, Iris Heid, Olaf Gefeller, Klaus Überla. Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020. Viruses. 2021; 13 (6):1118.

Chicago/Turabian Style

Ralf Wagner; David Peterhoff; Stephanie Beileke; Felix Günther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus Stark; André Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette Pfahlberg; Iris Heid; Olaf Gefeller; Klaus Überla. 2021. "Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020." Viruses 13, no. 6: 1118.

Preprint content
Published: 04 April 2021
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SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures, but the number of registered infections depends on testing strategies and deduced case fatality ratios (CFR) are poor proxies for IFR. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020 with particularly high CFR. To estimate seroprevalence, dark figure, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020 with misclassification error control, we conducted a population-based study, including home visits for elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests (64% of our random sample). Latent class analysis yielded 8.6% standardized county-wide seroprevalence, dark figure factor 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the dark figure was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60-69, 13.2% for age 70+, confirming a previously reported age-model for IFR. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.

ACS Style

Ralf Wagner; David Peterhoff; Stephanie Beileke; Felix Guenther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Helmut Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus J. Stark; Andre Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette B. Pfahlberg; Iris M. Heid; Olaf Gefeller; Klaus Überla. Estimates and determinants of SARS-CoV-2 seroprevalence and infection fatality ratio using latent class analysis: the population-based Tirschenreuth study in the hardest-hit German county in spring 2020. 2021, 1 .

AMA Style

Ralf Wagner, David Peterhoff, Stephanie Beileke, Felix Guenther, Melanie Berr, Sebastian Einhauser, Anja Schütz, Hans Helmut Niller, Philipp Steininger, Antje Knöll, Matthias Tenbusch, Clara Maier, Klaus Korn, Klaus J. Stark, Andre Gessner, Ralph Burkhardt, Michael Kabesch, Holger Schedl, Helmut Küchenhoff, Annette B. Pfahlberg, Iris M. Heid, Olaf Gefeller, Klaus Überla. Estimates and determinants of SARS-CoV-2 seroprevalence and infection fatality ratio using latent class analysis: the population-based Tirschenreuth study in the hardest-hit German county in spring 2020. . 2021; ():1.

Chicago/Turabian Style

Ralf Wagner; David Peterhoff; Stephanie Beileke; Felix Guenther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Helmut Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus J. Stark; Andre Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette B. Pfahlberg; Iris M. Heid; Olaf Gefeller; Klaus Überla. 2021. "Estimates and determinants of SARS-CoV-2 seroprevalence and infection fatality ratio using latent class analysis: the population-based Tirschenreuth study in the hardest-hit German county in spring 2020." , no. : 1.

Journal article
Published: 19 February 2021 in Healthcare
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(1) Background: Different sources of information are used by the population regarding skin cancer prevention. The pertinent quality of information that can be retrieved via an internet search engine needs assessment; (2) Methods: Four topical searches in common language were entered into Google™. The first 200 “hits” were stored for further use. Eligible websites were evaluated using content-based criteria based on the current German medical guideline “Skin cancer prevention” and employing generic (DISCERN, HONcode) quality criteria. (3) Results: Overlap between the four search results was between 0 and 7 of 200. The completeness of relevant content was scored with a median of 10 points (first quartile (Q1):6; Q3:14) and thus, it was much lower than the theoretical maximum of 43 points. Global quality, with a maximum of 10 points, was 3 in median (Q1:2; Q3:4). Quality and completeness, respectively, were somewhat higher in the higher ranks of search results. The generic quality was moderate. (4) Conclusions: A direct comparison with other sources of information (print, audio-visual, presentation, or personal counselling) is not possible, but important deficits concerning the quality and scope of relevant information on the internet are demonstrated.

ACS Style

Wolfgang Uter; Christina Eversbusch; Olaf Gefeller; Annette Pfahlberg. Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings. Healthcare 2021, 9, 229 .

AMA Style

Wolfgang Uter, Christina Eversbusch, Olaf Gefeller, Annette Pfahlberg. Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings. Healthcare. 2021; 9 (2):229.

Chicago/Turabian Style

Wolfgang Uter; Christina Eversbusch; Olaf Gefeller; Annette Pfahlberg. 2021. "Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings." Healthcare 9, no. 2: 229.

Journal article
Published: 08 February 2021 in International Journal of Environmental Research and Public Health
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Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

ACS Style

Katharina Diehl; Tatiana Görig; Charlotte Jansen; Maike Carola Hruby; Annette B. Pfahlberg; Olaf Gefeller. “I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index. International Journal of Environmental Research and Public Health 2021, 18, 1615 .

AMA Style

Katharina Diehl, Tatiana Görig, Charlotte Jansen, Maike Carola Hruby, Annette B. Pfahlberg, Olaf Gefeller. “I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index. International Journal of Environmental Research and Public Health. 2021; 18 (4):1615.

