Search

Zusammenfassung  Der Einsatz psychotherapeutischer Verfahren bei der Behandlung depressiver Störungen gilt heutzutage als unverzichtbar. Psychotherapien erwiesen sich bei leichten bis mittelschweren Depressionen als mindestens gleichwertig effektiv wie eine Pharmakotherapie, bei schweren und chronischen Depressionen gilt die Kombination beider Therapieformen als leitlinienempfohlene Standardbehandlung. Psychotherapeutische Ansätze weisen zwar eine längere Wirklatenz auf als Antidepressiva, wirken jedoch nachhaltiger. Da hinsichtlich der Effektivität von den im Handel befindlichen sowie in der Entwicklung stehenden Antidepressiva eher ernüchternde Ergebnisse publiziert wurden, gilt der Weiterentwicklung psychologischer Behandlungsansätze derzeit besondere Aufmerksamkeit. Die kognitive Verhaltenstherapie und die interpersonelle Psychotherapie können die höchste Evidenzstufe nachweisen, bei psychodynamischen Verfahren ist die Studienlage noch begrenzt. Bei chronischer Depression gewinnt eine neuere störungsspezifische Psychotherapie – das „cognitive behavioral analysis system of psychotherapy“ – zunehmend an Bedeutung. Insgesamt geht der Trend zu einer zunehmenden Spezifizierung der Therapie für umschriebene Zielgruppen. Herausforderungen für die Zukunft bestehen in der Steigerung der Effizienz, der weiteren Erforschung von Wirkmechanismen und Prädiktoren für eine differenzielle Indikation und schließlich darin, die wirksamen Psychotherapiemethoden für Patienten allgemein zugänglich zu machen. [ABSTRACT FROM AUTHOR]

AbstractBerger, Marc M., Christoph Dehnert, Damian M. Bailey, Andrew M. Luks, Elmar Menold, Christian Castell, Guido Schendler, Vitalie Faoro, Heimo Mairbäurl, Peter Bärtsch, and Eric R. Swenson. Transpulmonary plasma ET-1 and nitrite differences in high altitude pulmonary hypertension. High Alt. Med. Biol. 10:17–24, 2009.—Thirty-four mountaineers were studied at low (110 m) and high altitude (4559 m) to evaluate if increased pulmonary artery systolic pressure (PASP) at high altitude is associated with increased pulmonary endothelin-1 (ET-1) availability and alterations in nitrite metabolism across the lung. Blood samples were obtained using central venous and radial artery catheters for plasma ET-1 and nitrite. Pulmonary blood flow was measured by inert gas rebreathing to calculate transpulmonary exchange of plasma ET-1 and nitrite, and PASP was assessed by transthoracic Doppler echocardiography. After ascent to high altitude, PASP increased from 23 ± 4 to 39 ± 10 mmHg. Arterial and central venous plasma ET-1 increased, while plasma nitrite did not change significantly. At low altitude there was a transpulmonary loss of plasma ET-1, but a transpulmonary gain at high altitude. In contrast was a transpulmonary gain of plasma nitrite at low altitude and a transpulmonary loss at high altitude. PASP positively correlated with a transpulmonary gain of plasma ET-1 and negatively correlated with a transpulmonary loss of plasma nitrite. These results suggest that a transpulmonary gain of plasma ET-1 is associated with higher PASP at high altitude. Transpulmonary loss of plasma nitrite indicates either less pulmonary nitric oxide (NO) production, which contributes to higher PASP, or increased NO bioavailability arising from nitrite reduction, which may oppose ET-1-mediated vasoconstriction. [ABSTRACT FROM AUTHOR]

Highly water-soluble prodrugs 1a− gof anthelmintic benzimidazole carbamates 2a− gwere synthesized. These prodrugs combine high aqueous solubility and stability with high lability in the presence of alkaline phosphatases. The veterinary utility of 1awas shown by a pharmacodynamic and pharmacokinetic study performed in swine. Comparable anthelmintic efficacy was observed with prodrug 1aor the parent fenbendazole 2a. The pharmacokinetic results showed that 2ais better absorbed when derived from 1athan when applied as such. [ABSTRACT FROM AUTHOR]

