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The cellist took up the role in November 2024 having previously held teaching roles in Cologne and Maastricht
Cellist Gabriel Schwabe © Studio Monbijou
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Gabriel Schwabe has accepted a position of cello professor at the Music Academy in Lübeck
The cellist has been teaching in the post since November 2024 and has previously held roles at the University of Music and Dance in Cologne and the Conservatorium Maastricht
’I’m excited to join the faculty of the Academy of Music Lübeck
a school with a rich history of string teaching,’ Schwabe told The Strad. ’Following in the footsteps of giants like Shmuel Ashkenasi
Lynn Harrell or David Geringas is a wonderful challenge and I look forward to embracing the school’s traditions as well as continuing to explore my very own approach to teaching in this new and inspiring setting.’
German-Spanish cellist Schwabe is a laureate of three of the world‘s most prestigious cello competitions: the Grand Prix Emanuel Feuermann in Berlin
the Concours Rostropovich in Paris and the Pierre Fournier Award in London
As a soloist he has worked with orchestras such as the London Philharmonia
the Malmö and Norrköping Symphony Orchestras and the NCPA Orchestra Beijing with conductors such as Marek Janowski
Michael Sanderling and Marc Soustrot.
He has been a chamber music partner to artists such as Pinchas Zukerman
In 2010 he gave his recital debut at London’s Wigmore Hall
He is a regular guest at festivals such as the Jerusalem Chamber Music Festival
Amsterdam Biennale and Schleswig-Holstein Music Festival.
He has released seven albums as an exclusive recording artist for Naxos, among them a recording of the Elgar and Bridge Cello Concertos with the ORF Vienna Radio Symphony Orchestra and Christopher Ward
2024 will see the release of the complete Beethoven Sonatas and Variations with Nicholas Rimmer.
Schwabe received his musical education from Catalin Ilea at the University of Arts in Berlin and with Frans Helmerson at the Kronberg Academy
with further inspiration from Janos Starker
He is married to violinist Hellen Weiß and plays a cello by Giuseppe Guarneri ’ex-Boettcher’
Listen: The Strad Podcast #107: back to basics with cellist Gabriel Schwabe
Read: Cellist Jeffrey Zeigler rejoins the faculty of the Mannes School of Music in New York
In The Best of Technique you’ll discover the top playing tips of the world’s leading string players and teachers
It’s packed full of exercises for students
plus examples from the standard repertoire to show you how to integrate the technique into your playing
The Strad’s Masterclass series brings together the finest string players with some of the greatest string works ever written
Masterclass has been an invaluable aid to aspiring soloists
chamber musicians and string teachers since the 1990s
The Canada Council of the Arts’ Musical Instrument Bank is 40 years old in 2025
This year’s calendar celebrates some its treasures
including four instruments by Antonio Stradivari and priceless works by Montagnana
A chance to watch this epic work in its entirety
Who better to write music for cello than cellists themselves
Ben Michaels writes about commissioning six solo cello pieces by cellists
Cellist Amber Den Exter is receiving treatment following a car crash last month in Houston
which resulted in serious spinal injuries and paralysis
38 violists under the age of 30 have been selected to produce a video recital
for the chance to progress to the competition’s live rounds in November
Anna Boysen Lauritsen takes up the role of director
while founder Jacob Shaw steps aside into the role of artistic director
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A game that inspired more curiosity than confidence
Borussia Dortmund officially opened the 2024-25 season in Hamburg against fourth-tier Phönix Lübeck in Nuri Sahin’s first competitive game as BVB manager
The Pokal game got off to a sizzling start
as new signing Waldemar Anton tapped in a lovely Pascal Groß corner with less than three minutes on the clock
Dortmund extended their advantage at the half-hour mark
as Karim Adeyemi (playing as a makeshift striker) won a penalty
which captain Emre Can emphatically converted
with Dortmund enjoying over 80% of the ball (though not really threatening the opposition)
but we saw the best goal of the game in first-half stoppage time
with Brandt showing exceptional control to collect a long ball from new man Groß and finish beyond Lübeck keeper Leonhard
The Oberliga side actually managed to pull one back on 55 minutes
with centre-back Iloka pouncing on a sloppy Brandt giveaway and taking advantage of some clueless defending to power a wonderful finish past Kobel
Our three-goal cushion was restored less than 10 minutes later
as both the newly-introduced wide players combined
Couto playing Duranville in behind to slot home
though we nearly suffered some nasty shocks
with Lübeck hitting the aluminium twice off corners late on
Sahin opted to leave both Beier and Haller on the bench
This meant that Karim Adeyemi was the nominal sole striker in a new 3-2-4-1 shape
with one dropping deep and the other looking to stretch the Lübeck backline with a run in behind
while Brandt was given a free-roaming 10 role
Can and Groß comprised the black and yellow engine room
Anton and Schlotterbeck the three central defenders
While this shape is well-suited to the kind of quick passing and possession-oriented football that Sahin is looking to implement
we looked unused to it; despite the relative lack of pressure from our opponents
the passing was slow and disjointed and players were often poorly positioned in the buildup
This was also reflected in the goal we conceded
with the backline all at sea despite their numerical advantage
but I think it’s going to take some time before we’re fluent in his language
we relied on the fact that our players were fitter and capable of more brilliance than theirs (plus a little help from the aluminium); while this approach works against Phönix Lübeck
it remains to be seen how we’ll fair against Bundesliga opposition
This is at least partially attributable to the apparent foreignness of our new shape
but it was clear that last season’s problems with creativity continue to trouble us
our 88% possession yielded a paltry five shots (one a penalty)
with our starting wide players registering a combined total of: one shot
Our goals came from long balls and set pieces (sound familiar?)
While the threat from wide areas improved after the introductions of Duranville and Couto (who combined for our fourth)
I’m certain that the tiring Lübeck backline played a role in the apparent improvement
with Sabi taking on the active shuttling role and Groß offering the deeper playmaking option
I’ve no doubt this will improve as the boys familiarise themselves with the new approach
Our starting XI consisted of two debutants in Waldemar Anton and Pascal Groß
Waldi ghosting in unmarked at the back post to tap home a wonderful Groß corner
making the assist for Brandt’s wondergoal later on in the half as well
new right-back Yan Couto made the assist for young Julien Duranville
making only his fourth appearance as a Dortmund player
We also got a glimpse of Maxi Beier off the bench
with the new striker showing his ability to make good runs in behind
Image source: Eisemann N, Bunk S, Mukama T et al., Nature Medicine 2025 (CC BY 4.0)
also highlight the potential of AI to reduce the workload of radiologists without compromising diagnostic quality.
Image source: University of Lübeck; photo: private
evaluated data from over 460,000 women who participated in the MSP between 2021 and 2023 across 12 screening sites in Germany
Approximately half of the mammograms were analyzed using AI
while the other half were assessed through traditional double reading by radiologists
“Our initial aim was to demonstrate that AI-based evaluations are equivalent to human assessments,” explained Prof
principal investigator and Director of the Institute of Social Medicine and Epidemiology at the University of Lübeck and UKSH
the findings exceeded our expectations: AI significantly improves breast cancer detection rates.”
The study revealed that AI identified 6.7 cases of breast cancer per 1,000 women screened
compared to 5.7 cases per 1,000 detected through traditional methods
This equates to one additional cancer case detected per 1,000 women screened
the rate of women referred for further testing remained stable
with 37.4 per 1,000 for AI assessments compared to 38.3 per 1,000 for traditional double readings
emphasized the global significance of these findings: “The PRAIM study highlights the immense potential of AI to enhance screening programs worldwide
This evidence will elevate discussions about integrating AI into healthcare systems to a new level.”
Measuring the calcium build up in the arteries of the breast
researchers have developed an AI-generated score for predicting cardiovascular disease in women from their mammograms
Another key finding of the study is the potential for AI to improve efficiency in breast cancer screening
Simulations suggest that if all cases flagged as normal by AI were not reviewed by human readers
the breast cancer detection rate would still be 16.7% higher
the number of unnecessary recalls could be reduced by 15%.
Given that radiologists in Germany currently analyze 24 million individual images annually
the implementation of AI could significantly alleviate their workload
“We hope that the higher detection rates enabled by AI will improve outcomes for women with breast cancer
This will be the focus of future investigations,” said Prof
Breast cancer is the most common cancer among women in Germany
screens over 3 million women aged 50 to 75 annually
Despite the high accuracy of double readings
some breast cancer cases remain undetected
AI-based systems have the potential to address this diagnostic gap while simultaneously reducing the burden on radiologists.
The PRAIM study represents a significant step forward in integrating AI into clinical practice
Its findings underscore the transformative potential of AI to enhance cancer detection
and ultimately contribute to better outcomes for patients
Future research will focus on evaluating the long-term impact of AI on patient prognosis and its integration into routine clinical workflows.
Current AI systems for detecting breast cancer from mammography exams are more likely to produce false-positive results in black women and older patients
Despite their improving diagnostic accuracy
medical AI systems are often met with skepticism by radiologists
seem more inclined to embrace this technology
AI-supported screening for breast cancer can detect more cancer cases compared with traditional screening
and find more invasive cancers at an early stage
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GK: Gregor Kobel - Kobel is expected to start his fourth season at Borussia Dortmund in goal against Lübeck. The Swiss goalkeeper has so far put on scintillating displays and will hope to continue his fine run of form. Even though he is no longer the vice-captain
he will still be expected to be among the leading group of the club
RB: Yan Couto - The 22 year old Brazilian right-back is expected to make his competitive debut on Saturday
He played the first-half of the friendly against Aston Villa and will have to fight for his position as Julian Ryerson is another option for the role
Couto appears set to start the season at right-back
CB: Waldemar Anton - The new signing from Stuttgart is also expected to make the starting XI on Saturday
After his excellent season with the Swabians
Anton will hope to cement himself as a regular starter at Borussia Dortmund
CB: Nico Schlotterbeck - After the departure of Mats Hummels, Schlotterbeck will now be expected to be the main man in central defence for Borussia Dortmund. He will also hope to start ahead of Niklas Süle on Saturday
although the former Bayern man could also be in contention after a solid pre-season
Left-Back: Ramy Bensebaini - With Yan Couto’s signing there are two solid players for the right-back position
Bensebaini is yet to convince since his move from Borussia Mönchengladbach
It will be interesting to see if Sahin goes with the Algerian international or Ryerson in that role on Saturday
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GK: Gregor Kobel - Kobel is expected to start his fourth season at Borussia Dortmund in goal against Lübeck. The Swiss goalkeeper has so far put on scintillating displays and will hope to continue his fine run of form. Even though he is no longer the vice-captain
CB: Nico Schlotterbeck - After the departure of Mats Hummels, Schlotterbeck will now be expected to be the main man in central defence for Borussia Dortmund. He will also hope to start ahead of Niklas Süle on Saturday
DM: Emre Can - Even though his influence has decreased
Can remains the Borussia Dortmund captain and will start in the number six role against Phönix Lübeck
The Germany international will hope to dominate proceedings in midfield
can bring a lot of fresh input to the side
ability to create chances and versatile profile
he can be the leader BVB will need in this transitional season
AM: Julian Brandt - The newly appointed Borussia Dortmund vice-captain will have his sights set on another strong season with Borussia Dortmund
He will look to set the tone from the number ten role this weekend
AM: Marcel Sabitzer - After establishing himself as a key player for Borussia Dortmund during his first season with the club
the Austrian international will have his sights set on a strong sophomore campaign
Sabitzer could be in contention to play in the free attacking role on Saturday
although Jamie Gittens could also be a candidate for the spot
ST: Maximilian Beier - Beier is one of the best and most exciting signings BVB have made in recent years
he could be used in a variety of different roles over the course of the season
It will be interesting to see if he slots straight into the starting XI
Sebastien Haller could also be an option for the striker's role on Saturday
LW: Karim Adeyemi - After months of transfer speculations
it looks like Adeyemi will be staying at BVB
This means that he will probably get the nod for the left wing position
The young German has at times shown what he is capable of
He just needs to do it more consistently now
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The project from a cultural alliance known as Kein Spaß mit Nazis (No Fun With Nazis) will stand against the creeping rise of right-wing extremism and fascism
A protest rave against the rise of the far-right in Germany is set to take place in the northern city of Lübeck this Saturday
Scheduled to run from 6PM - 10PM in the Marienkirchhof plaza
it has been organised by a cultural alliance calling itself Kein Spaß mit Nazis
The event has been given the name Bass gegen Hass (Bass Against Hate) and will include a music programme curated by local promoter SUPERKUNSTFESTIVAL
The rally will take place a day before citizens vote in Sunday's federal election
Current polls show the conservative Christian Democrats leading
with the far-right group Alternative for Germany (AfD) in second
The more left-leaning Social Democrats are polling in third place
we position ourselves clearly and unambiguously against xenophobia and right-wing ideology
Freedom and democracy have always been the best signposts for a cosmopolitan society
and culture is its voice of praise and warning."