Chicago/Turabian Style

Katharina Diehl; Tatiana Görig; Charlotte Jansen; Maike Carola Hruby; Annette B. Pfahlberg; Olaf Gefeller. 2021. "“I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index." International Journal of Environmental Research and Public Health 18, no. 4: 1615.

Review
Published: 28 October 2020 in International Journal of Environmental Research and Public Health
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The rising incidence of cutaneous melanoma over the past few decades has prompted substantial efforts to develop risk prediction models identifying people at high risk of developing melanoma to facilitate targeted screening programs. We review these models, regarding study characteristics, differences in risk factor selection and assessment, evaluation, and validation methods. Our systematic literature search revealed 40 studies comprising 46 different risk prediction models eligible for the review. Altogether, 35 different risk factors were part of the models with nevi being the most common one (n = 35, 78%); little consistency in other risk factors was observed. Results of an internal validation were reported for less than half of the studies (n = 18, 45%), and only 6 performed external validation. In terms of model performance, 29 studies assessed the discriminative ability of their models; other performance measures, e.g., regarding calibration or clinical usefulness, were rarely reported. Due to the substantial heterogeneity in risk factor selection and assessment as well as methodologic aspects of model development, direct comparisons between models are hardly possible. Uniform methodologic standards for the development and validation of risk prediction models for melanoma and reporting standards for the accompanying publications are necessary and need to be obligatory for that reason.

ACS Style

Isabelle Kaiser; Annette B. Pfahlberg; Wolfgang Uter; Markus V. Heppt; Marit B. Veierød; Olaf Gefeller. Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation. International Journal of Environmental Research and Public Health 2020, 17, 7919 .

AMA Style

Isabelle Kaiser, Annette B. Pfahlberg, Wolfgang Uter, Markus V. Heppt, Marit B. Veierød, Olaf Gefeller. Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation. International Journal of Environmental Research and Public Health. 2020; 17 (21):7919.

Chicago/Turabian Style

Isabelle Kaiser; Annette B. Pfahlberg; Wolfgang Uter; Markus V. Heppt; Marit B. Veierød; Olaf Gefeller. 2020. "Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation." International Journal of Environmental Research and Public Health 17, no. 21: 7919.

Original article
Published: 27 February 2020 in British Journal of Dermatology
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Background Changing patterns of exposure lead to changes in the spectrum of contact allergy in the population and in patients patch tested for suspected contact allergy. The main contact allergens (haptens) are assembled in the so‐called baseline series. Objectives To present the current spectrum of contact allergy to baseline series allergens and its temporal development over the last 12 years collected in the 56 active departments of the tri‐national Information Network of Departments of Dermatology (IVDK). Methods Patch test data along with core demographic and clinical information, subdivided into periods of all patients patch tested with the baseline series in the IVDK were descriptively analysed. Moreover, log‐binomial regression analysis addressed temporal trends of specific contact allergies, adjusted for potentially confounding factors. Results Among the 125436 patients tested with the German baseline series, the most common allergens were nickel (14.7%), fragrance mix I (8.1%), Myroxylon pereirae resin (7.5%) and cobalt (5.2%), with no conclusive trend. The rise and fall, following (self) regulation in the EU of contact allergy to methylchloroisothiazolinone/ methylisothiazolinone (MI) reflected the MI contact allergy epidemic. Propolis showed a marked upward trend with a prevalence of 3.94% in the period 2015–2018. Conclusions Decreases in sensitisation prevalence likely reflect reduced exposure, with some lag, as for hydroxyisohexyl 3‐cyclohexene carboxaldehyde. If no (sufficient) decrease can be observed despite interventions, such as for nickel and chromium, affected subgroups should be identified and their causative exposures explored. Finally, increases like observed with propolis certainly warrant targeted investigation of exposures driving sensitisation, and possibly intervention.

ACS Style

W. Uter; O. Gefeller; V. Mahler; J. Geier. Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*. British Journal of Dermatology 2020, 183, 857 -865.

AMA Style

W. Uter, O. Gefeller, V. Mahler, J. Geier. Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*. British Journal of Dermatology. 2020; 183 (5):857-865.

Chicago/Turabian Style

W. Uter; O. Gefeller; V. Mahler; J. Geier. 2020. "Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*." British Journal of Dermatology 183, no. 5: 857-865.