In cone-beam CT, involuntary patient motion and inaccurate or irreproducible scanner motion substantially degrades image quality. To avoid artifacts this motion needs to be estimated and compensated during image reconstruction. In previous work we showed that Fourier consistency conditions (FCC) can be used in fan-beam CT to estimate motion in the sinogram domain. This work extends the FCC to cone-beam CT. We derive an efficient cost function to compensate for motion using detector translations. The extended FCC method have been tested with five translational motion patterns, using a challenging numerical phantom. We evaluated the root-mean-square-error and the structural-similarity-index between motion corrected and motion-free reconstructions. Additionally, we computed the mean-absolute-difference (MAD) between the estimated and the ground-truth motion. The practical applicability of the method is demonstrated by application to respiratory motion estimation in rotational angiography, but also to motion correction for weight-bearing imaging of knees. Where the latter makes use of a specifically modified FCC version which is robust to axial truncation. The results show a great reduction of motion artifacts. Accurate estimation results were achieved with a maximum MAD value of 708 μm and 1184 μm for motion along the vertical and horizontal detector direction, respectively. The image quality of reconstructions obtained with the proposed method is close to that of motion corrected reconstructions based on the ground-truth motion. Simulations using noise-free and noisy data demonstrate that FCC are robust to noise. Even high-frequency motion was accurately estimated leading to a considerable reduction of streaking artifacts. The method is purely image-based and therefore independent of any auxiliary data. [ABSTRACT FROM AUTHOR]

Cavity ring-down spectroscopy (CRDS) is a very sensitive diagnostic technique for absorption measurements. It is capable of measuring the absolute line-of-sight (LOS) integrated density of negative hydrogen ions (H[?], D[?]) which induce a weak absorption (a [?] 10[?]6 cm[?]1) along a LOS in plasmas containing negative hydrogen ions. CRDS has been applied to a high power rf driven negative ion source which is now the reference source for the ITER neutral beam injection system. The rf source operates at low pressure (typically 0.3 Pa). Negative hydrogen ions are produced mainly by the conversion of hydrogen particles at a caesium coated surface achieving negative ion densities comparable to the electron density near the surface. It is shown that CRDS very reliably measures the absolute volume density of negative hydrogen ions in these sources. The densities range from 1016 m[?]3 in volume operation to 1017 m[?]3 in caesium seeded operation. The measured volume density close to the extraction system and the extracted current density change consistently while varying different source parameters, such as the total pressure or the input power applied to the source. Results are shown for measurements in hydrogen and deuterium discharges with caesium seeding. An additional absorption is measured in the afterglow of the discharge and is attributed to the caesium dimer Cs2. [ABSTRACT FROM AUTHOR]

The protein coat of the tobacco mosaic virus (TMV) has been explored extensively for the construction of nanoscale architectures. In previous work, we have reported efficient TMV-based light harvesting systems bearing chromophores in a hollow channel of the assembled protein. We have also reported an N-terminal transamination/oximation method that could be used to attach electrodes and catalytic groups to the exterior surface of the rods. To complement these techniques, we report herein a new circular permutant of the TMV capsid protein that repositions the N- and C-termini to the center of the assemblies. This protein can be produced in very high yield through E. coliexpression and self-assembles into light harvesting rods that are much like those assembled from the wild-type protein. However, the disks formed from the permutant structure are stable over a significantly wider pH range, greatly improving the practicality of this assembled form for materials applications. The new position of the N-terminus allows functional groups to be installed in the inner pore of the disks, affording geometries reminiscent of natural photosynthetic systems. The permutant also shows the ability to coassemble with regular monomers, allowing the future generation of multicomponent rod structures that are modified on the exterior and interior surfaces, as well as in the internal RNA channel. [ABSTRACT FROM AUTHOR]

It was found that solvent hydrogen bond basicity (SHBB) significantly affects the regiochemistry of the SNAr reaction between secondary amines and activated polyfluoroarenes. A plausible mechanism involving a six-membered transition state is invoked for the formation of an ortho-substituted isomer, which is likely organized by a hydrogen bond. Evidence for this hypothesis is presented, and a regioselective amination reaction of activated polyfluoroarenes has been developed. [ABSTRACT FROM AUTHOR]