Find more information about Saturday's rally here
Back in 2018, far-right supporters at an AfD rally were outnumbered four to one by raving protestors at a demonstration in Berlin
In 2023, thousands of Berlin ravers attended a protest event against the planned expansion of the A100 motorway
The World Heritage Centre is at the forefront of the international community’s efforts to protect and preserve
World Heritage partnerships for conservation
Ensuring that World Heritage sites sustain their outstanding universal value is an increasingly challenging mission in today’s complex world
where sites are vulnerable to the effects of uncontrolled urban development
Our Partners Donate
Take advantage of the search to browse through the World Heritage Centre information
Lübeck – the former capital and Queen City of the Hanseatic League – was founded in the 12th century and prospered until the 16th century as the major trading centre for northern Europe
It has remained a centre for maritime commerce to this day
Despite the damage it suffered during the Second World War
consisting mainly of 15th- and 16th-century patrician residences
public monuments (the famous Holstentor brick gate)
Ancienne capitale de la Ligue hanséatique et reine de la Hanse
elle a été fondée au XIIe siècle et fut jusqu'au XVIe siècle la métropole du négoce pour toute l'Europe du Nord
Elle reste encore aujourd'hui un centre de commerce maritime
spécialement avec les pays nordiques
Malgré les dommages qu'elle a subis durant la Seconde Guerre mondiale
la structure de la vieille ville est conservée avec ses résidences patriciennes des XVe et XVIe siècles
ses monuments publics (notamment la célèbre porte fortifiée en brique de la Holstentor)
ses églises et ses greniers à sel
إنها العاصمة القديمة للتحالف (الهانزي) التجاري وملكة الهانزا
لقد تأسست المدينة في القرن السابع وبقيت حتى القرن السادس عشر مدينة التبادلات التجارية لكل أوروبا الشمالية
لا تزال حتى اليوم مركزاً للتجارة البحرية ولا سيما مع الدول الشمالية
على الرغم من الأضرار التي لحقت بها خلال الحرب العالمية الثانية، لا تزال بنية المدينة القديمة قائمة بمقرات النبلاء التي تعود إلى القرنين الخامس عشر والسادس عشر وبنصبها العامة (لا سيما الباب الشهير المعزز المصنوع من القرميد القادم من هولتنستور) وكنائسها ومخازن الملح فيها
吕贝克,汉萨同盟(the Hanseatic League)的前首都和皇后城,建于公元12世纪,作为北欧的重要商业中心曾一度繁荣
直到16世纪。今天,这里仍是海上商贸中心(尤其与北欧国家的海上贸易)。尽管在第二次世界大战中受到了一定的损毁,这座老城的基本城市结构还是保留了下来,这点从15世纪至16世纪建造的贵族居所,历史古迹(如著名的豪斯顿砖门)、教堂和盐场等都能够看出来。
бывшая столица и главный город Ганзейского союза
как главный центр торговли на севере Европы
В наше время Любек остается центром морской торговли
общественные здания и сооружения (включая знаменитые кирпичные ворота Хольштентор и соляные склады)
Antigua capital y ciudad reina de la Liga Hanseática
Lübeck fue fundada en el siglo XII y hasta el siglo XVI fue la principal metrópoli comercial de la Europa Septentrional
Actualmente sigue siendo un importante centro de comercio marítimo
sobre todo con los países nórdicos
Pese a los daños sufridos durante la Segunda Guerra Mundial
se ha conservado la estructura de la ciudad antigua con sus mansiones señoriales de los siglos XV y XVI
sus depósitos de sal y sus monumentos públicos como la famosa puerta fortificada de Holstentor
Founded in 1143 on the Baltic coast of northern Germany
Lübeck was from 1230 to 1535 one of the principal cities of the Hanseatic League
a league of merchant cities which came to hold a monopoly over the trade of the Baltic Sea and the North Sea
The plan of the Old Town island of Lübeck
with its blade-like outline determined by two parallel routes of traffic running along the crest of the island
dates back to the beginnings of the city and attests to its expansion as a commercial centre of Northern Europe
the richest quarters with the trading houses and the homes of the rich merchants are located
The very strict socio-economic organization emerges through the singular disposition of the Buden
small workshops set in the back courtyards of the rich hares
to which access was provided through a narrow network of alleyways (Gänge)
Lübeck has remained an urban monument characteristic of a significant historical structure even though the city was severely damaged during the Second World War
including the most famous monumental complexes- the Cathedral of Lübeck
the churches of St Peter and St Mary and especially the Gründungsviertel
the hilltop quarter where the gabled houses of the rich merchants clustered
Selective reconstruction has permitted the replacement of the most important churches and monuments
Omitting the zones that have been entirely reconstructed
the World Heritage site includes three areas of significance in the history of Lübeck
The first area extends from the Burgkloster in the north to the quarter of St Aegidien in the south
a Dominican convent built in fulfilment of a vow made at the battle of Bornhöved (1227)
contains the original foundations of the castle built by Count Adolf von Schauenburg on the Buku isthmus
The Koberg site preserves an entire late 18th-century neighbourhood built around a public square bordered by two important monuments
the Jakobi Church and the Heilig-Geist-Hospital
The sections between the Glockengiesserstrasse and the Aegidienstrasse retain their original layout and contain a remarkable number of medieval structures
Between the two large churches that mark its boundaries - the Petri Church to the north and the Cathedral to the south - the second area includes rows of superb Patrician residences from the 15th and 16th centuries
with its salt storehouses and the Holstentor
reinforces the monumental aspect of an area that was entirely renovated at the height of the Hansa epoch (about 1250 to 1400)
when Lübeck dominated trade in Northern Europe
the third area around St Mary’s Church
and the Market Square bear the tragic scars of the heavy bombing suffered during the Second World War
Criterion (iv): As outstanding examples of types of buildings
the most authentic areas of the Hanseatic City of Lübeck exemplify the power and the historic role of the Hanseatic League
The preserved quarters of the Old Town show in their unity the medieval structure of the Hanseatic Town and represent a high-ranking European monument
The overall impression of the Old Town is reinforced by individual architectural highlights of ecclesiastical and profane character
whereas the combined effect is revealed through the unique town silhouette with the seven high church towers
The heart of the Old Town is surrounded by water on all sides and
consisting mainly of 15th and 16th century Patrician residences
its layout is clearly recognisable as a harmonious
complete masterpiece and its uniquely uniform silhouette is visible from far
The laws and regulations of the Federal Republic of Germany and the State of Schleswig-Holstein guarantee the consistent protection of the Hanseatic City of Lübeck
The large number of historic monuments and the Old Town island are protected by the Act on the Protection and Conservation of Monuments in the federal state of Schleswig-Holstein
The Monument Preservation Plan is the basis for town planning and specific architectural interventions
the historic centre of Lübeck is protected by a preservation statute and a design statute; even the quarters of the late 19th century surrounding the Old Town are protected by preservation statutes
The regional development programme of the federal state of Schleswig-Holstein ensures the protection of the view axes and the silhouette of the World Heritage property
The City of Lübeck is responsible for the management of the World Heritage property
The coordination between the stakeholders is organised by a World Heritage commissioner within the municipal structure in order to duly indicate potential threats to the Outstanding Universal Value and to ensure the integration of relevant issues into the planning procedures
an integrative monitoring approach and a sustainable development of the World Heritage property
this differentiated protective system guarantees an efficient preservation of the historical substance of the property
To protect and sustain the Outstanding Universal Value
a buffer zone and additional view axes outside the buffer zone are in place to ensure the long-term protection and sustained preservation of the important views and of the structural integrity
external experts meet regularly in consultative bodies to monitor quality and discuss suitable solutions in town planning and construction practice
Regarding the tourism and visitor management
a tourism development concept (TDC) forms the basis for strategic activities.
Take a look around the northern German shop
I like working undisturbed with few distractions
so I found a place two miles outside the city of Lübeck in northern Germany
The building is next to a church and the priest occupies around half the space
I worked for five years in a tiny house nearby
where the ceilings were less than two metres high so I had to sit down to play the violin
Then in 2017 I asked if I could move my workshop into the empty part of the church house
So I’ve been here for seven years and I’ve been able to customise it to my own needs…
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A total of 1.6 million tonnes of decommissioned weapons
grenades and artillery and machine gun ammunition lie at the bottom of the Baltic and North Seas
all these weapons were taken from German and Allied arsenals by the barge load and dumped in the Bay of Lübeck as part of German disarmament
All these discarded weapons have serious consequences
as the metal shells and casings of bombs and cartridges corrode and release explosives
Carcinogens and mutagens end up in the water and in the food chain - in fish and mussels and eventually on our plates
"The German government is investing EUR 100 million in environmental protection
"We have to act now while the ammunition is still intact enough to be recovered."
we need an approach that allows us to salvage and dispose of munitions on an industrial scale 24/7." The experience gained from this pilot project should lead to a safe
overall concept for working on the high seas.