Multicenter study
Published: 07 February 2020 in Radiotherapy and Oncology
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This multicenter, phase 3 trial investigates whether the incorporation of concurrent paclitaxel and cisplatin together with a reduced total dose of radiotherapy is superior to standard fluorouracil–cisplatin based CRT. Patients with SCCHN, stage III–IVB, were randomized to receive paclitaxel/cisplatin (PacCis)–CRT (arm A; paclitaxel 20 mg/m2 on days 2, 5, 8, 11 and 25, 30, 33, 36; cisplatin 20 mg/m2, days 1–4 and 29–32; RT to a total dose of 63.6 Gy) or fluorouracil/cisplatin (CisFU)–CRT (arm B; fluorouracil 600 mg/m2; cisplatin 20 mg/m2, days 1–5 and 29–33; RT: 70.6 Gy). Endpoint was 3-year-disease free survival (3y-DFS). A total of 221 patients were enrolled between 2010 and 2015. With a median follow-up of 3.7 years, 3y-DFS in the CisFU arm and PacCis arm was 58.2% and 48.4%, respectively (HR 0.82, 95% CI 0.56–1.21, p = 0.52). The 3y-OS amounted to 64.6% in the CisFU arm, and to 59.2% in the PacCis arm (HR 0.82, 95% CI 0.54–1.24, p = 0.43). In the subgroup of p16-positive oropharyngeal carcinomas, 3y-DFS and 3y-OS was 84.6% vs 83.9% (p = 0.653), and 92.3% vs. 83.5% (p = 0.76) in arm A and B, respectively. Grade 3–4 hematological toxicities were significantly reduced in arm A (anemia, p = 0.01; leukocytopenia, p = 0.003), whereas grade 3 infections were reduced in arm B (p = 0.01). Paclitaxel/cisplatin–CRT with a reduced RT-dose is not superior to standard fluorouracil/cisplatin–CRT. Subgroup analyses indicate that a reduced radiation dose seems to be sufficient for p16+ oropharyngeal cancer or non-smokers. Clinical trial information: NCT01126216; EudraCT Number 2005-003484-23.

ACS Style

Rainer Fietkau; Markus Hecht; Benjamin Hofner; Dorota Lubgan; Heinrich Iro; Olaf Gefeller; Claus Rödel; Matthias G. Hautmann; Oliver Kölbl; Attila Salay; Christian Rübe; Patrick Melchior; Peter Breinl; Waldemar Krings; Stephan Gripp; Barbara Wollenberg; Rainer Keerl; Ulrike Schreck; Birgit Siekmeyer; Gerhard G. Grabenbauer; Panagiotis Balermpas. Randomized phase-III-trial of concurrent chemoradiation for locally advanced head and neck cancer comparing dose reduced radiotherapy with paclitaxel/cisplatin to standard radiotherapy with fluorouracil/cisplatin: The PacCis-trial. Radiotherapy and Oncology 2020, 144, 209 -217.

AMA Style

Rainer Fietkau, Markus Hecht, Benjamin Hofner, Dorota Lubgan, Heinrich Iro, Olaf Gefeller, Claus Rödel, Matthias G. Hautmann, Oliver Kölbl, Attila Salay, Christian Rübe, Patrick Melchior, Peter Breinl, Waldemar Krings, Stephan Gripp, Barbara Wollenberg, Rainer Keerl, Ulrike Schreck, Birgit Siekmeyer, Gerhard G. Grabenbauer, Panagiotis Balermpas. Randomized phase-III-trial of concurrent chemoradiation for locally advanced head and neck cancer comparing dose reduced radiotherapy with paclitaxel/cisplatin to standard radiotherapy with fluorouracil/cisplatin: The PacCis-trial. Radiotherapy and Oncology. 2020; 144 ():209-217.

Chicago/Turabian Style

Rainer Fietkau; Markus Hecht; Benjamin Hofner; Dorota Lubgan; Heinrich Iro; Olaf Gefeller; Claus Rödel; Matthias G. Hautmann; Oliver Kölbl; Attila Salay; Christian Rübe; Patrick Melchior; Peter Breinl; Waldemar Krings; Stephan Gripp; Barbara Wollenberg; Rainer Keerl; Ulrike Schreck; Birgit Siekmeyer; Gerhard G. Grabenbauer; Panagiotis Balermpas. 2020. "Randomized phase-III-trial of concurrent chemoradiation for locally advanced head and neck cancer comparing dose reduced radiotherapy with paclitaxel/cisplatin to standard radiotherapy with fluorouracil/cisplatin: The PacCis-trial." Radiotherapy and Oncology 144, no. : 209-217.