In Switzerland 'Secret' is a folk medicine called upon for burns. It has belonged to UNESCO's intangible cultural heritage since 2012. It is supposed to ease pain and accelerate the healing process of burns. As the practice is widely used in the population, this observational study investigated the opinion of caregivers and patients from the National Burn Center of Lausanne. Qualitative observational study based on a survey including ten questions aimed at identifying the professionals' perception of the phenomenon. Questions were developed from repeated encounters in the burn center. Data collection took five months. Thirty-six healthcare professionals (HP) and 12 selected patients (or parents for minors) discharged after burns were interviewed on a voluntary basis: all of the HPs knew about 'Secret' from the workplace, and 26 from home: 33 were convinced that it might be useful and reduce pain. The perceived efficiency of the practice (36 respondents) differs depending on professional category and personal experience. Only one HP considered the practice to be dangerous. The nurses and auxiliary nurses expressed that it should be used more widely. The 12 patients considered it as a complementary step, not a replacement for medical care. Health professionals globally considered this practice safe and helpful. The patients were interested in using parallel approaches and were careful about their expectations. This openness is probably an indication that HPs believe that acceptance of the culture and beliefs of patients and their families might positively affect response to treatment, whatever the burn size. [ABSTRACT FROM AUTHOR]

Powerful, low pressure negative hydrogen ion sources are a basic component of future neutral beam heating systems for fusion devices. The required high ion currents (>40 A) are obtained via the surface production process, which requires negative ion densities in the range of n_{\rm{H^-}} \approx 10^{17} {\rm m^{-3}} in the plasma region close to the extraction system. For spatially resolved diagnostics of the negative hydrogen ion densities, the laser photodetachment method has been applied to a high power, low pressure, rf-driven ion source (150 kW, 0.3 Pa) for the first time. The diagnostic setup and the data evaluation had to cope with the rf field (1 MHz), the high source potential during extraction ([?]25 kV) and the presence of magnetic fields (<10 mT). Horizontal profiles of negative ion densities and electron densities along 15 cm with a typical step length of 1 cm and a probe tip of 5 mm length show a broad maximum in the centre of the extraction region. The variation of a bias voltage applied to the plasma grid with respect to the source body yields a correlation between the detachment signals for the negative ion density and the electron density with the extracted ion and electron currents, respectively. The density ratio of negative hydrogen ions to electrons is in the range of n_{\rm{H^-}}/n_{\rm{e}} = 0.3\hbox{--}3 , demonstrating that the negative ions are the dominant negatively charged species in these types of ion sources. Absolute negative ion densities are in good agreement with line-of-sight integrated results of cavity ring-down spectroscopy and optical emission spectroscopy. [ABSTRACT FROM AUTHOR]

Zusammenfassung Pharmakologisches Neuroenhancement ist der Versuch, die kognitive Leistungsfähigkeit bei Gesunden zu verbessern. Durch eine gezielte Beeinflussung plastischer Vorgänge im Gehirn sollen dabei Lernen und Gedächtnis, Aufmerksamkeit und Vigilanz oder Stimmung und Kommunikationsfähigkeit optimiert werden. Anhand einer Übersicht über die aktuellen Möglichkeiten solcher Optimierungen wird erstens dargelegt, dass Fragen nach Nebenwirkungen und Wirksamkeit in vielen Fällen bisher nicht verlässlich beantwortet werden können. Zweitens wird argumentiert, dass sich pharmakologische Eingriffe ins Gehirn aus ethischer Sicht von sozial vermittelten Formen der Verbesserung geistiger Leistungen unterscheiden. Pharmakologisches Enhancement vermittelt ein Bild von Effizienz und Kontrolle, das die Gefahr birgt, dass wichtige Aspekte dessen, was wir unter allgemein unter geistiger Leistung verstehen, vernachlässigt werden. [ABSTRACT FROM AUTHOR]

Zusammenfassung  Aufgrund der neuen Approbationsordnung für Ärzte wird deutlich mehr Unterricht am Krankenbett gefordert als bisher. Da Patienten nur in begrenztem Maße im Studentenunterricht eingesetzt werden können, werden inzwischen verstärkt Simulationspatienten (SP), auch standardisierte Patienten genannt, in der Lehre eingesetzt. Im Gegensatz zu anderen medizinischen Fächern liegen für den Einsatz von SP im Unterricht in Psychiatrie und Psychotherapie kaum Daten vor. Im Rahmen eines Pilotprojekts sollte überprüft werden, ob SP in Ergänzung zu realen Patienten im praktischen Unterricht im Fach Psychiatrie und Psychotherapie von den Studierenden gut angenommen werden und ob psychische Erkrankungen von Laienschauspielern realitätsgetreu dargestellt werden können. Darüber hinaus sollte überprüft werden, ob der Einsatz von SP zu einer besseren Bewertung der Lehre führt. Von 139 Studierenden eines Semesters erhielt eine Hälfte nach Randomisierung praktischen Unterricht mit realen Patienten, die andere Hälfte sowohl mit realen Patienten als auch mit SP bei gleicher Gesamtzahl der Patientenkontakte. Es erfolgte eine Prä-Post-Analyse mit einem Fragebogen, der die Items „Kenntnisse in Gesprächsführung“, „Zutrauen, schwierige Themen wie Suizidalität ansprechen“, „Freude am Unterricht“ und „Interesse am Fach“ beinhaltete. Die SP wurden sehr gut von den Studierenden angenommen. Der Nutzen des Unterrichts und die Einschätzung der eigenen Kenntnisse im Fach Psychiatrie und Psychotherapie wurde in der Gruppe, die zusätzlich mit SP unterrichtet wurde, signifikant besser bewertet als in der Kontrollgruppe. Die Ergebnisse dieser Pilotstudie sind sehr ermutigend und deuten darauf hin, dass der systematische Einsatz von SP im praktischen Unterricht im Fach Psychiatrie und Psychotherapie ein geeigneter Ersatz für reale Patienten sein und die Ausbildung in bestimmten Aspekten sogar verbessern kann. [ABSTRACT FROM AUTHOR]