SeaTerra is responsible for recovering piles of ammunition from the seabed
as well as boxes of unidentified ammunition
"First we scan the area using magnetometers to collect data," said Guldin
three ships equipped with special technology
A vessel equipped with Dynamic Positioning (DP)
also known as Dynamic Positioning System (DPS)
acts as the main starting point for the salvage operation
Vessels with DPS can hold a position without anchoring or mooring thanks to a computer-controlled system for automatic positioning
we lower a camera and gripper system as well as a diving team to identify any ammunition that can be handled safely and can be put into baskets." A grenade
Around 95 per cent of the arms are safe to handle and can be picked up by the gripper
"The gripper is suspended from a crane and is brought into an optimum gripping position
The contact pressure can be adjusted - from five to 250 kilos - to gently lift the various objects into the basket without causing an explosion." Achieving such sensitivity was a real challenge
The gripper is supported by a remote-controlled underwater robot or crawler
which examines the seabed and collects small objects such as bullets
The finds are sorted and documented aboard the other ships. "We draw up a data sheet for every recovered object," said Guldin. "Most of the recovered ammunition is brought ashore for destruction and handed over to the Society for the Disposal of Chemical Warfare Agents and Legacy Armaments (GEKA)." The remainder is taken to a so-called wet storage facility for disposal
The Port of Lübeck is a key piece of infrastructure in the Hamburg Metropolitan Region and far beyond
around 25.6 million tonnes of seaborne goods were handled on Lübeck's quays
Most ferries and cargo ships set sail for Sweden and Finland or arrive from the region
Latvia and Lithuania are also important destinations
Efficiency is a big issue in Lübeck: "We want to make better use of our space and get more out of it
The aim should be to use the space fully before sealing new areas," said Michael Siemensen
who is responsible for strategic port development at the Lübeck Port Authority
Data can be transmitted in real time - and every minute counts in the Port of Lübeck
where cargo sometimes has to be unloaded or loaded onto a ship in just two hours
"Cargo" can mean anything from cars to truck trailers
new and used vehicles and products such as cardboard
Everything has to be in the right place at the right time: "Our long-term goal is a digital twin that provides all the information in real time
It is about knowing what is where and how to get it to the right place at the right time," said Siemensen
Procedures are now being digitised and networked as exemplified by the EVE42 robot
Around 1,600 spaces are available for unaccompanied truck trailers at Skandinavienkai
the hauliers do not park the trailers in allocated individual spaces
but in rows of 40 to 60 spaces: "The truck drivers usually bring one trailer and often take another with them
a trailer may not always be parked in a predetermined row of blocks
but next to one that has to be picked up," Siemensen pointed out
A search begins before freight is loaded onto a ship
The EVE42 robot scans rows in the quay autonomouslyand updates the booking system i.e.
The front of the trailer and even handwritten identifiers are being read successfully
Problems arise with autonomous driving
and are now being addressed with the University of Lübeck
Professor Georg Schildbach from the university's Autonomous Systems Lab said: "I assume that we will be able to achieve the goal of autonomous driving in the port within six months."
The robot is just one of many projects underway in the Port of Lübeck
Trailers will soon be arriving by both lorry and train
Digital systems will automatically identify trailers
Is it time-critical and where is the best place to park it
Trucks can be automatically detected on entering the port and the data compared to quay usage
it can be automatically diverted to another area until more space is available
This digitisation strategy should lead to rapid
The Port of Lübeck brings scientists on board for individual projects
The Port of Lübeck is also investigating possible sources of funding
it is difficult to say when the port will go fully digital
it is easier for software and machines to take over in a pure container port like Hamburg
the mix of cargo and the time factor make the Port of Lübeck special
Trailers are loaded onto the ship by tractor units
while ferry passengers drive their cars themselves
loading and unloading occurs simultaneously
fully automated loading and unloading by machine requires large time buffers
given the level of precision and speed required."agu/kk/pb
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Volume 2 - 2022 | https://doi.org/10.3389/frsip.2022.883696
This article is part of the Research TopicImmersive and Interactive Audio for Extended RealityView all 5 articles
we evaluated a microphone array with six microphones mounted on a pair of glasses
we conducted two listening experiments comparing four rendering methods based on acoustic scenes captured in different rooms2
The evaluation includes a microphone-based stereo approach (sAB stereo)
a beamforming-based stereo approach (sXY stereo)
beamforming-based binaural reproduction (BFBR)
and BFBR with binaural signal matching (BSM)
the perceptual evaluation included binaural Ambisonics renderings
which were based on measurements with spherical microphone arrays
In the EMA experiment we included a fourth-order Ambisonics rendering
while in the glasses array experiment we included a second-order Ambisonics rendering
In both listening experiments in which participants compared all approaches with a dummy head recording we applied non-head-tracked binaural synthesis
with sound sources only in the horizontal plane
The perceived differences were rated separately for the attributes timbre and spaciousness
Results suggest that most approaches perform similarly to the Ambisonics rendering
and microphone-based stereo were rated the best for EMAs
and BFBR and microphone-based stereo for the glasses array
Alternative approaches for the binaural reproduction of non-spherical array configurations are therefore required
Several approaches have been proposed in the literature and are reviewed below
who introduced a beamformer whose output is first-order Ambisonics signals (SH signals after radial filtering)
Although the eXMA approach is a promising method
eXMA was still in the optimization phase and is thus not further evaluated in this study
This section introduces the microphone arrays and the data used for quantitative and perceptual evaluation
it presents an overview of the fundamental theory of the binaural rendering approaches
We chose to evaluate the approaches based on two different array configurations
which are introduced in the following sections
Microphone distribution of the EMA with six microphones (left) and eight microphones (right); Both have a center microphone exactly in the front (the direction of the arrow)
The microphones used for AB stereo are indicated with “A” and “B”
Only the EMA with eight microphones has microphones at ϕ =90° and ϕ =270°
A diagram of the glasses array and its approximate microphone positions
The array has one microphone exactly at the front (4)
two at the back of the temple arms used for AB stereo
one additional microphone at the right temple arm (1)
This figure and the microphone positions are not a depiction of any current or future product
For the comparative Ambisonics renderings in the quantitative and perceptual evaluation
we employed SMA impulse responses measured under the exact same conditions as for the EMAs and glasses array
we decided to render capture from an Eigenmike at the fourth order
Since the employed database only includes 29th order SMA measurements
we again applied resampling in the SH domain at N = 29 to the 32-microphone Eigenmike sampling scheme
It should be mentioned that the resampled signals have the same sampling grid as the original Eigenmike measurements
the radius of the original SMA (0.0875 m) cannot be adjusted to that of the Eigenmike (0.042 m)
leading to slightly different aliasing effects
we rendered 8-channel OctoMic data of the second order
The general idea of the BFBR approach is to filter and sum each microphone signal x(ω)=[x1(ω),…,xM(ω)]T with the beamforming filters c(ω)=[c1(ω),…,cM(ω)]T
which shows binaural signals calculated with the BFBR method from simulated array signals of a single plane wave impinging on an EMA6 from the frontal direction
The BFBR method was performed with different numbers of beams
the frontal HRTF is depicted as the dashed black line
The figure shows that with increasing the number of beams
the spectral roll-off compared to the frontal HRTF increases
we used 32 uniformly distributed MD beams for binaural reproduction
as preliminary listening tests demonstrated the best results for our array geometries
The spectral roll-off was equalized with a minimum phase filter
which compensates for the deviation of the transfer function of a reference microphone from the transfer function of the BFBR output from a single plane wave impinging on the array from the frontal direction
Magnitude spectra of frontal binaural signals rendered with BFBR with different numbers of beams
based on a single plane wave impinging on an EMA6 from the frontal direction
a frontal HRTF of a KU100 dummy head for the frontal direction is depicted
for BSM the array signals x(ω) are filtered and summed with pre-calculated filters c(ω)l,r
leading to the binaural signals b(ω)l,r
one set of filter coefficients is required for each ear separately
To calculate the BSM filters it is assumed that the sound field consists of L acoustic events (sound sources) s(ω)=[s1(ω),…,sL(ω)]T
the binaural signals a listener would be exposed to in the sound field are
with hl,r=[h1(ω)l,r,…,hL(ω)l,r]T being the HRTFs for the directions of the sound sources s
The BSM filters can be calculated by minimizing the error
it is favourable to use microphone locations close to the positions of the listener’s ears
uniform distribution of the microphones along the equator has advantages
both EMAs have uniformly distributed microphones
only the EMA8 has microphones exactly at ϕ = 90° and ϕ = 270°
the microphones closest to the ears are on the back of the glasses’ temple arms
For the AB stereo approach, we directly used the impulse responses of the AB microphones without any processing or equalization. The AB microphones on the EMAs are depicted in Figure 1. Again, it is worth mentioning that the EMA8 has microphones at ϕ = 90° and ϕ = 270°, while the EMA6 does not. For the glasses array case, we used the microphones on the temple arms of the glasses (labeled A and B in Figure 2)
steering to (ϕ = 45°
θ = 90°) and (ϕ = 315°
Since the beams originate from the center of the array
the beamforming-based XY stereo also can hardly produce any ITD cues
we did not apply any post-processing or equalization
We adapted both methods from the stereo recording with microphones
To emphasize that we simulated these techniques with microphone arrays
we refer to them as sAB (simulated AB) and sXY (simulated XY) in the following
The comparative Ambisonics renderings were calculated with
the ILDs and ITDs of the KU100 HRTFs are depicted by the black dashed line as a reference
The ITD curve of the Ambisonics rendering matches the reference curve quite well
followed by the curves for BSM and sAB stereo
sXY stereo produces some notable excursions and seems to perform the worst
This supports the assumption that beamforming-based XY stereo can hardly synthesize ITDs
sAB stereo matches the reference curve the best
whereas BSM and Ambisonics perform similarily to each other
The ILD curve of sXY stereo exhibits some outliers
specifically near 45° and 315°
Both BFBR and sXY ILD curves are very jagged
This might be due to the beams calculated with few microphones which exhibit side-lobes
In contrast the BSM or Ambisonics ILD curves are quite smooth
ITDs and ILDs of the EMA6 array using different binaural reproduction approaches
The reference values (black dashed lines) were calculated from the KU100 HRTFs
sAB and BSM both exhibit a dip at the top of the ILD curve at around 90° and 270°
which can also slightly be seen in the reference curve
for the EMA6 this dip can only be seen in the sAB curve
ITD and ILD errors of the EMA6 array using different binaural reproduction approaches
ITDs and ILDs of the EMA8 array using different binaural reproduction approaches
ITD and ILD errors for the EMA8 array using different binaural reproduction approaches
both stereo approaches have smaller ITD errors for the glasses array compared to the EMAs
BFBR produces errors above the ITD JND for 90° and 270°
In the ILD error curve no systematic difference compared to the EMAs can be observed
ILDs and ITDs of the glasses array using different binaural reproduction approaches
The reference values (black dashed lines) were calculated from the KEMAR HRTFs
ITD and ILD errors for the glasses array using different binaural reproduction approaches
we analyzed the spectral differences in the form of the averaged differences of the magnitude spectra
where bref are the reference binaural signals, and Ωd is the set of Nd directions of the binaural signals (where Ωd is a set of 360 directions in the horizontal plane in steps of 1°). Figure 10 depicts the spectral differences of the EMA6 and shows that Ambisonics and BSM lead to similar differences
While Ambisonics performs better near 1 kHz
BFBR leads to slightly larger errors than BSM at 1 kHz
but performs equivalently at higher frequencies
sXY stereo leads to notable differences even at frequencies up to 1.1 kHz
which matches the findings from the ILD/ITD figures
The largest magnitude errors are at frequencies above 10 kHz for both stereo approaches
most probably due to the lack of pinnae cues
Figure 11 depicts the average magnitude differences of the binaural signals calculated from the glasses array capture
The figure clearly shows that the magnitude differences are higher than for the EMAs
the highest errors can be observed for the sXY stereo renderings
The magnitude differences of the BSM and the Ambisonics renderings are the lowest
The differences of BSM are below 10 dB for almost all frequencies
The differences for Ambisonics clearly increase above approximately 16 kHz
The figure shows a similar trend as with the EMAs
that BSM has larger magnitude differences at lower frequencies compared to Ambisonics
but similar or even lower errors at higher frequencies
BFBR has larger magnitude errors for nearly all frequencies compared to BSM and Ambisonics
the errors of both stereo curves increase at very high frequencies
Magnitude differences for the glasses array
The quantitative evaluation suggests that BSM and sAB stereo can lead to similar perceptual results to the Ambisonics renderings
