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Abstract Background This was a prespecified secondary analysis of a randomized trial, which analyzed bone density following stereotactic body radiotherapy (SBRT) versus conventional three-dimensional conformal radiotherapy (3DCRT) as part of palliative management of painful spinal metastases. Methods Fifty-five patients were enrolled in this single-institutional randomized exploratory trial (NCT02358720). Participants were randomly assigned to receive SBRT (single-fraction 24 Gy) or 3DCRT (30 Gy/10 fractions). Quantitative bone density was evaluated at baseline, 3 and 6 months in both irradiated and unirradiated spinal bodies, along with rates of pathologic fractures and vertebral compression fractures. Results As compared to baseline, bone density became significantly higher at 3 and 6 months following SBRT by a median of 33.8% and 72.1%, respectively (p

Abstract Background Due to an increase in migration and globalization, cross-cultural encounters in health care are also becoming more frequent. As psychotherapy is grounded in a cultural context and must be congruent with the patient’s cultural beliefs of his or her illness in order to be effective, the consideration of cross-cultural differences in illness representations becomes increasingly important. Especially research on illness representations concerning mental disorders is scarce. Methods The aim of the current study was to compare illness representations between Iranian (N = 87) and German (N = 90) patient samples as well as subclinical samples (Iranian N = 264, German N = 102) using a multivariate analysis of covariance (MANCOVA). Illness representations were measured using the Illness Perception Questionnaire Revised (IPQ-R). Initially, a factor analysis was conducted in order to ensure comparability of the IPQ-R between the Iranian and the German sample. Results The factor analysis already revealed differences in item compositions of the IPQ-R subscales indicating differences of the conception of illness representations between the samples. Further, the Iranian samples showed a significantly higher amount of supernatural causal beliefs and emotional representation of the illness than the German samples. Surprisingly, the Iranian patient sample showed the highest amount of illness coherence. Conclusion The current paper contributes to a deeper understanding of cross-cultural differences in illness representations regarding mental disorders. Nevertheless, further research is needed to confirm current findings and to further elaborate on the relationships found.

Abstract Background The effect of radiotherapy, in particular the application of different multi-fraction schedules in the management of unstable spinal bone metastases (SBM), is incompletely understood. This study aims to compare the radiological response regarding various dose and fractionation schedules of radiotherapy in the palliative treatment of SBM. Methods We retrospectively assessed 1047 patients with osteolytic SBM, treated with palliative radiotherapy at our department between 2000 and 2015. Lung cancer (40.2%), breast (16.7%) and renal cancer (15.2%) were the most common solid tumors in this study. Different common multi-fraction regimen (5x4Gy, 10x3Gy, 14 × 2.5Gy and 20x2Gy) were compared with regard to radiological response and recalcification at 3 and 6 months after radiotherapy. The Taneichi score was used for classification of osteolytic SBM. Results Median follow up was 6.3 months. The median overall survival (OS) in the short-course radiotherapy (SCR) group using less than 10 treatment fractions was 5.5 months vs. 9.5 months in the long-course radiotherapy (LCR) group using in excess of 10 fractions (log rank p

Abstract Background The Patient Health Questionnaire’s depression module (PHQ-9) is a widely used screening tool to assess depressive disorders. However, cross-linguistic and cross-cultural validation of the PHQ-9 is mostly lacking. This study investigates whether scores on the German and Turkish versions of the PHQ-9 are comparable. Methods Data from Germans without a migration background (German version, n = 1670) and Turkish immigrants in Germany (either German or Turkish version, n = 307) were used. Differential Item Functioning (DIF) was assessed using Item Response Theory (IRT) models. Results Several items of the PHQ-9 were found to exhibit DIF related to language or ethnicity, e.g. ‘sleep problems’, ‘appetite changes’ and ‘anhedonia’. However, PHQ-9 sum scores were found to be unbiased, i.e., DIF had no notable impact on scale levels. Conclusions PHQ-9 sum scores can be compared between Turkish immigrants and Germans without a migration background without any adjustments, regardless of whether they complete the German or the Turkish version.