Alkyl-capped silicon nanocrystals can be dispersed in aqueous media by shaking or stirring their solutions in organic solvents (DMSO, ether, THF) with excess water. THF is the most straightforward choice with which to prepare stable aqueous dispersions, because the nanocrystals are very soluble in THF and it is also miscible with water. As little as 0.01% v/v tetrahydrofuran is sufficient. DMSO and ether were the preferred choices for subsequent staining of live cells because THF shows some acute toxicity even when very dilute. The luminescence intensity of the aqueous dispersions is linear in particle concentration and independent of pH over the range 5–9. The sols retain their photoluminescence and are stable against flocculation for at least 6 months. [ABSTRACT FROM AUTHOR]

For heating and current drive the neutral beam injection system for ITER requires a deuterium beam with an energy of 1 MeV for up to 1 h. In order to inject the required 17 MW the ion source has to deliver 40 A of negative ion current. For an accelerated current density of 200 A m[?]2 at the specified source pressure of 0.3 Pa the extraction area is 0.2 m2 resulting in a large area source of 1.5 × 0.6 m2. Two types of sources have been under discussion, the filamented arc source and the inductively driven RF source, the latter now having been chosen for the ITER reference design. The development of negative ion RF sources, which fulfil these specifications is being carried out at the Max-Planck-Institut für Plasmaphysik at three test facilities in parallel. The required current densities at the ITER relevant pressure have been achieved and even exceeded in a test facility equipped with a small ion source (extraction area of 0.007 m2) at limited pulse length (<4 s). The extraction area can be extended up to 0.03 m2 and the pulse length up to 3600 s at a second test facility which is dedicated to long pulse operation experiments where pulses up to 800 s have already been achieved. The ion source at the third test facility has roughly the full width and half the height of the ITER source but is not equipped with an extraction system. The aim is to demonstrate the size scaling and plasma homogeneity of RF ion sources. First results from different diagnostic techniques (optical emission spectroscopy and Langmuir probe) are very promising. [ABSTRACT FROM AUTHOR]

Zusammenfassung Hintergrund  Von Vertretern der Krankenkassen und der Krankenh�user werden f�r den station�ren psychiatrischen Bereich immer wieder Fragen einer leistungsgerechten Verg�tung diskutiert. Dabei ist weitgehend unklar, welche Merkmale der Kliniken und der Patienten derzeit mit den Kosten station�rer Aufenthalte korrespondieren. Material und Methoden  Die Studie bezieht sich auf 1202 Episoden von Patienten mit den ICD-10-Aufnahmediagnosen F31.3–F31.5, F32, F33, F34.1, F43.20 und F43.21, die im Zeitraum vom 01.09.2001 bis 01.03.2003 in 10 Kliniken in Baden-W�rttemberg, Bayern und Nordrhein-Westfalen dokumentiert wurden. Mit schrittweisen multiplen Regressionsanalysen werden zun�chst kostenrelevante Pr�diktoren auf Patientenebene identifiziert. Mittels hierarchischer Regressionen werden auch Klinikmerkmale in die Auswertungen mit aufgenommen. Ergebnisse   Durch Aufnahme- und stabile Patientenmerkmale l�sst sich nur ein relativ geringer Anteil des Ressourcenverbrauchs vorhersagen, eine substanzielle Aufkl�rung der Kostenvarianz gelingt jedoch bei Ber�cksichtigung des gesamten Behandlungsprozesses. Adjustiert man f�r kostenpr�diktive Aufnahmemerkmale, dann entstehen f�r eine Krankenkasse in einer universit�ren Einrichtung h�here Episodenkosten, bei Ber�cksichtigung des gesamten Behandlungsverlaufs hingegen bestehen keine �berzuf�lligen Kostenunterschiede zwischen den Kliniken. Schlussfolgerung  Sogar innerhalb einer psychiatrischen Syndromgruppe l�sst sich der Ressourcenverbrauch station�rer Episoden nur bei Ber�cksichtigung des gesamten Behandlungsverlaufs befriedigend erkl�ren. Ebenso wie im somatisch-station�ren Bereich spielen dabei Prozeduren eine wesentliche Rolle. [ABSTRACT FROM AUTHOR]