we conducted two comparative listening experiments
Differences in the timbre are related to any differences in coloration
Differences in the spaciousness are related to any spatial differences
participants rated eight MUSHRA pages in total: EMA6 in the CR1 with the speech signal
EMA6 in the CR1 with the drums test signal
These factor combinations were repeated for the two metrics
We did not set up a complete factorial design with all factor combinations to avoid the experiment being too long
participants conducted training consisting of user interface familiarization and signal familiarization
19 participants took part in the experiment
Most of whom were staff of the audio group at Reality Labs Research at Meta; none reported any hearing issues
The experiment was conducted in remote settings. It was implemented in Matlab and shared with each participant, who conducted the test with their own equipment, i.e., their PC or Mac, audio device, and headphones. We recommended the use of Beyerdynamic DT990 Pro headphones, which where used by 15 participants. According to the choice of headphones, the binaural chain was equalized with appropriate headphone compensation filters provided by Bernschütz et al. (2012)
If no headphone filters were available in the database
participants were instructed to adjust the volume to a comfortable level that should not change during the experiment
All participants were asked to perform the test in a room which was as quiet as possible
To evaluate participants’ rating differences between renderings
we ranked each rendering within each comparison of stimulus and attribute (by each MUSHRA screen)
We then analyzed the ranks for each rendering using a hierarchical multivariate ordinal regression under a Bayesian framework
regression models calculate the distribution of parameter estimates as the posterior distribution
our model estimated the posterior distribution of each rank for each combination of participant
for each Markov-chain Monte Carlo (MCMC) iteration
To derive a single estimate of ranking in each independent variable combination
we calculated the weighted sum of rankings for each MCMC iteration as follows
where p is the expected probability of rank k at each iteration i
In order to evaluate ranking differences between renderings
we calculated the posterior distribution of differences between rankings for each MCMC iteration for each independent variable combination
Ranking difference estimates for which the highest density credible interval does not include zero are considered statistically significant differences
All models were constructed using the Stan programming language (Carpenter et al., 2017) through the cmdstan (Gabry and Češnovar, 2021) and brms (Bürkner, 2017, 2018) packages in R statistical computing software (R Core Team, 2021)
A graphical overview of the results is presented in Figure 12 in the form of boxplots of the inter-subject variance in the MUSHRA points for each MUSHRA screen and rated attribute separately
The plots show that for the timbre attribute (top) most of the ratings are within the range of the Ambisonics rendering
An exception is the box for the BFBR results from the EMA6 in reverberant conditions
sAB stereo and BSM achieved the highest median ratings
They are consequently higher than the median ratings of the Ambisonics renderings
The results of the spaciousness attribute (bottom) show that only sAB stereo and BSM were rated similar to or higher than the Ambisonics rendering
An interesting observation is that in the reverberant condition
BSM was rated significantly better then all other renderings
A similar trend is shown in the boxplots for the timbre results in the reverberant condition
Comparing the results of the spaciousness attribute for the EMA6 and EMA8 with drums shows that the EMA8 might be favourable for the sAB stereo approach
This might be due to the microphone distribution
EXPERIMENT 1: Boxplots of the inter-individual variation in the MUSHRA points for each MUSHRA page separately
(H) Spaciousness: reverberation EMA6 drums
Visual inspection reveals that for the spaciousness attribute
Ambisonics N = 4 was ranked higher than BFBR for speech with the EMA6 in dry conditions
sAB was ranked higher with the EMA8 in dry conditions
and BSM was ranked higher with the EMA6 in reverberant conditions
sAB was ranked higher for drums and BSM was ranked higher for both drums and speech
Both sAB and BSM were also ranked higher with EMA8 in dry conditions
BSM and sXY were ranked higher with EMA6 in the reverberant room
BFBR was always ranked in the range of Ambisonics for the timbre attribute
EXPERIMENT 1: Median ranks for each rendering by attribute
Points represent median rank and error bars depict the 89% highest density credible interval
EXPERIMENT 1: Median rank differences between renderings and Ambisonics N =4 by attribute
Points represent median rank difference and error bars depict the 89% highest density credible interval
Asterisks indicate statistically significant differences
The median rank differences (Figure 14) suggests that sAB and BSM perform the best for the EMAs
all rendering approaches were rated in a similar range as the N = 4 Ambisonics rendering
we employed array impulse responses measured in a room with variable acoustics for two different source positions (loudspeaker one at 23° with a distance of 2 m
loudspeaker 2 at 325° with a distance of 1.5 m)
We used measurements in dry conditions (RT60 = 0.447 s
and in more reverberant conditions (RT60 = 0.564 s
The measurements were done with the 6-microphone glasses array described in Section 2.1.2
and for the comparative Ambisonics renderings with an 8-microphone OctoMic array
The binaural reference in Experiment 2 was measured with a KEMAR dummy head
The test signals were the same as for Experiment 1 such that in total participants again rated eight MUSHRA pages: dry conditions with loudspeaker 1 (spk 1) and the drums signal
dry conditions with spk one and speech signal
dry conditions with spk 2 and drums signal
and the reverberant condition with spk one and the drums signal
we only tested a subset of all factor combinations
no headphone compensation filters were available for the KEMAR dummy head
the second experiment was conducted without any headphone equalization
and data analysis were identical to Experiment 1
A graphical overview of the results is presented in Figure 15 in the form of boxplots of the inter-subject variance in the MUSHRA points for each MUSHRA page and the timbre and spaciousness attributes
the glasses array is the more challenging condition
except for the results of the BSM renderings for spk 2
all timbre ratings are within the range of the Ambisonics results
BFBR and sAB seem to perform the best regarding the timbre
the boxplots do not indicate any approach as being the best
Only the results for sXY stereo for spk 2 are notably worse compared to the other conditions
EXPERIMENT 2: Boxplots of the inter-individual variation in the MUSHRA points for each MUSHRA page separately
(H) Spaciousness: reverberation spk1 drums
Median ranks for each rendering and test signal, together with 89% credible intervals, are shown in Figure 16
EXPERIMENT 2: Median ranks for each rendering by attribute
To investigate how the approaches performed compared to the Ambisonics renderings Figure 17 shows the median rank differences between each rendering approach and Ambisonics N = 2
together with 89% credible intervals and asterisks indicating statistically significant differences
Ambisonics N = 2 was ranked higher than sXY for spk 2 in dry conditions
BFBR was ranked higher for speech with spk one in dry conditions and for drums with spk one in reverberant conditions
Ambisonics N = 2 was ranked higher than BSM with spk 2 in dry conditions
Median rank differences suggest that in most cases all renderings were rated similar to the Ambisonics rendering
EXPERIMENT 2: Median rank differences between renderings and Ambisonics N =2 by attribute
Points represent median rank differences and error bars depict the 89% highest density credible interval
A primary motivation of the study was to investigate if capture from non-spherical arrays
can lead to auralization that is comparable to the established Ambisonics chain
Both quantitative and perceptual evaluation suggest that for EMAs with six and eight microphones
sAB stereo and BSM performed comparably to
the fourth-order Ambisonics reproduction of SMA capture with an Eigenmike sampling scheme
considering the increased microphone count 32) of the Eigenmike compared to the EMA6 and EMA8
For the glasses array with six microphones
BFBR and sAB stereo performed comparably only to a second-order Ambisonics reproduction of SMA capture with an OctoMic
the glasses array is certainly the more challenging array configuration; that is also supported by the quantitative evaluation
It can be assumed that sAB stereo highly depends on the location of the microphones; this is supported by the ITD and ILD analyses
The results of the EMA experiment show that regarding the spaciousness
microphones at ϕ = 90° and ϕ = 270° might be advantageous
the timbre is not affected by the microphone position
we could not find any significant difference in the performance of sAB stereo between the EMAs and the glasses array
The listening experiment results show that sXY reproduces the sound scene with a relatively accurate timbre
sXY stereo does not lead to good spatial reproduction
This strongly matches the findings from the quantitative evaluation
sXY cannot restore the correct ITDs and ILDs
for one thing due to collocation of the beams and for another due to non-optimal beamforming
MD beamforming with a small number of microphones introduces side lobes
which might cause the ITD and ILD distortions
the original XY stereophony employs microphones with cardioid directivity instead of maximum directivity
BFBR was rated better for the glasses array than for the EMAs; the quantitative evaluation does not clearly supported this
BFBR has larger magnitude differences for the glasses array than for the EMAs compared to BSM or Ambisonics
It might be due to the inconsistent use of the rating scale
Another explanation could be that for the EMAs all microphones are in the horizontal plane
This does not affect the ITD and ILD analysis since we only considered horizontal sound incidences but may affect complex sound scenes
the source distance was 2.4 and 6 m; for the glasses array 1.5 and 2 m
This might further influence the performance of BFBR
it is interesting to mention that BSM behaves in the opposite way; it was rated better for the EMAs
Madmoni et al. (2021) investigated the influence of the microphone distribution on the performance of BSM
they only investigated semi-circular array configurations
They concluded that for static reproduction
microphones placed close to the ears are favourable
uniformly sampling on a full-circular array has advantages
Our study did not find any significant difference between the EMA6 and EMA8
Future work is suggested to develop design criteria for optimal array configurations for the BSM method
which interpolates between neighboured microphone signals according to the listeners’ head orientation
The significant advantage of sXY stereo is its simplicity; it does not require HRTF processing
sXY stereo does not necessarily require microphones at the position of the listener’s ears
Binaural signals for different head orientations could be synthesized by varying the directions of the XY beams
The clear benefit of BFBR is that it is the most flexible approach
Since the sound field is decomposed into different directional components
This could be used to either synthesize different head orientations or amplify specific directions of the sound field
different HRTFs can easily be integrated since they are not incorporated in the beamforming coefficients
beamforming plays an important role in consumer devices
for applications that enhance speech intelligibility
BSM seems to reproduce the most accurate binaural signals
the BSM filters already incorporate the HRTFs
which is why a complete set of BSM filters is required for each head orientation
applying dynamic binaural synthesis would require a large set of beamforming coefficients
This study only focuses on scene-based approaches, i.e., re-synthesis of the entire captured scene. In future work, it would also be conceivable to apply parametric approaches, like DiraC (Pulkki, 2007) or SIRR (Merimaa and Pulkki, 2004)
objects or specific dominant sound sources of the sound field could be extracted and spatially rendered
We presented a comparison of approaches for the binaural rendering of capture from equatorial microphone arrays and capture from a glasses microphone array
A MUSHRA-like listening experiment applying non-head-tracked binaural synthesis showed that the approaches have potential to synthesize spatial sound scenes with similar quality as Ambisonics renderings from spherical microphone array capture with a similar number of microphones
Beamforming-based binaural reproduction with binaural signal matching and a microphone-based stereo approach performed the best for equatorial arrays
beamforming-based binaural reproduction and microphone-based stereo performed the best
The results further suggest that for non-head-tracked binaural reproduction
the more sophisticated beamforming approaches (BSM or BFBR) do not outperform the simple microphone-based stereo approach
Future work is suggested to investigate how the approaches perform with head-tracked dynamic binaural reproduction
we only focused on sound sources in the horizontal plane
The performance of the approaches with elevated sound sources or vertical head movements needs to be investigated in future work
The raw data supporting the conclusions of this article will be made available by the authors
The studies involving human participants were reviewed and approved by an internal research review committee and an external institutional review board (IRB)
Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements
implemented or maintained the tested algorithms
He also wrote the first draft of manuscript
and PC assisted in refining the research question and experimental design
JC designed and performed the statistical analysis
All authors contributed to manuscript revision
and read and approved the submitted version
This work was done during an internship with Reality Labs Research at Meta
The authors would like to thank Lior Madmoni and Boaz Rafaely for providing us with the code of BSM
as well as our collegues from Reality Labs - Research
and Andrew Luck who greatly assisted in this internship project
Many thanks also to all voluntary participants
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
*also at Institute of Communications Engineering
TH Köln - University of Applied Sciences
1Throughout this article
2https://www.vvaudio.com/landing/VVOctoEncode_OctoMic.