Abstract Mean platelet volume (MPV) was recently published as a possible marker of coronary artery disease in patients at high risk for major adverse cardiac events. Because platelets play an important role in atherosclerosis, we examined the relationship between critical limb ischemia (CLI) and MPV in patients with peripheral arterial occlusive disease (PAOD). Our study comprised 2124 PAOD patients. Univariate logistic regression was performed to analyze potential predictors for CLI. Nagelkerke’s R² is reported. Cross validation was performed using the leave-one-out principle. ROC analyses were performed to identify the best cut off value for MPV predicting CLI; to this end, Youden’s index was calculated. For CLI diabetes (p

Penggunakan material posolan yang berasal dari bahan organik dalam adukan beton terus meningkat. Material posolan ini dapat berupa hasil sampingan dari produk pertanian/perkebunan. Salah satu produk sampingan dari pengolahan produk perkebunan adalah ampas kopi. Tujuan dari penelitian ini untuk mengetetahuinilai kuat tekan dari beton yang mengandung abu ampas kopi (AAK) sebesar 5% dengan bahan tambah superplasticizer pada variasi 0,5%, 1% dan 2% dari berat semen. Abu ampas kopi didapat dengan cara dibakar pada suhu 700 OC, kemudian dihaluskan hingga lolos saringan no.200 (75 µm). Benda uji yang digunakan berbentuk silinder dengan diamater 150 mm x 300 mm sebanyak 40 buah. Mutu beton yang direncanakan adalah 35 MPa dengan fas 0,385. Hasil pengujian kuat tekan beton normal pada umur 28 hari (BN) sebesar 35,98 MPa. Pada pengurangan air adukan 10% dan penambahan superplasticizer 0,5%, 1% dan 2% didapat nilai kuat tekan sebesar 42,32 MPa, 43,33 MPa, dan 47,83 MPa, meningkat sebesar 17 % sampai 33% dari kuat tekan beton normal. Hasil penelitian juga menunjukkan bahwasubstitusiabu ampas kopi 5% terdadap berat semen tanpa superplasticizermemberi peningkatan kuat tekan sebesar 3,78% dari beton normal.Pada substitusiAAK sebesar 5% dan dengan tambahan superplasticizer sebesar 0,5%, 1% dan 2%, dihasilakn kuat tekan masing-masing sebesar 44,71 MPa, 45,90 MPa dan 49,74 MPa. Ketiga mutu beton ini dapat di katagorikan dalam beton mutu tinggi.

Abstract Background Stereotactic body radiation therapy (SBRT) using intensity-modulated radiotherapy (IMRT) with dose escalation by simultaneous integrated boost (SIB) can be a safe modality for treating spinal bone metastases with enhanced targeting accuracy and improve local tumor control. Methods/Design This is a single-center, prospective, randomized, controlled trial. One hundred and twenty patients with spinal bone metastases will receive palliative radiation therapy at the Heidelberg University Hospital. SBRT will be given in five or ten fractions with or without SIB. Four treatment arms are planned: IMRT with 30 Gy in ten fractions, IMRT with 30 Gy in ten fractions and SIB to 40 Gy, IMRT with 20 Gy in five fractions, and IMRT with 20 Gy in five fractions and SIB to 30Gy in five fractions will be compared. The target parameters will be measured at baseline level and at three and six months after radiation. Discussion The primary endpoint of this study was to assess and compare the local tumor control (by means of different fractionation schedules and biological doses to the tumor area). Secondary endpoints are acute and chronic adverse events, pain relief, quality of life, and fatigue. Trial registration ClinicalTrials.gov, NCT02832765 . Registered on 27 July 2016.

Reactive powder concrete (RPC) merupakan varian baru dari beton mutu ultra tingggi (ultra high strength concrete) yang diperkenalkan kepada umum pertama kali pada tahun 1994. Beton modern ini memiliki beberapa keunggulan dibandingkan beton konvensional (normal concrete) atau beton kinerja tinggi (high performance concretes). Penelitian tentang RPC di Indonesi masih sangat terbatas, RPC pertama bermaterial lokal Indonesia dikembangkan tahun 2009, dengan sumber silika berasal dari silica fume. Sebagai bagian dari berbagai penelitian lanjutan tentang RPC, hasil akhir dari riset ini diharapkan dapat menghasilkan RPC yang benar-benar sesuai dengan karakteristik material di Indonesia. Sumber silika yang digunakan berasal dari limbah bahan organik sehingga dapat menekan biaya produksi dan menghasilan green concrete yang dapat mengurangi dampak negatif limbah terhadap lingkungan. Kata kunci: Reactive Powder Concrete, Silika, Limbah Bahan Organik