In this study, we developed a new setup for the validation of clinical workflows in adaptive radiation therapy, which combines a dynamic ex vivo porcine lung phantom and three-dimensional (3D) polymer gel dosimetry. The phantom consists of an artificial PMMA-thorax and contains a post mortem explanted porcine lung to which arbitrary breathing patterns can be applied. A lung tumor was simulated using the PAGAT (polyacrylamide gelatin gel fabricated at atmospheric conditions) dosimetry gel, which was evaluated in three dimensions by magnetic resonance imaging (MRI). To avoid bias by reaction with oxygen and other materials, the gel was collocated inside a BAREX™ container. For calibration purposes, the same containers with eight gel samples were irradiated with doses from 0 to 7 Gy. To test the technical feasibility of the system, a small spherical dose distribution located completely within the gel volume was planned. Dose delivery was performed under static and dynamic conditions of the phantom with and without motion compensation by beam gating. To verify clinical target definition and motion compensation concepts, the entire gel volume was homogeneously irradiated applying adequate margins in case of the static phantom and an additional internal target volume in case of dynamically operated phantom without and with gated beam delivery. MR-evaluation of the gel samples and comparison of the resulting 3D dose distribution with the planned dose distribution revealed a good agreement for the static phantom. In case of the dynamically operated phantom without motion compensation, agreement was very poor while additional application of motion compensation techniques restored the good agreement between measured and planned dose. From these experiments it was concluded that the set up with the dynamic and anthropomorphic lung phantom together with 3D-gel dosimetry provides a valuable and versatile tool for geometrical and dosimetrical validation of motion compensated treatment concepts in adaptive radiotherapy. [ABSTRACT FROM AUTHOR]

A contract, started in January 2005, was awarded to a consortium of Astrium GmbH and Astrium Ltd for the LISA Mission Formulation. The scope of the contract was the development of a reference design for the mission architecture and for the mission elements (with particular focus on the payload) and a successive phase of derivation of requirements, to be concluded with a mission design review. The technical starting point was the output of the previous LISA study formalized in the Final Technical Report, issued in the year 2000. During the design phase, different architecture concepts were identified and traded off, including the LISA orbits, the measurement scheme and the opto-mechanical architecture. During the Mission Design Review (July 2008) the consolidated mission baseline design, and the specifications of the flight elements and of the payload subsystem and major components were presented. This paper gives a brief overview of the major design points of the latest design of the LISA system. [ABSTRACT FROM AUTHOR]

Objectives To determine whether valganciclovir 450 mg every 48 h for cytomegalovirus (CMV) prophylaxis provides appropriate ganciclovir exposure in solid organ transplant recipients during continuous renal replacement therapy (CRRT). Patients and methods Ganciclovir pharmacokinetics was intensively studied in two lung transplant recipients under valganciclovir 450 mg every 48 h over one dosing interval. In vitro experiments using blank whole blood spiked with ganciclovir further investigated exchanges between plasma and erythrocytes. Results Ganciclovir disposition was characterized by apparent total body clearance of 3.3 and 5.8 L/h, terminal half-life of 16.9 and 14.1 h, and apparent volume of distribution of 60.3 and 104.9 L in Patients 1 and 2, respectively. The observed sieving coefficient was 1.05 and 0.96, and the haemofiltration clearance was 3.3 and 3.1 L/h. In vitro experiments confirmed rapid efflux of ganciclovir from red blood cells into plasma, increasing the apparent efficacy of haemofiltration. Conclusions A valganciclovir dosage of 450 mg every 48 h appears adequate for patients under CRRT requiring prophylaxis for CMV infection, providing concentration levels in the range reported for 900 mg once daily dosing outside renal failure. [ABSTRACT FROM AUTHOR]