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Received: 25 February 2022; Accepted: 19 July 2022;Published: 15 August 2022
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he could have ended up designing rockets for Boeing
or making any number of other scientific contributions
Georg Luebeck wound up at Fred Hutchinson Cancer Center
his mathematical models of biological processes like cancer initiation and growth have helped everyone from uranium miners at risk for lung cancer to astronauts facing the effects of galactic cosmic radiation
Or is it 33?” Luebeck said of his time at the Hutch
“So much of the research and the methods and the technologies have changed
whole-genome sequencing and array technologies to interrogate genomes down to the single-cell level.”
there is much more data — clouds full of it — and an even greater need to make sure it’s all interpreted in ways that make sense
That’s where Luebeck’s mathematical modeling of multi-stage carcinogenesis comes in
“It’s important to have an intellectual context in which you can explain your data,” he said
you can easily be led astray and misinterpret the data.”
Luebeck earned his doctorate in theoretical physics at the University of Washington and went on to do postdoctoral work at the Neils Bohr Institute for Astronomy
Physics and Geophysics in Copenhagen before returning to Seattle and joining the Hutch
Luebeck still remembers meeting his mentor-to-be during that first job interview
and he pulled out two research papers from a huge stack and suggested my reading them,” Luebeck said
genetics and biostatistics were new to him then
He soon was able to assist his mentor Moolgavkar and began working in lung cancer with former Hutch radiation biophysicist Dr
investigating the association between lung cancer and radon exposure
“There was a public health concern of radon in homes and in the population of uranium miners,” he said
was much less of a ‘cancer initiator’ — a long-held dogma — and much more of a ‘cancer promotor,’ increasing the growth of bad lesions.”
He and Moolgavkar used data from several studies to develop new lung cancer risk models
The approach they used “assumed a series of biological processes that we modeled computationally and mathematically,” he said
“It was a new way of modeling risks from environmental exposures such as radon.”
Luebeck and Moolgavkar were joined by others across the world interested in radiation carcinogenesis
in particular modeling cancer risks among A-bomb survivors
“It became clear that the biological cancer models we developed had wider applications including cancer sites such as colon
trying to understand how long it takes for cancers and their precursors to develop
that he first became interested in the concept of tissue aging
“The idea that tissue aging somehow also plays a role in the initiation of a cancer was something that clicked with me,” he said
Luebeck and his colleagues were able to bring mathematical models to this area
by looking at the age of the tissue and backtracking to when a cancer and its precursor first arose
“We were able to use statistical approaches to turn this information into a molecular clock,” he said
“When you find an adenoma in colon screening
How old is it?’ Colorectal cancers presumably arise in adenoma
but when did the adenoma (the one that makes the cancer) first arise
That’s the question that’s hard to investigate
Luebeck created a cancer model that showed that a founder premalignant cell that goes on to become cancerous can actually develop in the first decade of life
The paper, published in 2019 in the journal Cancer Research
found that precancerous lesions ”can persist for decades before becoming cancerous,” data that suggests that “early dietary and lifestyle interventions may be more effective than later changes in reducing colorectal cancer incidence,” the authors wrote
Can that information somehow be used to improve colon screening
“We could start thinking about chemoprevention [taking cancer-preventive drugs]
that detect the precursors in which malignancies arise,” he said
Luebeck’s modeling and molecular clocks are considered for use in other cancers
Over the last ten years, in collaboration with Fred Hutch physician-scientist Dr. Bill Grady and former graduate student Kit Curtius (now at UC San Diego)
Luebeck created a DNA methylation clock for esophageal cancers that arise as a result of the condition Barrett’s esophagus
But the critical information nobody was able to provide was: How long has this tissue been in place?”
BE starts with injury to the tissue by acid reflux
But many people don’t know if they have BE
“Reflux or bile juices cause erosion in the lower esophagus and the tissue can turn into metaplasia [sometimes a precursor to cancer],” he said
“Roughly half the people who get esophageal cancers never had GERD symptoms.”
Only a fraction of people with BE actually go on to develop esophageal adenocarcinoma or EAC (about 5%)
So those who are diagnosed with it are at risk of overdiagnosis and possibly overtreatment
while some of those who are not may develop EAC without a chance of an intervention
“Does age really matter as a risk factor for cancer
“There’s a clear correlation between age and cancer risk
the more stem cell divisions and the higher the number of mutational events that lead to cancer
Since many people who develop EAC have no symptoms from Barrett’s esophagus
Preventive Services Task Force doesn’t currently offer any kind of screening guidelines for it
Luebeck also hopes this work will enable clinicians to find a way to identify those at risk
Luebeck’s desire to continue clocking cancer — and collaborate with others at the Hutch determined to do the same — have kept him intrigued and engaged for more than three decades
years in which he’s seen “mind-boggling” progress in cancer research and technology
the most enjoyable thing is the interaction with other people at the Hutch
just being exposed to ideas and the teamwork that comes from it
People have different strengths — in computer modeling or computer programming or in the medical field or genetics — we bring all these together.”
Fred Hutchinson Cancer Center is an independent organization that serves as UW Medicine's cancer program
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it is unclear whether ecDNA is a later manifestation of genomic instability
or whether it can be an early event in the transition from dysplasia to cancer
to better understand the development of ecDNA
we analysed whole-genome sequencing (WGS) data from patients with oesophageal adenocarcinoma (EAC) or Barrett’s oesophagus
These data included 206 biopsies in Barrett’s oesophagus surveillance and EAC cohorts from Cambridge University
We also analysed WGS and histology data from biopsies that were collected across multiple regions at 2 time points from 80 patients in a case–control study at the Fred Hutchinson Cancer Center
the frequency of ecDNA increased between Barrett’s-oesophagus-associated early-stage (24%) and late-stage (43%) EAC
suggesting that ecDNA is formed during cancer progression
In the cohort from the Fred Hutchinson Cancer Center
33% of patients who developed EAC had at least one oesophageal biopsy with ecDNA before or at the diagnosis of EAC
In biopsies that were collected before cancer diagnosis
higher levels of ecDNA were present in samples from patients who later developed EAC than in samples from those who did not
We found that ecDNAs contained diverse collections of oncogenes and immunomodulatory genes
ecDNAs showed increases in copy number and structural complexity at more advanced stages of disease
Our findings show that ecDNA can develop early in the transition from high-grade dysplasia to cancer
and that ecDNAs progressively form and evolve under positive selection
Two surveillance studies of patients with Barrett’s oesophagus
including a longitudinal case–control study with multi-regional WGS sampling
provided us with an opportunity to study the role of ecDNA in the transition from Barrett’s oesophagus to EAC
Breakdown of the histological disease states among patients with Barrett’s oesophagus in the Cambridge selected cross-sectional study
representing the highest disease state for that patient
The FHCC cohort consisted of 80 patients for whom biopsies were collected prospectively
The cohort was separated later into two groups of 40 patients who had cancer outcomes (CO) and non-cancer outcomes (NCO)
Sample collection at time points TP-1 and TP-2 for sequencing biopsies and histology biopsies
Two sequencing biopsies were collected at each time point
ethylenediaminetetraacetic acid (EDTA) application and microdissection were performed to isolate Barrett’s oesophagus (BE) tissue and improve purity for sequencing
Highlighted box indicates isolated Barrett’s oesophagus tissue (box width indicates approximately 50 µm)
WGS biopsies and histology biopsies were collected independently
Some histology and sequencing biopsies were taken at the same level of the oesophagus (on-level)
and some histology biopsies fell within a ±1-cm window of the measured height of the sequencing biopsy (windowed histology)
Experimental workflow for analysing the WGS samples
A brief overview of the process by which biopsies were selected
sequenced and characterized by AmpliconArchitect
Characterization of the ecDNA status and cancer stage of patient samples from the Cambridge cohorts of patients with early- and late-stage EAC
Comparison of the ecDNA status and histological group of samples reveals an association between ecDNA and early-stage EAC
The odds ratio (OR) and the confidence interval (CI) of the OR are shown
Characterization of the ecDNA status and on-level histology of samples collected for FHCC CO patients across time points TP-1 and TP-2 for the two oesophageal sequencing samples (‘upper’ and ‘lower’)
The maximum histology of any biopsy from that time point is also shown
Asterisk indicates cancer diagnosis made at next endoscopy (1.44 and 8.16 months after TP-2 for patients 568 and 772
Comparison of ecDNA status in any FHCC patient sample and cancer-outcome status among patients reveals an association between ecDNA and cancer outcome
the proportion of TP-1 samples without HGD or EAC in on-level histology (having Barrett’s oesophagus or LGD) versus with HGD in the on-level histology
shows an enrichment for ecDNA with advanced disease status (Fisher’s exact test
the proportion of TP-2 samples without EAC in on-level histology (having HGD or Barrett’s oesophagus) versus with EAC in on-level histology
shows an association between ecDNA and the development of EAC (Fisher’s exact test
the patient died of causes unrelated to Barrett’s oesophagus 2.84 years after TP-2
showing a highly significant association between ecDNA in Barrett’s oesophagus biopsies and progression to EAC (Fisher’s exact test
HGD was treated immediately after detection
so it was not possible to determine whether the HGD samples would subsequently have progressed to cancer
All eight FHCC samples in which ecDNA was found before cancer diagnosis (TP-1) showed biallelic disruption of TP53
The appearance of ecDNA as a subset of TP53-altered cases suggests that the prior loss of TP53 enables ecDNA formation
indicating that there are other mechanisms of ecDNA formation after TP53 alteration
Timeline of sample collection for FHCC CO patient 391 relative to patient age
Summary of the ecDNA status and windowed-histology status for four endoscopies
with the time interval between each indicated
The distance of the biopsy from the gastro-oesophageal junction (GEJ) is also shown
The two resection samples are labelled as E8 and C5
Two distinct species of ecDNA are labelled as ecDNA-1 and ecDNA-2
Inferred phylogeny of Barrett’s oesophagus samples from patient 391 across the four endoscopies
with branching reporting the ecDNA formation events
annotated by the histological status of the sample (windowed)
in which EAC was diagnosed and present within ±1 cm
ecDNAs detected in pre-cancer are frequently maintained through the transition to cancer
and genomically overlapping ecDNAs identified from multi-region sampling are likely to have a common origin
these data suggest that ecDNA can be a truncal event in the formation and evolution of EAC
Proportion of patients with ecDNA detected in any sample across all study cohorts
Maximum genomic copy number (CN) of ecDNA segments in pre-cancer samples and EAC (or EAC-linked for FHCC) samples
Complexity score of focally amplified ecDNA-positive genomic regions for pre-cancer and EAC samples
For ecDNAs identified across multiple FHCC samples that were determined to be clonal on the basis of amplicon similarity
the increase in ecDNA copy number for each pair of clonal ecDNAs
separated by the difference in associated histology of the two samples
shows an association between increasing copy number and increasing histological severity
Comparative overlap of Barrett’s-oesophagus-associated oncogenes found on ecDNA in the four cohorts
For oncogenes recurrently detected on ecDNA in samples from different patients
the number of patients with a sample that has the listed oncogene included on ecDNA
Oncogene copy number for the focally amplified oncogene with the highest copy number on each unique focal amplification (ecDNA or non-ecDNA fsCNA) is significantly higher on ecDNA versus non-ecDNA fsCNA
raising the possibility that tumours might achieve subclonal ecDNA heterogeneity early on
and that competition between multiple distinct ecDNAs could have a role in the evolution of EAC
ecDNAs contained 0.76 unique oncogenes per amplicon (97 oncogenes in 127 ecDNAs)
compared to 0.52 (192/373) unique oncogenes per amplicon in non-extrachromosomal focal somatic copy number amplifications (fsCNAs)
suggesting that ecDNA may allow a wider variety of oncogene amplifications
suggesting that—despite the high diversity of ecDNA-borne oncogenes—ecDNAs are positively selected in a manner that is specific to cancer type
It has been unclear whether ecDNA can contribute to the transformation of pre-cancer to cancer
or whether it is a later manifestation of tumour genomic instability
in multiple cohorts of patients with Barrett’s oesophagus
and that its presence is strongly associated with EAC progression
ecDNA amplifies a broader range of oncogenes
and their copy numbers increase rapidly and markedly in EAC
Increased ecDNA heterogeneity may also enhance adaptation to changing conditions
the clonal selection and maintenance of immunomodulatory genes on ecDNA before cancer development could aid immune evasion
these results indicate that ecDNA contributes to the development of cancer through several mechanisms
These findings shed light on how ecDNA can arise before the development of full-blown cancer
indicating that it is not simply a late manifestation of genome instability