Air medical transportation (AMT) of patients plays a critical role in the prehospital care of the ill patient. Despite its importance, there is no requirement in emergency medicine training programs to have direct experience or education on the topic, and data detailing current AMT experiences across programs are limited. A survey detailing program characteristics, AMT experience characteristics, and curriculum factors relating to AMT experience was sent to all 275 credentialed emergency medicine residency training programs in the United States. Our outcomes were to describe the characteristics of AMT and non-AMT programs (proportions) and to evaluate associations (odds ratios with 95% confidence intervals) between program characteristics and 1) AMT experience opportunity and 2) level of resident participation among AMT programs. Two hundred (73%) programs responded, with 135 of 200 (68%) offering some type of AMT experience. The majority of programs offering AMT were 3 years (113 [84%]), university based (63 [47%]), and located in small urban areas (57 [42%]). When AMT was offered, most programs reported that the overall resident participation was low (≤ 20%). Programs that did not offer shift reduction or additional pay for participation in AMT were significantly more likely to have low participation than those with incentives (odds ratio = 4.8; 95% confidence interval, 1.8-15.3). Around one third of AMT experiences allowed for direct patient care. Less than half of the responding programs reported a dedicated AMT curriculum. The majority of emergency medicine residency training programs offer an AMT experience, but this experience is highly variable, and overall participation by residents is low. Given the importance of AMT in the care of emergency patients, standardization and increased access to AMT experience and education should be considered by emergency medicine training programs moving forward. [ABSTRACT FROM AUTHOR]

Demonstration of association between common genetic variants and chronic human diseases such as obesity could have profound implications for the prediction, prevention and treatment of these conditions. Unequivocal proof of such an association, however, requires adherence to established methodological guidelines, which include independent replication of initial positive findings. Recently, single nucleotide polymorphisms (SNPs) within GAD2 were found to be associated with class III obesity (BMI > 40 kg/m2) in 188 families (612 individuals) segregating the condition and a case-control study of 575 cases and 646 lean controls. Functional data supporting a pathophysiological role for one of the SNPs (-243A>G) were also presented. In the present study, we attempted to replicate this association in larger groups of subjects, and to extend the functional studies of the -243A>G SNP. In 2,327 subjects comprising 692 German nuclear families with severe, early-onset obesity, we found no evidence for a relationship between the three GAD2 SNPs and obesity, whether SNPs were studied individually or as haplotypes. In two independent case-control studies (a total of 680 class III obesity cases and 1,186 lean controls), there was no significant relationship between the -243A>G SNP and obesity (odds ratio (OR) = 0.99, 95 percent CI 0.83 - 1.18, in the pooled sample). These negative findings were reinforced by a meta-analysis for the association between the 243G allele and class III obesity, which yielded an OR of 1.11 (95 percent CI 0.90 - 1.36) in a total sample of 1,252 class III obese cases and 1,800 lean controls. Finally, we were unable to confirm or extend the functional data pertaining to th e -243A>G variant. Potential confounding variables in association studies invo lving common variants and complex diseases (low power to detect modest genetic effects, over-interpretation of marginal data, population stratification and biological plausibility) are also discussed in the context of GAD2 and severe obesity.

In this study, the attachment of microcapsules on the membrane surface and its influence on the flow field for a cross-flow membrane setup are investigated. The microcapsules were placed on the top layer of the membrane. The overall purpose of this modification was the prevention of membrane biofouling. Therefore, in a first step, the influence of such a combination on the fluid flow was investigated using computational fluid dynamics (CFD). Here, different properties, which are discussed as indicators for biofouling in the literature, were considered. In parallel, different fixation strategies for the microcapsules were experimentally tested. Two different methods to add the microcapsules were identified and further investigated. In the first method, the microcapsules are glued to the membrane surface, whereas in the second method, the microcapsules are added during the membrane fabrication. The different membrane modifications were studied and compared using CFD. Therefore, virtual geometries mimicking the real ones were created. An idealized virtual geometry was added to the comparison. Results from the simulation were fed back to the experiments to optimize the combined membrane. For the presented setup, it is shown that the glued configuration provides a lower transmembrane pressure than the configuration where microcapsules are added during fabrication.