Review
Published: 09 July 2019 in BMJ Open
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Introduction(Over)exposure to ultraviolet radiation is a major risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced by the WHO and partner organisations in 1995 as a simple measure of the intensity of solar UV radiation, providing guidance for the population to use appropriate sun protective measures. Little is known about the impact of the UVI on actual sun protection behaviour. Our systematic review aims to assess global levels of awareness, understanding and use of the UVI as prerequisites for the preventive effectiveness of this public health tool.Methods and analysisSystematic searches will be performed in 10 electronic literature databases including Medline, Scopus and Web of Science–Core Collection, two clinical trials registries and at least two grey literature databases (OpenGrey, Bielefeld Academic Search Engine). Additional literature sources will be retrieved using hand search of reference lists of included studies and snowballing methods. We will include studies with all types of quantitative study designs and participants reporting on at least one outcome in the three main categories (i) awareness, (ii) understanding and (iii) use of the UVI. We will assess the risk of bias within studies with an abbreviated version of the AXIS tool, designed specifically for cross-sectional studies. As we expect large heterogeneity in outcomes, we will conduct a narrative synthesis of results instead of a meta-analysis.Ethics and disseminationEthical approval and patient consent are not required as this is a systematic review based on published studies. The results of this study will be published in an international peer-reviewed journal.Prospero registration numberCRD42018093693.

ACS Style

Maria Lehmann; Maria Heinitz; Wolfgang Uter; Annette B Pfahlberg; Olaf Gefeller. The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review. BMJ Open 2019, 9, e028092 .

AMA Style

Maria Lehmann, Maria Heinitz, Wolfgang Uter, Annette B Pfahlberg, Olaf Gefeller. The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review. BMJ Open. 2019; 9 (7):e028092.

Chicago/Turabian Style

Maria Lehmann; Maria Heinitz; Wolfgang Uter; Annette B Pfahlberg; Olaf Gefeller. 2019. "The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review." BMJ Open 9, no. 7: e028092.

Journal article
Published: 12 June 2019 in International Journal of Environmental Research and Public Health
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Overexposure to ultraviolet (UV) radiation is the main modifiable risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced as a tool to visualize the intensity of UV radiation on a certain day, which should enable and encourage people to take appropriate protective measures. The ‘low’ exposure category of the UVI, defined by a rounded UVI value of 0, 1 or 2, was linked to the health message ‘No protection required’ by the World Health Organization and partner organizations. However, published evidence corroborating this advice is not available. To evaluate the erythemal risk of low UVI days, we analyzed 14,431 daily time series of ambient erythemal irradiance data measured at nine stations of the German solar UV monitoring network during the years 2007–2016. We analyzed the proportion of days in the sample for which ambient erythemal doses calculated for various time intervals exceed average minimal erythemal doses (MEDs) of the Fitzpatrick skin phototypes I–VI to assess the potential for erythema arising from sun exposure on days with low UVI values. Additionally, we calculated for each day the minimum exposure duration needed to receive one MED. Our results indicate that on days with a UVI value of 0, risk of erythema is indeed negligible. Conversely, the abovementioned health message appears misleading when melano-compromised individuals (skin type I and II) spend more than 1.5 hours outdoors on days with a UVI value of 2. Under rare circumstances of prolonged exposure, MEDs of the two most sensitive skin types can also be exceeded even on days with a UVI value of 1. Hence, current WHO guidance for sun protection on days with low UVI values needs reconsideration.

ACS Style

Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. Public Health Messages Associated with Low UV Index Values Need Reconsideration. International Journal of Environmental Research and Public Health 2019, 16, 2067 .

AMA Style

Maria Lehmann, Annette B. Pfahlberg, Henner Sandmann, Wolfgang Uter, Olaf Gefeller. Public Health Messages Associated with Low UV Index Values Need Reconsideration. International Journal of Environmental Research and Public Health. 2019; 16 (12):2067.

Chicago/Turabian Style

Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. 2019. "Public Health Messages Associated with Low UV Index Values Need Reconsideration." International Journal of Environmental Research and Public Health 16, no. 12: 2067.

Research article
Published: 15 February 2019 in Photochemistry and Photobiology
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According to the World Health Organization and partner organizations, no protection against ultraviolet (UV) radiation is required on days with ‘low’ values (i.e. values of less than 3) of the Global Solar Ultraviolet Index (UVI). Erythemal irradiance (Eer) data of such days were analyzed to evaluate this claim. Measurements from 9 stations of the German solar UV monitoring network from 2007 to 2016 yielded 14,431 daily Eer time series of low UVI days. Erythemal doses for certain fixed time intervals ‐ acquired from measurements on horizontal planes ‐ were compared with the average minimal erythemal dose (MED) of skin phototype II. Doses from days with rounded UVI values of 0 were insufficient to induce erythema and even on days with rounded UVI values of 1 doses exceeding 1 MED of skin type II could only be acquired under very specific circumstances of prolonged exposure. Conversely, sun exposure on days with rounded UVI values of 2 can indeed provide doses sufficient to induce erythema in skin type II after two hours around noon. In conclusion, our analyses do not support the claim of harmlessness currently associated with the entire low UVI exposure category in public guidance on interpretation of the UVI. This article is protected by copyright. All rights reserved.