and raise the possibility of earlier intervention or prevention for patients with ecDNA-containing tumours
The significance of odds ratios and differences in event frequencies between groups were assessed by Fisher’s exact test
The default test type was two-sided in statistical tests
the box limits are the upper and lower quartiles and the whiskers are 1.5 times the interquartile range
or represent minimum or maximum values if there are no outliers
Patients with low-grade Barrett’s oesophagus and high-grade Barrett’s oesophagus underwent surveillance at Cambridge University Hospitals NHS Trust and consented prospectively to a biomarker and genomic characterization study (Cell Determinants Biomarker
Strict selection criteria were implemented to ensure that only the highest-cellularity biopsies
Potential biopsies were placed into optimal cutting temperature compound and a single section was cut and stained with haematoxylin and eosin (H&E)
These were reviewed by at least two consultant pathologists to assess the composition of the biopsy
All pathologists were blinded to the grade of the patient
Samples with no agreement were reviewed by a third pathologist to reach a consensus
Dysplastic samples for sequencing had to have a pathological cellularity for dysplasia of at least 30% and were labelled to be consistent with the highest pathology grade reported within the biopsy (tumour cellularity of 70% or higher for early-stage cancers)
Non-dysplastic Barrett’s oesophagus biopsies had to contain intestinal metaplasia
Barrett’s oesophagus research samples were collected at every 2 cm of the Barrett’s oesophagus segment at endoscopy
A snap-frozen section was taken from each Barrett’s oesophagus sample to determine the grade of dysplasia
Patients in the pre-cancer categories who received previous ablative treatment were excluded
Samples with squamous contamination were excluded
Genomic regions with a total copy number greater than 4.5 and an interval size greater than 10 kbp were identified
merged and refined with the amplified_intervals.py script
Each seed region was given to AmpliconArchitect separately to improve runtime on each sample
AmpliconArchitect was run in the default explore mode to reconstruct amplicon structures and amplicons formed by the same regions were deduplicated on the basis of genomic overlap such that for overlapping AmpliconArchitect amplicons
the amplicon with the highest-level classification was kept (ranked by ecDNA
with ties being broken by largest amplicon size
which provides a cloud-based platform for TCGA data analysis
AmpliconClassifier also specified BED files corresponding to the classified regions and annotated the identity of genes on the focal amplifications
If a sequencing biopsy had a histology biopsy from the same level along the oesophagus (measured from the gastro-oesophageal junction)
then it was denoted as having on-level histology
If a sequencing biopsy had a histology biopsy from within ±1 cm of the same level
it was denoted as having windowed histology
When multiple histology samples could be paired with the sequencing
the histology biopsy with the most severe disease state was assigned
Alteration was defined as one or more copies of TP53 being affected by a mutational event
When evaluating the presence of genes on ecDNA
the average gene copy number was required to be 4.5 or higher and the 5′ end intact
Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article
Extrachromosomal oncogene amplification drives tumour evolution and genetic heterogeneity
Targeted therapy resistance mediated by dynamic regulation of extrachromosomal mutant EGFR DNA
Extrachromosomal DNA is associated with oncogene amplification and poor outcome across multiple cancers
Extrachromosomal oncogene amplification in tumour pathogenesis and evolution
Extrachromosomal DNA: an emerging hallmark in human cancer
The evolutionary dynamics of extrachromosomal DNA in human cancers
Predictors of progression in Barrett’s esophagus: current knowledge and future directions
Predictors of dysplastic and neoplastic progression of Barrett’s esophagus
Temporal and spatial evolution of somatic chromosomal alterations: a case-cohort study of Barrett’s esophagus
Genomic catastrophes frequently arise in esophageal adenocarcinoma and drive tumorigenesis
Genomic copy number predicts esophageal cancer years before transformation
Multi-omic cross-sectional cohort study of pre-malignant Barrett’s esophagus reveals early structural variation and retrotransposon activity
Somatic whole genome dynamics of precancer in Barrett’s esophagus reveals features associated with disease progression
ecDNA hubs drive cooperative intermolecular oncogene expression
Live-cell imaging shows uneven segregation of extrachromosomal DNA elements and transcriptionally active extrachromosomal DNA hubs in cancer
Circular ecDNA promotes accessible chromatin and high oncogene expression
Functional enhancers shape extrachromosomal oncogene amplifications
Exploring the landscape of focal amplifications in cancer using AmpliconArchitect
Distinct classes of complex structural variation uncovered across thousands of cancer genome graphs
Unscrambling cancer genomes via integrated analysis of structural variation and copy number
Rearrangement processes and structural variations show evidence of selection in oesophageal adenocarcinomas
Stachler, M. D. et al. Genomic signatures of past and present chromosomal instability in the evolution of Barrett’s esophagus to esophageal adenocarcinoma. Preprint at bioRxiv https://doi.org/10.1101/2021.03.26.437288 (2023)
8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice
The Cancer Genome Atlas Research Network.Integrated genomic characterization of oesophageal carcinoma
Links between mutant p53 and genomic instability
Chromothripsis drives the evolution of gene amplification in cancer
Chromothripsis followed by circular recombination drives oncogene amplification in human cancer
Chromosome segregation errors generate a diverse spectrum of simple and complex genomic rearrangements
Tolerance of whole-genome doubling propagates chromosomal instability and accelerates cancer genome evolution
Massive genomic rearrangement acquired in a single catastrophic event during cancer development
Mechanisms generating cancer genome complexity from a single cell division error
Immunohistologic analysis of the inflammatory infiltrates associated with osseointegrated implants
Functional genomic landscape of cancer-intrinsic evasion of killing by T cells
NLRC5: a key regulator of MHC class I-dependent immune responses
MHC class II transactivator CIITA is a recurrent gene fusion partner in lymphoid cancers
RMI2 plays crucial roles in growth and metastasis of lung cancer
Evolutionary dynamics in Barrett oesophagus: implications for surveillance
Characterizing the ecological and evolutionary dynamics of cancer
Computing the statistical significance of overlap between genome annotations with iStat
Clonal heterogeneity and tumor evolution: past
Abnormal TP53 predicts risk of progression in patients with Barrett’s esophagus regardless of a diagnosis of dysplasia
Ordered and deterministic cancer genome evolution after p53 loss
CNVkit: genome-wide copy number detection and visualization from targeted DNA sequencing
Allele-specific copy number analysis of tumors
SciPy 1.0: fundamental algorithms for scientific computing in Python
The mean and variance of the moments of chi-squared when used as a test of homogeneity
Li, H. Aligning sequence reads, clone sequences and assembly contigs with BWA-MEM. Preprint at arXiv https://doi.org/10.48550/arXiv.1303.3997 (2013)
A framework for variation discovery and genotyping using next-generation DNA sequencing data
A program for annotating and predicting the effects of single nucleotide polymorphisms
Integrative Genomics Viewer (IGV): high-performance genomics data visualization and exploration
Strelka2: fast and accurate calling of germline and somatic variants
ONGene: a literature-based database for human oncogenes
The landscape of selection in 551 esophageal adenocarcinomas defines genomic biomarkers for the clinic
Paired exome analysis of Barrett’s esophagus and adenocarcinoma
HisgAtlas 1.0: a human immunosuppression gene database
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Department of Computer Science and Engineering
Bioinformatics and Systems Biology Graduate Program
Divisions of Human Biology and Public Health Sciences
Department of Biopharmaceutical Convergence
Department of Biohealth Regulatory Science
Department of Cellular and Molecular Medicine
The Jackson Laboratory for Genomic Medicine
Children’s Medical Center Research Institute
University of Texas Southwestern Medical Center
and Medicine for Human Health (Sarafan ChEM-H)
led the Cambridge University UK team and T.G.P
Computational methods introduced in the manuscript were conceived by J.L
provided input during the writing of the paper
All authors provided feedback on the analyses
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SAB member and has equity interest in Boundless Bio and Abterra
and the terms of this arrangement have been reviewed and approved by the University of California
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is a member of the SAB of Dimension Genomics
is named on patents related to Cytosponge and associated assays that were licensed to Covidien (now Medtronic)
is a co-founder of Boundless Bio and an advisor to Stellanova Therapeutics and NeuroTrials
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also declares provisional patent applications for ‘Clustered mutations for the treatment of cancer’ (US provisional application serial number 63/289,601) and ‘Artificial intelligence architecture for predicting cancer biomarker’ (serial number 63/269,033)
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is a part-time paid consultant for Boundless Bio
declare a patent application related to this work: ‘Methods and compositions for detecting ecDNA’ (US patent application number 17/746,748)
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Oncoprint table for samples from Cambridge patient with Barrett’s oesophagus and EAC segregated by histology type showing ecDNA status
histology or cancer stage (if applicable) TP53 alteration (by mutational analysis
non-ecDNA) status and prior therapy (chemotherapy or radiation) on the tumours in patients with cancer
Proportion of Cambridge EAC tumour samples with ecDNA separated by tumour stage I versus stage II or higher
Oncoprint tables of samples from FHCC CO patient WGS samples encoding ecDNA status
TP53 alteration (at least one gene copy affected)
as well as on-level and windowed histology for each time point and both upper and lower oesophageal samples for time points TP-1 and TP-2
Maximum histology from any histology biopsy is shown at the bottom of each time point
Asterisk indicates cancer diagnosis made at next endoscopy since biopsies from the diagnostic EAC endoscopy were unavailable for CO patient ID 772 and lacked sufficient DNA for CO patient ID 568
so biopsies from the penultimate endoscopy were substituted (occurring 1.44 and 8.16 months after TP-2 for patients 568 and 772
Oncoprint tables of FHCC NCO patient WGS samples encoding ecDNA status
Oncoprint tables of biopsies from NCO patients from the FHCC cohort with long-term follow-ups (in orange
Distribution of FHCC NCO follow-up durations from TP-2 to the time at which the patient was last known to be alive (top
mean = 13.9 years) or TP-2 to death (bottom
Association of ecDNA presence and TP53 status in biopsies from patients from the FHCC cohort
Association of ecDNA presence and TP53 status in samples from patients from the Cambridge cohort
Proportion of FHCC samples with WGD separated by TP53 alteration status
Proportion of FHCC samples with chromothripsis separated by TP53 alteration status
Proportion of TP53 alteration FHCC samples with ecDNA
All statistical differences in frequencies were assessed by one-sided Fisher’s exact test
Barrett’s oesophagus segment samples from patient 391 show conserved focal amplification of BFB and emergence of ecDNA between time points TP-1 and TP-2
The structure of ecDNA-1 detected in the lower pre-cancer sample from TP-2 in patient 391
and an identical structure derived from the adenocarcinoma resection
detected in the upper sample from TP-2 in patient 391
in which EAC was present in the histology window
Amplicon similarity analysis of ecDNA-1 and -2 reveals common origins of the structures
The length of predicted genomic intervals captured on ecDNA
for each distinct ecDNA in the combined cohorts
compared by pre-cancer versus EAC (Mann–Whitney U test
For oncogenes detected on ecDNA in samples from at least one patient
the number of patients with at least one sample having the oncogene listed on ecDNA
and the frequency of that gene on other types of focal amplifications
Proportion of the set of possible unique genes on ecDNA
Difference assessed by one-sided Fisher’s exact test
Distribution of the number of oncogenes on individual ecDNA
For immunomodulatory-associated genes detected on ecDNA
the number of patients with at least one sample having the gene listed on ecDNA
and the frequency of that gene on other focal amplifications as well
Copy number for the highest copy number focally amplified immunomodulatory-associated gene in each unique amplicon that was ecDNA or non-ecDNA fsCNA
ecDNAs show a significantly higher copy number of immunomodulatory-associated genes on ecDNA versus non-ecDNA fsCNA (Mann–Whitney U test
This file contains Supplementary Methods and Supplementary Figures 1-4
This file contains sample metadata and histology labels
This file contains FHCC patient age at sampling and additional histology labels
This file contains focal amplification classifications for all samples in the study
This file contains properties related to the sample purity
coverage for the FHCC and Cambridge samples
This file contains focal amplification similarity scores for ecDNAs
This file contains genes carried on all focal amplifications
This file contains a list of immunomodulatory genes used in this study
This file contains a list of oncogenes used in this study
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UK-based midstream LNG & bio-LNG company Avenir LNG has conducted its first ship-to-ship (STS) LNG bunkering operation in Germany in the Port of Lübeck for ferry owner and operator TT-Line
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(WEAU) - Eau Claire police say Maxwell Luebeck has been taken into custody by the Wisconsin State Patrol on Highway 53 near Superior
Court records show Luebeck is charged with armed robbery
EAU CLAIRE, Wis. (WEAU) - Eau Claire police are naming the suspect in the robbery of WESTconsin Credit Union.