The benefit of fiber-reinforced composites originates from the interaction between the fiber reinforcement and the matrix. This interplay controls many of its mechanical properties and is of utmost importance to enable its unique performance as a lightweight material. However, measuring the fiber−matrix interphase strength with micromechanical tests, like the Broutman test, is challenging, due to the many, often unknown boundary conditions. Therefore, this study uses state-of-the-art, high-resolution X-ray computed microtomography (XRM) as a tool to investigate post mortem the failure mechanisms of single carbon fibers within an epoxy matrix. This was conducted at the example of single carbon fiber Broutman test specimens. The capabilities of today’s XRM analysis were shown in comparison to classically obtained light microscopy. A simple finite element model was used to enhance the understanding of the observed fracture patterns. In total, this research reveals the possibilities and limitations of XRM to visualize and assess compression-induced single fiber fracture patterns. Furthermore, comparing two different matrix systems with each other illustrates that the failure mechanisms originate from differences in the fiber−matrix interphases. The carbon fiber seems to fail due to brittleness under compression stress. Observation of the fiber slippage and deformed small fracture pieces between the fragments suggests a nonzero stress state at the fragment ends after fiber failure. Even more, these results demonstrate the usefulness of XRM as an additional tool for the characterization of the fiber−matrix interphase.

Acrylamide is probably carcinogenic to humans (International Agency for Research on Cancer, group 2A) with major occurrence in heated, mainly carbohydrate-rich foods. For roasted coffee, a European Union benchmark level of 400 µg/kg acrylamide is of importance. Regularly, the acrylamide contents are controlled using liquid chromatography combined with tandem mass spectrometry (LC–MS/MS). This reference method is reliable and precise but laborious because of the necessary sample clean-up procedure and instrument requirements. This research investigates the possibility of predicting the acrylamide content from proton nuclear magnetic resonance (NMR) spectra that are already recorded for other purposes of coffee control. In the NMR spectrum acrylamide is not directly quantifiable, so that the aim was to establish a correlation between the reference value and the corresponding NMR spectrum by means of a partial least squares (PLS) regression. Therefore, 40 commercially available coffee samples with already available LC–MS/MS data and NMR spectra were used as calibration data. To test the accuracy and robustness of the model and its limitations, 50 coffee samples with extreme roasting degrees and blends were additionally prepared as the test set. The PLS model shows an applicability for the varieties Coffea arabica and C. canephora, which were medium to very dark roasted using drum or infrared roasters. The root mean square error of prediction (RMSEP) is 79 µg/kg acrylamide (n = 32). The current PLS model is judged as suitable to predict the acrylamide values of commercially available coffee samples.

The aim of the study was to analyze survival and stability of patients with urothelial cell cancer and spinal bone metastases (SBM) after radiotherapy (RT). Furthermore, to assess the effects of RT on bone mineral density (BMD) as a local response in SBM after RT.

Perancangan campuran beton (mix design) merupakan upaya untuk menentukan besarnya jumlah semen, agregat halus, agregat kasar, dan air yang akan digunakan dalam 1 m3 adukan guna memperoleh kuat tekan rencana dan kemudahan kerja yang ditetapkan. Aspek keuntungan ekonomis campuran beton sangat ditentukan dari jumlah kandungan semen. Campuran beton dengan packing density yang baik akan menghasilkan jumlah kandungan semen yang lebih sedikit. Penelitian ini bertujuan untuk mengoptimalkan komposisi campuran beton dengan menggunakan metode Andreasen-Andersen packing model berbantuan perangkat lunak EMMA. Hasil penelitian menunjukkan bahwa penggunaan metode Modified Andreasen Packing Model menghasilkan campuran beton berkandungan semen lebih rendah, dan kuat tekan beton pada umur 28 hari lebih tinggi dibandingkan dengan metode SNI 03-2834-2000. Pada mutu beton rencana 15 MPa – 25 MPa, penggunaan semen lebih rendah 6% - 9% dan kuat tekannya meningkat sebesar 6% - 7%. Selanjutnya pada mutu beton rencana 30 MPa – 40 MPa, penggunaan semen lebih rendah 14% - 27% dan kuat tekannya meningkat sebesar 5% - 13%.

Abstract Background This retrospective analysis aimed to analyse the stability of spinal bone metastases in colorectal cancer (CRC) patients following radiotherapy (RT) by use of a validated score and to assess prognostic factors for stability and survival. Methods Ninety-four patients with osteolytic spinal bone metastases from CRC were treated at the Department of Radiation Oncology at the University Hospital Heidelberg between 2000 and 2014. The stability of each affected vertebral body was assessed according to the validated Taneichi bone stability score on the basis of the treatment planning CT scan prior to RT and also based on the follow-up CT examinations at 3 and 6 months after RT. Additionally, bone survival rates (time between first day of RT and death from any cause) as well as prognostic factors for bone survival were evaluated for all study patients. Results Before RT, 59 patients (63%) were rated unstable according to the Taneichi score. Pathological fractures within the irradiated region were diagnosed in 43 patients (46%) prior to RT. New fractures or progression of previously collapsed vertebrae were diagnosed in 4 patients (4%) after irradiation. Significant re-calcification and stabilization of former unstable bone metastases was only observed in 3/59 patients (3%) and 5/59 patients (9%). The median bone survival was 4.2 months (range 0.5–67.3 months) and 6 months after RT 61% of the patients were dead. Karnofsky performance score (KPS) (< 70% vs. ≥ 70%), chemotherapy and bisphosphonate therapy were predictive prognostic factors for bone survival. Conclusions Our study population is characterized by poor bone survival and low re-calcification rates of unstable spinal bone lesions 3 and 6 months after RT. To avoid unnecessary hospitalisation and improve remaining QoL, short fractionated treatment schedules of RT may be prefered in this highly palliative situation, particularly for patients with a KPS