ACS Style

Maria Lehmann; Henner Sandmann; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period. Photochemistry and Photobiology 2019, 95, 1076 -1082.

AMA Style

Maria Lehmann, Henner Sandmann, Annette B. Pfahlberg, Wolfgang Uter, Olaf Gefeller. ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period. Photochemistry and Photobiology. 2019; 95 (4):1076-1082.

Chicago/Turabian Style

Maria Lehmann; Henner Sandmann; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. 2019. "ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period." Photochemistry and Photobiology 95, no. 4: 1076-1082.

Proceedings
Published: 14 November 2018 in Proceedings
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Overexposure to ultraviolet (UV) radiation is the main modifiable risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced as a tool to visualize the intensity of UV radiation on a certain day which should enable and encourage people to take appropriate protective measures. The exposure category ‘low’ of the UVI, including values from 0 to 2, was linked to the health message ‘No protection required’ by the World Health Organization and collaborating centres. However, published evidence corroborating this advice is scarce. Therefore, we analysed ambient erythemal irradiance data of 14,431 daily UVI time series of low UVI days. Data were gathered at nine stations of the German solar UV monitoring networkcovering all major climate areas in Germanyin the years 2007–2016. We compared ambient erythemal doses calculated for various time intervals with average minimal erythemal doses (MEDs) of the Caucasian Fitzpatrick skin phototypes I-IV to assess the potential for skin damage arising from sun exposure on days with low UVI values. The most common months for the occurrence of days with low UVI values in our dataset were January and December, February and November, and March and October for UVI 0, 1 and 2, respectively. Our results indicate that on days with a UVI value of 0, risk of deterministic radiation injury (solar erythema) is negligible. Conversely, the above-mentioned health message appears misleading when melano-compromised individuals spend several hours outdoors on days with a UVI value of 2, as median doses exceed the MEDs of Fitzpatrick skin types I and II after an exposure duration of only 2 h around solar noon. Under very rare specific circumstances, MEDs of those two most sensitive skin types can also be exceeded even on days with UVI 1. Hence, two aspects of current public health messages may need reconsideration: on the one hand, the health message related to an ‘innocuous level’ of the UVI and, on the other hand, a possible adaption of UVI-related health messages to different skin types.

ACS Style

Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration. Proceedings 2018, 6, 6 .

AMA Style

Maria Lehmann, Annette B. Pfahlberg, Henner Sandmann, Wolfgang Uter, Olaf Gefeller. Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration. Proceedings. 2018; 6 (1):6.

Chicago/Turabian Style

Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. 2018. "Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration." Proceedings 6, no. 1: 6.

Journal article
Published: 21 August 2018 in International Journal of Environmental Research and Public Health
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Minimizing exposure to ultraviolet radiation (UVR) is strongly recommended as the most important primary prevention measure regarding skin cancer. The responsibility for adequate sun protection of young children lies with their parents and external caregivers. Since a high proportion of 3- to 6-year-old children in Germany attend nurseries, the practice of sun protection in this setting was assessed. A survey was conducted in 246 nurseries in southern Germany during spring and summer of 2014 and 2015. Shade coverage in the outdoor area of the nursery was assessed by study team members and UVR protective behavior of staff was assessed by an interview with the directors. On average, 52% of the entire outdoor area and 65% of the children’s outdoor play area were covered by shade, with a significant difference between nurseries of different sizes, pointing to a better shade coverage in larger nurseries. The daily outdoor stay was not regularly scheduled before or after peak sun intensity hours around noon to avoid intense UVR exposure. General sun protection rules were present in the majority of the nurseries and addressed predominantly wearing sunhats and applying sunscreen. Our findings show that current sun protection recommendations for children are only partially met in nurseries and indicate a lower level of sun protection in small institutions. Especially, avoidance of excessive exposure to UVR around noon and the importance of shade provision over play structures needs to be emphasized in future information campaigns.

ACS Style

Cornelia Fiessler; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation. International Journal of Environmental Research and Public Health 2018, 15, 1793 .

AMA Style

Cornelia Fiessler, Annette B. Pfahlberg, Wolfgang Uter, Olaf Gefeller. Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation. International Journal of Environmental Research and Public Health. 2018; 15 (9):1793.

Chicago/Turabian Style

Cornelia Fiessler; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. 2018. "Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation." International Journal of Environmental Research and Public Health 15, no. 9: 1793.