According to the Eau Claire Police Department
the suspect from the armed robbery at WESTconsin Credit Union has been identified as 25-year-old Maxwell Luebeck
A search warrant was served at Luebeck’s home
Eau Claire Police say Luebeck is believed to be driving a blue/green 2009 Hyundai Tucson Sport Utility- WI License Plate-ARJ 7875
It is believed Luebeck’s vehicle was seen in the area of Ashland
The Eau Claire Police Department describes Luebeck as “a while male
Luebeck should be considered armed and should not be approached
anyone with information on Luebeck’s location should contact local law enforcement immediately
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Iceland is one of the leading countries in the world for gender equality
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“Carlebach Küchentuch #5” (2015)
English translation: In the town hall near the synagogue
where Salomon Carlebach was Rabbi from 1870 to 1919
Felix Carlebach and his family are honored by the people of Lübeck
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a solo exhibition by Pratt alumnus Ken Aptekar (M.F.A
Annen Museum in the city of Lübeck in northern Germany
which is the German word for “neighbors,” draws from Lübeck’s long and complicated multicultural history to explore themes of tolerance
and “otherness.” Aptekar was commissioned by the museum to create the exhibition
Aptekar and the exhibition have garnered media attention in a number of outlets
including a feature in The Guardian and coverage on German national public television
Lübeck serves as the focal point for the broader themes and tensions explored in the exhibition
which had lived alongside Christians for centuries
and Turkish Muslims now have a significant presence there
adding to the diversity of the town’s population
the atmosphere in Lübeck has remained charged
with several terrorist attacks targeting the Lübeck synagogue in the past two decades and anti-Muslim immigrant demonstrations on the rise
whose art often combines painting with text
to consider Lübeck’s cultural history and Christian Lübeckers’ attitudes towards the Muslims and Russian Jews now living there
Aptekar incorporated images from the museum’s famed collection of medieval Christian altarpieces and overlaid them with text elements offering new messages from one neighbor to another
utilizing art history to highlight themes that have particular relevance in Europe and around the world today
“I’ve observed a frightening rise in violent responses to otherness
Living in both Paris and New York has heightened my sense of urgency to respond to the Paris attacks of November 13 and Charlie Hebdo
and to the hateful rhetoric of politicians who exploit fear of others to grab power,” said Aptekar
“I saw in the history of this town in Germany a great opportunity for art to spark conversations across the cultural divide
My hope is that the exhibition will encourage peaceful
and rewarding exchanges with our neighbors
Aptekar received grants from the Memorial Foundation for Jewish Culture and the New York Foundation for the Arts/Artspire/Malka Fund to create the works on view at St
whose presentation was supported by the Possehl Stiftung in Lübeck
He has also created commissioned works for museums including the Corcoran Museum in Washington
D.C.; the Victoria and Albert Museum in London; and the Musée Robert Dubois-Corneau in Brunoy
The story in The Guardian can be found here.
It’s Lübeck’s main landmark, and in addition, a structure so famous that it was stamped on two-euro coins in 2006. The Holsten Gate was built in the 15th century to protect the city against foreign conquest. Nowadays its walls, some of which are up to 3.50 meters thick, enclose a museum detailing the city’s history.
Lübeck’s Old Town boasts many elaborately ornamented brick buildings - like the Burgtor, the northern city gate, with the customs house. The entire Old Town has been a UNESCO World Heritage site since 1987. The use of baked red bricks as building materials arrived in northern Europe in the 12th century. It led to the emergence of the northern German Brick Gothic architectural style.
Seafaring and trade made Lübeck rich in the Middle Ages. More and more people flocked to the city, but space on the Old Town island was limited, so courtyards behind the main buildings were built up. Small, two story buildings and narrow lanes resulted. Nowadays, small alleys still lead from the main streets into the jumble of the courtyards — ideal places to explore!
Lübeck’s ship’s captains used to meet here. The Schiffergesellschaft is the former seafarers‘ guild house. Nowadays the gabled building, which dates from 1535, houses a restaurant with a maritime theme. Regional cuisine is served. Of course, that includes seafood dishes in many variations.
This sweetmeat made of almonds and sugar originated in the Orient, but it has a long tradition in Lübeck. Here confectioners always had the ingredients to hand, because the city was an important commercial center. Goods from around the world were available here. To this day, Lübeck is famed for its marzipan.
At the young age of 22, Thomas Mann wrote “Buddenbrooks,” about the rise and fall of a Lübeck merchant’s family. Later the writer was awarded the Nobel Prize in literature for the work. A museum in Lübeck is devoted to him: the Buddenbrookhaus is furnished as a setting for his novel.
Lübeck is considered the "queen of the Hanseatic League”. In the Middle Ages the city played a major role in organizing the northern German merchants’ confederation. It’s no wonder, then, that in 2015 the European Hanseatic League Museum was opened in Lübeck. Specially decorated rooms illustrate the way life was lived at the time the League flourished.
What was good for the Hanseatic League merchants is still good for Lübeck: its proximity to the sea. The seaside resort of Travemünde is a district of Lübeck. As its name implies, it lies at the mouth of the Trave, where the river flows into the Baltic. After sightseeing in the Old Town, just come here, get yourself a Strandkorb — a roofed wicker beach chair - and enjoy the sea breeze.
Lübeck is considered northern Germany’s Christmas town. Several Christmas markets invite you to buy presents and drink mulled wine in the Old Town. The biggest is the historical Christmas market in front of the town hall. The building, which dates from 1308, frames the decorated marketplace.
Background: Pathogenic variants in the Leucine-rich repeat kinase 2 (LRRK2) gene are the most common known monogenic cause of Parkinson's disease (PD). LRRK2-linked PD is clinically indistinguishable from idiopathic PD and inherited in an autosomal dominant fashion with reduced penetrance and variable expressivity that differ across ethnicities and geographic regions.
Objective: To systematically assess clinical signs and symptoms including non-motor features, comorbidities, medication and environmental factors in PD patients, unaffected LRRK2 pathogenic variant carriers, and controls. A further focus is to enable the investigation of modifiers of penetrance and expressivity of LRRK2 pathogenic variants using genetic and environmental data.
Conclusions: LIPAD is a large-scale international scientific effort focusing on deep phenotyping of LRRK2-linked PD and healthy pathogenic variant carriers, including the comparison with additional relatively frequent genetic forms of PD, with a future perspective to identify genetic and environmental modifiers of penetrance and expressivity
Clinical Trial Registration:ClinicalTrials.gov, NCT04214509.