Robert Sielski,1 Julia Anna Glombiewski,1 Winfried Rief,1 Geert Crombez,2 Antonia Barke1 1Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany; 2Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium Abstract: According to the dual process model of coping, assimilative or accommodative strategies can be applied to deal with aversive life situations. In people with chronic pain, the tenacious focus on achieving analgesia is often referred to as assimilative coping and associated with more disability and catastrophic thinking. In contrast, accommodative coping (accepting one’s pain and setting new goals) appears to have beneficial effects. To assess how people with chronic pain use these different coping strategies, questionnaires measuring these concepts are needed. Following international guidelines, a German version of the Pain Solutions Questionnaire (PaSol) was prepared. A sample of 165 participants with chronic low back pain (CLBP; 60% women; age 53 ± 8.4 years) filled in the questionnaire and measures for pain-related disability, affective distress, catastrophic thinking, and attention to pain. Item analyses, an exploratory factor analysis, and correlations with pain-related measures were calculated. In addition, data from 98 participants who received psychological treatment were examined to investigate the PaSol’s sensitivity to change. The exploratory factor analysis reproduced the original questionnaire’s four-factor structure. Internal consistencies for the subscales ranged from Cronbach’s α=0.72 to α=0.84. Mean item difficulties for the subscales ranged from pi=0.62 to pi=0.79. The highest correlations were found for Meaningfulness with catastrophic thinking (r=−0.58) and affective distress (r=−0.36). The PaSol subscale Meaningfulness predicted pain-related disability; the subscales Meaningfulness and Solving Pain predicted affective distress. Furthermore, the PaSol was found to be sensitive to detect changes over time. The German version of the PaSol is a reliable and valid instrument in the measurement of assimilative and accommodative coping strategies in people suffering from CLBP. It may provide a useful tool when examining temporal dynamics of the changing coping strategies in the transition from acute to chronic pain as well as during pain treatments. Keywords: acceptance, back pain, coping, problem-solving, German, validation

Karoline Pieritz,1 Sarina J Schäfer,2 Jana Strahler,3 Winfried Rief,1 Frank Euteneuer1 1Division of Clinical Psychology and Psychotherapy, Philipps Universität, Marburg, 2Division of Psychological Methods and Evaluation, Fernuniversität, Hagen, 3Division of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität, Giessen, Germany Background: Experiences of social pain due to social exclusion may be processed in similar neural systems that process experiences of physical pain. The present study aimed to extend the findings on social exclusion and pain by examining the impact of social exclusion on an affective (ie, heat pain tolerance) and a sensory component of pain (ie, heat pain intensity). Whether a potential effect may be moderated by chronic life stress, social status, or social support was further examined. Materials and methods: A community-based sample of 59 women was studied. Social exclusion and inclusion were experimentally manipulated by using a virtual ball-tossing game called Cyberball in which participants were randomly assigned to either being excluded or being included by two other virtual players. Heat pain tolerance and intensity were assessed before and after the game. Potential psychosocial moderators were assessed via a questionnaire. Results: The main finding of this study is that chronic stress moderates the impact of social exclusion on pain tolerance (p