Journal article
Published: 13 June 2018 in International Journal Of Epidemiology
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To provide an integrated software environment for model fitting and variable selection in regression models with a bounded outcome variable. The proposed modelling framework is implemented in the add-on package betaboost of the statistical software environment R. The betaboost methodology is based on beta-regression, which is a state-of-the-art method for modelling bounded outcome variables. By combining traditional model fitting techniques with recent advances in statistical learning and distributional regression, betaboost allows users to carry out data-driven variable and/or confounder selection in potentially high-dimensional epidemiological data. The software package implements a flexible routine to incorporate linear and non-linear predictor effects in both the mean and the precision parameter (relating inversely to the variance) of a beta-regression model. The software is hosted publicly at [http://github.com/boost-R/betaboost] and has been published under General Public License (GPL) version 3 or newer.

ACS Style

Andreas Mayr; Leonie Weinhold; Benjamin Hofner; Stephanie Titze; Olaf Gefeller; Matthias Schmid. Thebetaboostpackage—a software tool for modelling bounded outcome variables in potentially high-dimensional epidemiological data. International Journal Of Epidemiology 2018, 47, 1383 -1388.

AMA Style

Andreas Mayr, Leonie Weinhold, Benjamin Hofner, Stephanie Titze, Olaf Gefeller, Matthias Schmid. Thebetaboostpackage—a software tool for modelling bounded outcome variables in potentially high-dimensional epidemiological data. International Journal Of Epidemiology. 2018; 47 (5):1383-1388.

Chicago/Turabian Style

Andreas Mayr; Leonie Weinhold; Benjamin Hofner; Stephanie Titze; Olaf Gefeller; Matthias Schmid. 2018. "Thebetaboostpackage—a software tool for modelling bounded outcome variables in potentially high-dimensional epidemiological data." International Journal Of Epidemiology 47, no. 5: 1383-1388.

Commentary
Published: 18 April 2018 in British Journal of Dermatology
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Linked Article: Downs and Harrison. Br J Dermatol 2018; 178:958–964.

ACS Style

O. Gefeller. The Garment Protection Factor: further advances in labelling sun‐protective clothing. British Journal of Dermatology 2018, 178, 835 -836.

AMA Style

O. Gefeller. The Garment Protection Factor: further advances in labelling sun‐protective clothing. British Journal of Dermatology. 2018; 178 (4):835-836.

Chicago/Turabian Style

O. Gefeller. 2018. "The Garment Protection Factor: further advances in labelling sun‐protective clothing." British Journal of Dermatology 178, no. 4: 835-836.

Journal article
Published: 01 February 2018 in European Journal of Vascular and Endovascular Surgery
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ACS Style

Ulrich Rother; Werner Lang; Raymund E. Horch; Ingo Ludolph; Alexander Meyer; Olaf Gefeller; Susanne Regus. Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery. European Journal of Vascular and Endovascular Surgery 2018, 55, 215 -221.

AMA Style

Ulrich Rother, Werner Lang, Raymund E. Horch, Ingo Ludolph, Alexander Meyer, Olaf Gefeller, Susanne Regus. Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery. European Journal of Vascular and Endovascular Surgery. 2018; 55 (2):215-221.

Chicago/Turabian Style

Ulrich Rother; Werner Lang; Raymund E. Horch; Ingo Ludolph; Alexander Meyer; Olaf Gefeller; Susanne Regus. 2018. "Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery." European Journal of Vascular and Endovascular Surgery 55, no. 2: 215-221.

Editorial
Published: 28 September 2017 in Computational and Mathematical Methods in Medicine
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Olaf Gefeller; Benjamin Hofner; Andreas Mayr; Elisabeth Waldmann. Predictive Modelling Based on Statistical Learning in Biomedicine. Computational and Mathematical Methods in Medicine 2017, 2017, 1 -3.

AMA Style

Olaf Gefeller, Benjamin Hofner, Andreas Mayr, Elisabeth Waldmann. Predictive Modelling Based on Statistical Learning in Biomedicine. Computational and Mathematical Methods in Medicine. 2017; 2017 ():1-3.

Chicago/Turabian Style

Olaf Gefeller; Benjamin Hofner; Andreas Mayr; Elisabeth Waldmann. 2017. "Predictive Modelling Based on Statistical Learning in Biomedicine." Computational and Mathematical Methods in Medicine 2017, no. : 1-3.

Review article
Published: 02 August 2017 in Computational and Mathematical Methods in Medicine
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Statistical boosting algorithms have triggered a lot of research during the last decade. They combine a powerful machine learning approach with classical statistical modelling, offering various practical advantages like automated variable selection and implicit regularization of effect estimates. They are extremely flexible, as the underlying base-learners (regression functions defining the type of effect for the explanatory variables) can be combined with any kind of loss function (target function to be optimized, defining the type of regression setting). In this review article, we highlight the most recent methodological developments on statistical boosting regarding variable selection, functional regression, and advanced time-to-event modelling. Additionally, we provide a short overview on relevant applications of statistical boosting in biomedicine.