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.710572
Background: Pathogenic variants in the Leucine-rich repeat kinase 2 (LRRK2) gene are the most common known monogenic cause of Parkinson's disease (PD)
LRRK2-linked PD is clinically indistinguishable from idiopathic PD and inherited in an autosomal dominant fashion with reduced penetrance and variable expressivity that differ across ethnicities and geographic regions
Objective: To systematically assess clinical signs and symptoms including non-motor features
medication and environmental factors in PD patients
unaffected LRRK2 pathogenic variant carriers
A further focus is to enable the investigation of modifiers of penetrance and expressivity of LRRK2 pathogenic variants using genetic and environmental data
Methods: Eligible participants are invited for a personal or online examination which comprises completion of a detailed eCRF and collection of blood samples (to obtain DNA
We plan to enroll 1,000 participants internationally: 300 with LRRK2-linked PD
200 with LRRK2 pathogenic variants but without PD
100 PD patients with pathogenic variants in the GBA or PRKN genes
and 200 healthy persons without pathogenic variants
Results: The eCRF consists of an investigator-rated (1 h) and a self-rated (1.5 h) part
The first part includes the Movement Disorder Society Unified Parkinson's Disease Rating
The self-rating part consists of a PD risk factor
and the Epworth Sleepiness as well as the Hospital Anxiety and Depression Scales
The first 15 centers have been initiated and the first 150 participants enrolled (as of March 25th
Conclusions: LIPAD is a large-scale international scientific effort focusing on deep phenotyping of LRRK2-linked PD and healthy pathogenic variant carriers
including the comparison with additional relatively frequent genetic forms of PD
with a future perspective to identify genetic and environmental modifiers of penetrance and expressivity
Clinical Trial Registration: ClinicalTrials.gov
data on many populations are still missing
no genetic testing guidelines and no clinical trial-ready cohorts exist to date
The ROPAD study is still ongoing and continues to identify LRRK2 pathogenic variant carriers internationally
It gathers only basic clinical data: age at examination
does not allow a systematic in-depth characterization of LRRK2 pathogenic variant carriers
Recently published data from the currently largest multinational prospective study that includes LRRK2 pathogenic variant carriers, i.e., the Parkinson's Progression Markers Initiative (PPMI), provide more phenotypic details on LRRK2 pathogenic variant carriers across international sites (6)
as the focus of the PPMI study is predominantly on biomarkers
it does not cover environmental factors in-depth
and only includes participants with a PD diagnosis 2 years or less before enrolment who are untreated with PD medication
There remains a gap in combining phenotypic
and environmental data on LRRK2 pathogenic variant carriers internationally
regardless of the onset of signs and symptoms and their medication status
The objectives of the LIPAD study are (1) to provide a systematic characterization of PD patients and unaffected carriers with pathogenic variants in the LRRK2 gene; and (2) to enable the investigation of modifiers of penetrance of LRRK2 pathogenic variants using genetic and environmental data
we describe a protocol and a feasibility study of the first 150 participants and give a brief overview of nested studies within LIPAD
the LIPAD protocol has also been adapted to take place online due to COVID19 contact restriction measures
we expect to have a sufficient number of participants in the LRRK2+/ PD+
family members of pathogenic LRRK2 variant carriers will be asked to participate in the LIPAD study and will be genetically tested for the familial pathogenic LRRK2 variant
they will be assigned either to LRRK2+/PD- or HC group
Healthy persons without pathogenic variants will be recruited from spouses of study participants or the general population
Within an anticipated 24-month recruitment period per site
~25 centers in 10 countries on three continents will be established
Each center will have 24 months for recruitment after initiation
The majority of the centers will be those already participating in ROPAD
additional centers that do not participate in ROPAD but follow LRRK2 pathogenic variant carriers will be invited to become LIPAD sites
LRRK2+/PD+: PD patients carrying a pathogenic LRRK2 variant
LRRK2+/PD-: unaffected carriers of pathogenic LRRK2 variants
genPD: PD patients with pathogenic variants in PD genes other than LRRK2
iPD; LRRK2-/PD+: patients with idiopathic PD from the same populations
HC: healthy persons without pathogenic variants
Recruited participants have to meet one of the following criteria: (i) clinical diagnosis of PD according to the Movement disorder Society (MDS) diagnostic criteria
(ii) first- or second-degree relative of a participant that is positive for a pathogenetic LRRK2 variant
(iii) healthy participants with or without a family history of PD in a control group
All participants have to be above 18 years of age and have to sign an informed consent form
Participants with the following LRRK2 variants will be included in the LRRK2+ group: p.Gly2019Ser (c.6055G>A)
Upon completion of genetic screening (e.g.
participants are invited for a personal examination using the three-level biomaterial protocol
an electronic Case Report Form (eCRF) is administered and blood samples for DNA
and household dust for toxicological analyses are collected
The three-level protocol was designed to accommodate available laboratory facilities at the different sites. The details of the three levels for biomaterial sampling are listed in Supporting Information Methods S2 in Supplementary Material
In case genetic testing has not been performed before
a dried blood spot card will be sent for DNA extraction and genetic screening
There are no serious safety concerns associated with the study
Participants may experience temporary discomfort during venous blood sampling and while answering the questions
they are instructed that they are free to omit questions they would rather not answer
There are no health risks associated with the collection of urine and house dust
Data analysis will be performed at the Institute of Neurogenetics (University of Luebeck
which is the systematic characterization of PD patients and unaffected carriers with pathogenic variants in the LRRK2 gene
we will describe the frequency of all clinical signs and symptoms including non-motor signs and the most important influencing factors such as sex
This will result in raw and corrected frequencies with 95% confidence intervals
We will use t-tests for numerical and continuous variables and chi-square tests for categorical variables at a significance level of 0.05 for the comparisons of the clinical signs and symptoms across the groups
which is to investigate the modifiers of penetrance of pathogenic LRRK2 variants using genetic and environmental data
we will examine penetrance in logistic regression models to quantify the influence of different factors impacting penetrance
All LIPAD centers can suggest nested projects
which will be coordinated by a Scientific Advisory Board
These projects can apply for external funding
The following nested studies are planned or have started at the Institute of Neurogenetics (University of Luebeck):
Penetrance of LRRK2-linked PD depends on the age of a given individual subject
already demonstrate neurodegenerative changes including hyposmia
abnormal midbrain hyperechogenicity upon transcranial sonography
structural changes of the gray and white matter
and functional reorganization of neural networks
Although first morphological and functional brain changes in pathogenic LRRK2 variant carriers have already been identified
the overall picture is still elusive due to the relatively low number of included subjects in most studies
is a promising secondary endpoint for clinical trials given its wide availability
To reveal an MRI-based biomarker for LRRK2+/PD+ and prodromal LRRK2+/PD+
we aim to acquire the following MRI modalities:
and R2*) to reveal physical tissue properties
Diffusion-weighted imaging for multicompartment diffusion models to reveal neuroinflammation and microstructural alterations
Neuromelanin imaging to reveal substantia nigra and locus coeruleus degeneration
Blood-oxygen-level-dependent functional MRI to identify changes in functional connectivity
Magnetic resonance spectroscopy to depict the mechanisms of neurodegeneration
such as involvement of energy metabolism due to mitochondrial dysfunction
which may be subject to faster change than other aspects of MR-based imaging (e.g.
To investigate whether metabolic changes in LRRK2 carriers already exist before the motor manifestation or are secondary to it
Energy consumption at rest using indirect calorimetry
where energy consumption is determined by measuring the air the subject breathes
the proportion of body fat mass and lean mass
employing air displacement plethysmography
Measurement of physical activity and sleep behavior under everyday conditions using accelerometry
The study participants are asked to wear the accelerometer in the form of a wristwatch continuously for 7 days
We will perform a genome-wide association study analysis in manifesting vs
non-manifesting carriers aimed at discovering genetic modifiers of penetrance of LRRK2 pathogenic variants
A comprehensive eCRF has been developed, consisting of an investigator-rated (1 h) and a self-rated (1.5-h) part. The questionnaires are listed in Table 1
We used validated versions of questionnaires and scales in the local languages
Content of the LIPAD electronic case report form
The first 10 centers across Germany and five international sites have been initiated with further centers currently undergoing ethical review (Figure 2). The first 150 participants have been enrolled (as of March 25th, 2021); Table 2
International centers participating in LIPAD
In blue: centers with ethics approval; in black: centers in the process of receiving ethics approval
Exemplary demographic and clinical characteristics of the first 150 enrolled LIPAD participants
LIPAD is a large-scale international scientific effort focusing on deep phenotyping of LRRK2-linked PD and healthy pathogenic variant carriers
including a comparison with additional relatively frequent genetic forms of PD
and with a future perspective to identify genetic and environmental modifiers of penetrance and expressivity
revealing an important knowledge gap in multinational
A comprehensive investigation of modifiers of penetrance and expressivity requires assessment of a considerable number of pathogenic variant carriers
Due to the direct enrolment of family members at an international scale
the LIPAD study will enable the analysis of modifiers of penetrance in different populations in one setting
mainly through the international multicenter ROPAD study
will ensure participation of a large number of LRRK2+/PD+ patients
which will be conducted on a subset of participants
we are aiming to provide a more in-depth phenotypic characterization especially of non-affected carriers of LRRK2 pathogenic variants
a complication affecting many patient studies across the world are measures imposed on personal visits to contain SARS-CoV-2 in many countries
limiting the possibility for the collection of data and biomaterials
To allow the study to proceed under these circumstances
we adjusted the protocol and procedures to collect the necessary data online
patients receive a package with patient information
Then an online appointment with the study team takes place
the data is collected and the examination is performed
Study participants send signed informed consent forms and a household dust sample back to the study center by post
Biomaterials will be taken at a general practitioner's office or the study center at a later time point when study visits become possible again
The study will revert to the on-site recruitment as soon as possible after the pandemic restrictions are lifted
LIPAD aims for a longitudinal follow-up of its study participants over a 10–15-year time period
The exact protocol is currently being developed and potential funding opportunities are being explored
The studies involving human participants were reviewed and approved by Ethics Committee (EC) of the University of Lübeck (19-065); EC LÄK Hessen (2019-1364-zvBO); EC LÄK Hamburg (MC-002/20); EC LÄK Brandenburg [AS 35(bB)/2020]; EC Würzburg (161/19_z-sc); EC Kiel (B 292/19); EC Marburg (111/20); EC UK IRAS (project ID: 275553
REC reference: 20/NE/011); EC USA IRB tracking number: 20193494; Pavia
The patients/participants provided their written informed consent to participate in this study
Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson
Özgür Öztop Çakmak
University Hospital Marqués de Valdecilla
Parkinson's Disease and Movement Disorder Center of Boca Raton
Charité University Medicine Berlin
University of Pavia and IRCCS Mondino Foundation
Department of Brain and Behavioral Sciences
University Medical Center Hamburg-Eppendorf
TU: organization and execution of the research project
design and execution of statistical analysis
and writing the first draft of the manuscript
E-JV and AR: conception and organization of the research project
review and critique of statistical analysis
NS and SS: organization and execution of the research project
and GG: organization of the research project
and JV: review and critique of statistical analysis and review and critique of the manuscript
KL: organization of the research project and review and critique of the manuscript
and CK: conception and organization of the research project
design and review and critique of statistical analysis
All authors contributed to the article and approved the submitted version
The LIPAD study has been supported by institutional funds (Institute of Neurogenetics
AB (NDAL) was funded by Suna and Inan Kirac Foundation
ESc was supported by the Luxembourg National Research Fund (FNR) for project A18/BM/12341006
and AR were employed by company CENTOGENE GmbH
The authors declare that this study received funding from Centogene GmbH
The funder was involved in the study design
organization of the research project and review and critique of the manuscript
AB is grateful to Suna and Inan Kirac Foundation for their sustained support and both to the Foundation and Koç University-KUTTAM for the excellent research environment created
ESc acknowledges the efforts of Begoña Talavera
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fneur.2021.710572/full#supplementary-material
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LRRK2 in Parkinson disease: challenges of clinical trials
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LRRK2 parkinsonism in Tunisia and Norway: a comparative analysis of disease penetrance
Mitochondrial DNA deletions discriminate affected from unaffected LRRK2 mutation carriers
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Age at onset of LRRK2 p.Gly2019Ser is related to environmental and lifestyle factors
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MetFrag relaunched: incorporating strategies beyond in silico fragmentation
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Connecting environmental exposure and neurodegeneration using cheminformatics and high resolution mass spectrometry: potential and challenges
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Klein C and The LIPAD Study Group (2021) LIPAD (LRRK2/Luebeck International Parkinson's Disease) Study Protocol: Deep Phenotyping of an International Genetic Cohort
Received: 16 May 2021; Accepted: 13 July 2021; Published: 09 August 2021
*Correspondence: Christine Klein, Y2hyaXN0aW5lLmtsZWluQG5ldXJvLnVuaS1sdWViZWNrLmRl