Abstrak Semen merupakan bahan pengikat agregat dalam pembuatan beton. Semen yang bereaksi dengan air, selain menghasilkan Calcium Silicate Hydrate (CSH) juga menghasilkan senyawa sampingan yaitu kalsium hidroksida (Ca(OH)2). Senyawa Ca(OH)2 memberi dampak buruk terhadap kualitas beton. Untuk mengatasinya, dalam adukan beton ditambah bahan posolan (pozzolanic material) yang mengandung silika (SiO2) yang akan bereaksi dengan Ca(OH)2 untuk menghasilkan CHS sekunder. Material posolanik organik dapat berupa limbah industri pangan (agro waste). Salah satu limbah agro waste yang belum termanfaatkan dengan baik adalah ampas kopi. Pada penelitian ini, abu ampas kopi digunakan sebagai material pengganti sebagian semen. Ampas kopi yang digunakan dibakar dalam furnace pada suhu 700ºC dan kemudian diayak dengan saringan No. 200 (75 mm). Material lain yang digunakan adalah kerikil berasal dari desa Krueng Sawang dan semen Andalas Tipe I. Benda uji berbentuk silinder dengan dimensi 150 mm x 300 mm dengan masing-masing variasi 5 buah benda uji. Kuat tekan rencana beton normal 20 MPa dengan fas 0,484. Pengujian kuat tekan dilakukan pada saat umur beton 56 hari. Hasil pengujian berdasarkan persentase abu ampas kopi 5%, 10%, 15%, dan 25% terhadap volume semen didapat kuat tekan berturut-turut 26,085 MPa, 20,162 MPa, 20,080 MPa, dan 15,358 MPa. Sedangkan kuat tekan beton normal tanpa substitusi abu ampas kopi didapat sebesar 25,406 MPa. Hasil ini menunjukkan bahwa penggantian parsial abu ampas kopi sebesar 5% terhadap semen dapat meningkatkan kuat tekan sebasar 2,67% dari beton normal. Selanjutnya, pada subsitusi 10% dan 15%, hasil kuat tekan masih memenuhi kuat tekan rencana (fc’). Kata kunci: semen, abu ampas kopi, posolan, kuat tekan beton.

Sebelum keluarnya SNI 7656:2012, perancangan campuran beton normal dilakukan menurut SNI 03-2834-2000. Pada penelitian ini telah dilakukan suatu perbandingan rancangan terhadap kedua SNI tersebut pada mutu beton 20 MPa. Benda uji digunakan berbentuk silinder dengan ukuran 150 mm x 300 mm, sebanyak 5 benda uji untuk masing-masing SNI. Hasil penelitian menunjukkan kuat tekan yang dihasilkan oleh SNI 2000 dan SNI 2012 berturut-turut: 21,95 MPa dan 23,01 MPa. Selanjutnya, nilai slump untuk kedua rancangan beton tersebut bertut-turut: 60 mm dan 70 mm. Hasil ini memperlihatkan bahwa nilai kuat tekan yang diperoleh dari rancangan campuran berdasarkan SNI 2012 lebih tinggi dibanding nilai kuat tekan SNI 2000 dan keduanya memberikan nilai slump yang baik. Kedua SNI memberikan hubungan empiris dan relatif dari terhadap bahan beton dalam campuran, sehingga rancangan kadar bahan yang dihasilkan oleh masing-masing metode akan berbeda satu sama lain, yang pada akhirnya akan memberikan hasil kuat tekan yang berbeda pula. Kata kunci: Campuran beton, kuat tekan, beton normal.

Abstract Background Metastatic bone disease is a common and severe complication in patients with advanced cancer. Radiotherapy (RT) has long been established as an effective local treatment for metastatic bone disorder. This study assesses the effects of RT combined with muscle-training exercises in patients with unstable bone metastases of the spinal column from solid tumors. The primary goal of this study is to evaluate the feasibility of muscle-training exercises concomitant to RT. Secondly, quality of life, fatigue, overall and bone survival, and local control will be assessed. Methods/Design This study is a single-center, prospective, randomized, controlled, explorative intervention study with a parallel-group design to determine multidimensional effects of a course of exercises concomitant to RT on patients who have unstable metastases of the vertebral column, first under therapeutic instruction and subsequently performed by the patients themselves independently for strengthening the paravertebral muscles. On the days of radiation treatment the patients will be given four different types of exercises to ensure even isometric muscle training of all the spinal muscles. In the control group progressive muscle relaxation will be carried out parallel to RT. The patients will be randomized into two groups: differentiated muscle training or progressive muscle relaxation with 30 patients in each group. Discussion Despite the clinical experience that RT is an effective treatment for bone metastases, there is insufficient evidence for a positive effect of the combination with muscle-training exercises in patients with unstable bone metastases. Our previous DISPO-1 trial showed that adding muscle-training exercises to RT is feasible, whereas this was not proven in patients with an unstable spinal column. Although associated with several methodological and practical challenges, this randomized controlled trial is needed. Trial registration ClinicalTrials.gov, identifier: NCT02847754 . Registered on 27 July 2016.