ACS Style

Andreas Mayr; Benjamin Hofner; Elisabeth Waldmann; Tobias Hepp; Sebastian Meyer; Olaf Gefeller. An Update on Statistical Boosting in Biomedicine. Computational and Mathematical Methods in Medicine 2017, 2017, 1 -12.

AMA Style

Andreas Mayr, Benjamin Hofner, Elisabeth Waldmann, Tobias Hepp, Sebastian Meyer, Olaf Gefeller. An Update on Statistical Boosting in Biomedicine. Computational and Mathematical Methods in Medicine. 2017; 2017 ():1-12.

Chicago/Turabian Style

Andreas Mayr; Benjamin Hofner; Elisabeth Waldmann; Tobias Hepp; Sebastian Meyer; Olaf Gefeller. 2017. "An Update on Statistical Boosting in Biomedicine." Computational and Mathematical Methods in Medicine 2017, no. : 1-12.

Journal article
Published: 14 June 2017 in Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
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Die Vermittlung von Wissen zu Risikofaktoren sowie Schutzverhalten stellt eine wesentliche Grundlage der primären Hautkrebsprävention dar. Die tatsächlich von der Bevölkerung genutzten Informationskanäle sind auf diesem Gebiet weitgehend unbekannt. Deskriptive Darstellung der einschlägigen Informationsquellen, die Eltern von 3‑ bis 6‑jährigen Kindern als besonders relevante Zielgruppe nutzen, sowie Analyse von Zusammenhängen zwischen soziodemografischen Faktoren, Arten von Informationsquellen und dem Wissensstand. Querschnittsstudie mittels selbstausgefülltem Fragebogen mit Onlineoption von Oktober 2011 bis Februar 2012 mit 3129 Familien, deren Kind einen der teilnehmenden Kindergärten des Landkreises Erlangen-Höchstadt bzw. der Stadt Erlangen und der Stadt Ansbach besuchten (87,5 % Response auf Kindergartenebene, 56,5 % auf Ebene der Beobachtungseinheit [Familie]). Es bestanden relativ geringe strukturelle Unterschiede zwischen den Standorten. Das Internet wurde von nur 13,3 % der Befragten genutzt. Eine positive Assoziation zwischen Nutzung mehrerer Informationsquellen und relevantem Wissen sowie präventivem Verhalten war zu verzeichnen. Darüber hinaus konnte eine negative Assoziation zwischen Nutzung des Internets und erworbenem Wissen festgestellt werden. Demgegenüber war die Nutzung von Printmedien sowie audiovisueller bzw. persönlich vermittelter Information positiv mit Wissen assoziiert. Prävention sollte verstärkt auf Teile der Bevölkerung mit geringerer formaler Bildung zugeschnitten werden. Bei der Wissensvermittlung scheint derzeit dem Internet keine große Bedeutung zuzukommen; die negative Assoziation zwischen Internetnutzung und Wissen ist möglicherweise auf verbreitete irreführende Informationen zurückzuführen. The dissemination of knowledge on risk factors and preventive strategies is a core element of skin cancer prevention. However, little is known about the information channels utilised by the population for this purpose. Descriptive analysis of information sources used by parents of 3‑ to 6‑year-old children as a particularly relevant target group and analysis of association patterns between socio-demographic factors, types of information sources and acquired knowledge. A cross-sectional study was performed using a self-administered questionnaire with an online option between October 2011 and February 2012 with 3129 families who had at least one child visiting a kindergarten in the county of Erlangen-Höchstadt, the city of Erlangen or the city of Ansbach (Bavaria, Germany), with an 87.5% response rate on the level of kindergartens and 56.5% on the level of observational units (families). There were few structural differences between study regions. The internet was used by only 13.3% of participants. A positive association was found between the use of multiple information sources and relevant knowledge and, partly, protective behaviour. A negative association was identified between the use of the internet and knowledge. In contrast, the use of print media or audio-visual or personal channels of information was positively associated with knowledge. Preventive efforts should be increased that target parts of the population with lower formal education. The internet does not seem to play an important role and may even adversely affect knowledge, possibly due to unvalidated and misleading information.

ACS Style

Wolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2017, 60, 856 -864.

AMA Style

Wolfgang Uter, Cornelia Fießler, Olaf Gefeller, Annette Pfahlberg. Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2017; 60 (8):856-864.

Chicago/Turabian Style

Wolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. 2017. "Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern." Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 60, no. 8: 856-864.