Although instable negative emotions and problems in emotion regulation (ER) are common in patients with psychosis and are discussed as potential factors involved in the formation and maintenance of paranoia, it is unclear whether they increase the risk of developing paranoia in nonclinical controls. The present study aims to investigate whether the instability of negative emotions leads to paranoia in healthy participants. It should be further analyzed if the application of maladaptive ER strategies enhances subclinical paranoid ideation and if the use of adaptive ER strategies reduces subclinical paranoid ideation. Method: Nonclinical controls ( n = 83) repeatedly reported the presence and instability of negative emotions, paranoia, and the use of maladaptive (expressive suppression, rumination) and adaptive (reappraisal, acceptance) ER strategies in their daily life on six consecutive days using electronic mobile assessment. Results: Hierarchical linear regression analysis revealed that nonclinical controls reporting a pronounced instability of negative emotions showed more pronounced paranoia at a subsequent time point. Moreover, participants who used expressive suppression at a certain time experienced more severe paranoia at the subsequent time point. Conclusion: If these findings are confirmed in high-risk samples, ER processes could be considered as an additional factor in theoretical models of paranoia formation.

There has been a growing interest in research on stigma and attitude toward psychotherapy, and these variables are expected to show cross-cultural variations. The Stigma Scale for Receiving Psychological Help (SSRPH), the Self-Stigma of Seeking Help (SSOSH) and the Inventory of Attitudes to Seeking Mental Health Services (IASMHS) are widely used and this study examined their measurement invariance as this is a prerequisite for use in cross-cultural studies. Data were collected online from groups of Chinese students in China (n = 413) and German students in Germany (n = 416). Confirmatory factor analyses in single samples and measurement invariance testing in a multi-group framework were conducted to test the cross-group equivalence. Findings demonstrate that the SSRPH and the modified model of IASMHS had partial scalar measurement invariance, but the SSOSH showed cultural variance in factor structure. Comparisons of latent means indicated no differences between the two groups with respect to the social stigma attached to professional psychological help, but a higher psychological openness of Chinese students toward help-seeking. Findings are discussed from intercultural and methodological perspectives. In the future, intercultural cooperation should be promoted in order to develop a cross-culturally valid concept of stigma against psychological help that could be used as the basis for intercultural comparison and developing interventions to reduce stigma.

Within historical as well as sociological research a gulf exists between the study of matters of production, marketing and distribution on the one hand and questions of consumption and the use of goods in social practices on the other hand. Developing theoretical frameworks and methodologies that cut across this divide remains an ongoing challenge. This article considers different conceptual frameworks that open up an institutional perspective on the social and economic organization of production and consumption. Offering a close examination, in particular, of the mode of provision-approach through comparison with antecedent perspectives such as Polanyi’s conceptual scheme for studying the substantive economy, this article refines these tools and outlines their possible applications within empirical and historical research.

[Background] The cognitive model of depression was highly stimulating for a better understanding and development of treatment for depression. However, the concept of “cognition” is rather broad and unspecific, and we suggest to focus on the cognitive subset of expectation. [Method] We conducted a narrative review on the role of expectations, and present an expectation-focused model of explaining why depression tends to persist despite the occurrence of positive events. [Results] Several results from basic neuroscience to effects in clinical interventions indicate that expectations play a special role not only for the understanding of the development of mental disorders and the effects of treatment approaches, but especially for an improved understanding of the persistence of mental disorders. If expectations are a major mechanism of depression, the treatment of depression must maximize the violation of dysfunctional expectations. We also introduce the concept of immunization that describes any cognitive or behavioral strategies to reduce the effect of expectation violation experiences, and hereby contributing to expectation maintenance despite expectation contradicting events. We postulate that the development of immunization strategies could help to better understand the transition from episodic to chronic depression. [Conclusion] While in early periods of depression development, a focus on expectation change might be sufficient in treatment, the treatment of patients with chronic depression requires addressing these cognitive and behavioral immunization strategies more intensively. Further implications for treatment and research are outlined that are derived from this balance between expectation violation and cognitive immunization in depression.

Introducing the new journal Clinical Psychology in Europe (CPE). Overcoming artificial barriers by focusing on evidence instead of traditions.Bridging the gap from basic experimental to treatment-related research.Supporting open science recommendations.Covering a broad variety of research efforts.Full open access but no publication fees.

Background The predictive value of coronary artery calcium (CAC) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast‐enhanced images. The primary outcome of 2‐year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56–68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

Deficits in general emotion regulation skills have been shown to be associated with various mental disorders. Thus, general affect-regulation training has been proposed as promising transdiagnostic approach to the treatment of psychopathology. In the present study, we aimed to evaluate the efficacy of a general affect-regulation as a stand-alone, group-based treatment for depression. For this purpose, we randomly assigned 218 individuals who met criteria for major depressive disorder (MDD) to the Affect Regulation Training (ART), to a waitlist control condition (WLC), or to a condition controlling for common factors (CFC). The primary outcome was the course of depressive symptom severity as assessed with the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Multi-level analyses indicated that participation in ART was associated with a greater reduction of depressive symptom severity than was participation in WLC (d = 0.56), whereas the slight superiority of ART over CFC (d = 0.25) was not statistically significant. Mediation analyses indicated that changes in emotion regulation skills mediated the differences between ART/CFC and WLC. Thus, the findings provide evidence for enhancing emotion regulation skills as a common mechanism of change in psychological treatments for depression. The study was registered with ClinicalTrials.gov (NCT01330485) and was supported by grants from the German Research Association (DFG; BE 4510/3-1; HI 456/6-2). Future research should compare the (cost-) efficacy of ART with that of disorder-specific interventions.

Objective: Despite the public health value of vaccines, vaccination uptake rates are stagnating. Expected adverse events following immunization are a major source of concern and play a role in the emergence of vaccine hesitancy. Since nocebo mechanisms are involved in the perception of adverse reactions, positive side-effect communication is warranted. The aim of the present study was to compile a comprehensive communication strategy that minimizes expectations of nocebo effects while respecting the informed consent procedure. Method: In a randomized 2× 2 between-subject design, 652 participants received information about COVID-19 or influenza vaccination using either standard side-effect messaging or messaging enriched with proven elements of expectation-optimizing framing. A physician presented information online via video. Moderation analyses were conducted to examine effects among particular subpopulations. Expected adverse event ratings following an imagined immunization, cost-benefit ratios of the vaccination, and future vaccination intentions were assessed. Results: Information content ratings were equally high in each group. Positive framing significantly decreased adverse event expectations in the COVID-19 information group and raised the cost-benefit ratio in the influenza condition, indicating higher benefits than cost expectations. Moderation analysis revealed that the framed side-effect communication lowered the expected COVID-19 vaccination uptake willingness in individuals with strong anti-vaccination attitudes. Conclusions: Facing the ongoing coronavirus mass vaccinations, positive information frames have a small but significant impact on vaccination concerns while upholding informed consent. Although intervention trials are still pending, this approach could help decrease vaccine hesitancy by reducing fearful expectations. However, it seems that it should not be used without considering vaccination attitudes. [ABSTRACT FROM AUTHOR]

Adenylate kinase catalyses the interconversion of adenosine phosphates, and plays a crucial role in maintaining cellular energy homeostasis. Here, the authors use single molecule optical tweezers to understand how the enzyme’s conformation dynamics modulates catalysis.

Jenny Riecke,1 Sebastian Holzapfel,1 Winfried Rief,1 Harald Lachnit,2 Julia A Glombiewski1 1Department for Clinical Psychology and Psychotherapy, 2Department for Associative Learning, University of Marburg, Marburg, Germany Study design: Cross-cultural translation and psychometric testing. Objective: The purpose of the present study was to examine reliability and validity of a cross-cultural adaption of the German Quebec Back Pain Disability Scale (QBPDS) in a context of a randomized controlled trial evaluating the effectiveness of graded in vivo exposure in chronic low back pain patients. Background: The QBPDS is one of the most widely used disease-specific disability questionnaires. In particular, for cognitive behavioral treatments with a clear focus on behavioral aspects such as graded in vivo exposure, the QBPDS provides an ascertained strategy with a sound conceptual basis and excellent quality criteria. Nevertheless, there is conflicting evidence concerning factor structure and a German adaption is missing. Methods: The cross-cultural adaption followed international guidelines. Psychometric testing was performed using data from 180 participants with chronic low back pain. The psychometric analyses included internal consistency, convergent, and divergent validity. Exploratory factor analysis was used to determine the underlying factor structure. Results: The QBPDS showed strong psychometric properties, with high internal consistency for the full scale (α=0.94) and good convergent and divergent validity. The factor analysis revealed a four-factor solution (bending, ambulation, brief effortful movements, and long-lasting postures). Conclusion: The translation and cross-cultural adaption of the QBPDS into German was successful. The German version proved to be a valid and reliable instrument and is well suited for use in the context of an exposure-based psychological treatment. Keywords: Chronic pain, back pain, questionnaire, functional disability, German, validation