Head and neck cancer
Published: 20 May 2017 in Journal of Clinical Oncology
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6016 Background: Concurrent CRT with 70.6 Gy is the standard treatment for locally advanced head and neck cancer (LA-SCCHN). There exist no prospective data on safety and efficacy of a reduced radiation (RT) dose. Methods: Pts with stage III-IVB LA-SCCHN were randomized 1:1 to receive 70.6 Gy with concurrent cisplatinum (20mg/m²/d IV on days 1-5 and 29-33) and fluorouracil (600 mg/m²/d CIV on days 1-5 and 29-33) (standard arm A) versus 63,6 Gy with intensified chemotherapy using concurrent cisplatinum (20mg/m²/d IV on days 1-4 and 29-32) and paclitaxel (20mg/m²/d IV on days 2, 5, 8, 11 and 25, 30, 33, 36) (experimental arm B). After a planned interim analysis recruitment was stopped due to statistical reasons. Results: Between 06/2010 and 02/2015 a total of 221 pts were randomized with 105 pts receiving treatment in arm A and 112 in arm B (4 pts dropped out). Median follow-up was 38 months. Pts’ characteristics: Oral cavity (15%), oropharynx (54%), hypopharynx (28%), larynx (14%); 17 pts had more than one primary site; tumor stage: III (14%), IV (86%); HPV-status (p16) was positive in 20%, negative in 38%, currently pending in 42%. A total of 96 PFS-related events occurred. 3-year PFS (ITT) was 58% in the standard arm A and 48% in experimental arm B (p = 0.454). 3-year OS (ITT) was 64% in arm A and 59% in arm B (p = 0.688). 3-year rates of distant metastases, loco-regional recurrences and death were 10% vs 12%, 17% vs 21% and 15% vs 19% for pts in arm A and B, respectively. As for the p16-positive subgroup, 3-year PFS/OS were 77%/76% in arm A (n = 21) and 69%/80% in arm B (n = 22), respectively. Grade 3+ hematologic adverse events during therapy (arm A/arm B): Anemia 11%/4% (p = 0.038); neutropenia 40%/16% (p < 0.001); thrombocytopenia 8%/3% (p = 0.130). Conclusions: These preliminary results indicate that pts receiving concurrent CRT for LA-SCCHN did not benefit from a lower total RT dose of 63.6Gy despite intensified chemotherapy. However, in the subgroup of p16-positive pts a reduced RT dose may be sufficiently effective. Clinical trial information: NCT01126216.

ACS Style

Rainer Fietkau; Heinrich Iro; Markus Hecht; Benjamin Hofner; Olaf Gefeller; Panagiotis Balermpas; Claus Roedel; Matthias Hautmann; Oliver Koelbl; Horst Leber; Attila Salay; Christian Ruebe; Peter Breinl; Waldemar Krings; Stephan Gripp; Barbara Wollenberg; Rainer Keerl; Ulrike Schreck; Birgit Siekmeyer; Gerhard Grabenbauer. Randomised phase-III-trial of concurrent chemoradiation (CRT) for locally advanced head and neck cancer (stage III-IVB): Comparing dose reduced radiotherapy (63,6 Gy) with paclitaxel/cisplatinum to standard radiotherapy (70,6 Gy) with fluorouracil/cisplatinum. Journal of Clinical Oncology 2017, 35, 6016 -6016.

AMA Style

Rainer Fietkau, Heinrich Iro, Markus Hecht, Benjamin Hofner, Olaf Gefeller, Panagiotis Balermpas, Claus Roedel, Matthias Hautmann, Oliver Koelbl, Horst Leber, Attila Salay, Christian Ruebe, Peter Breinl, Waldemar Krings, Stephan Gripp, Barbara Wollenberg, Rainer Keerl, Ulrike Schreck, Birgit Siekmeyer, Gerhard Grabenbauer. Randomised phase-III-trial of concurrent chemoradiation (CRT) for locally advanced head and neck cancer (stage III-IVB): Comparing dose reduced radiotherapy (63,6 Gy) with paclitaxel/cisplatinum to standard radiotherapy (70,6 Gy) with fluorouracil/cisplatinum. Journal of Clinical Oncology. 2017; 35 (15_suppl):6016-6016.

Chicago/Turabian Style

Rainer Fietkau; Heinrich Iro; Markus Hecht; Benjamin Hofner; Olaf Gefeller; Panagiotis Balermpas; Claus Roedel; Matthias Hautmann; Oliver Koelbl; Horst Leber; Attila Salay; Christian Ruebe; Peter Breinl; Waldemar Krings; Stephan Gripp; Barbara Wollenberg; Rainer Keerl; Ulrike Schreck; Birgit Siekmeyer; Gerhard Grabenbauer. 2017. "Randomised phase-III-trial of concurrent chemoradiation (CRT) for locally advanced head and neck cancer (stage III-IVB): Comparing dose reduced radiotherapy (63,6 Gy) with paclitaxel/cisplatinum to standard radiotherapy (70,6 Gy) with fluorouracil/cisplatinum." Journal of Clinical Oncology 35, no. 15_suppl: 6016-6016.