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Radiochromic films are versatile 2D dosimeters with high-resolution and near tissue equivalence. To assure high precision and accuracy, a time-consuming calibration process is required. To improve the time efficiency, a novel calibration method utilizing the ratio of the same dose profile measured at different monitor units (MUs) is introduced and tested in a proton and photon beam.The calibration procedure employs the dose ratio of film measurements of the same relative profile for different absolute dose values. Hence, the ratio of the dose is constant at any point of the profile, but the ratio of the net optical densities is not constant. The key idea of the method is to optimize the calibration function until the ratio of the calculated doses is constant. The proposed method was tested in the dose range between 0.25-12 and 1-6 Gy in a proton and photon beam, respectively. A radial symmetric profile and a rectangular profile were created, both having a central plateau region of about 3 cm diameter and a dose falloff of about 1.5 cm at larger distances. The dose falloff region was used as input for the optimization method and the central plateau region served as dose reference points. Only the plateau region of the highest dose entered the optimization as an additional objective. The measured data were randomly split into differently sized training and test sets. The optimization was repeated 1000 times with random start value initialization using the same start values for the standard and the gradient method. Finally, a proton plan with four dose levels was created, which were separated spatially, to test the possibility of a full calibration within a single measurement.Parameter estimation was possible with as low as one dose ratio used for optimization in both the photon and the proton case, yet exhibiting a high sensitivity on the dose level. The root mean squared deviation (RMSD) of the dose was less than 1% when the dose ratio was in the order of 20, whereas the median RMSD of all optimizations was 1.7%. Using four dose levels for optimization resulted in a median RMSD of 1% when randomly selecting the dose levels. Having at least one dose ratio of about 20 included in the optimization considerably improved the RMSD of the calibration function. Using six or eight dose levels reduced the sensitivity on the dose level selection and the median RMSD was 0.8%. A full calibration was possible in a single measurement having four dose levels in one plan but spatially separated.The number of measurements required to obtain an EBT3 film calibration function could be reduced using the proposed dose ratio method while maintaining the same accuracy as with the standard method.

To evaluate the dosimetric accuracy for small field proton irradiation relevant for pre-clinical in vivo studies using clinical infrastructure and technology. In this context additional beam collimation and range reduction was implemented.The clinical proton beam line employing pencil beam scanning (PBS) was adapted for the irradiation of small fields at shallow depths. Cylindrical collimators with apertures of 15, 12, 7 and 5mm as well as two different range shifter types, placed at different distances relative to the target, were tested: a bolus range shifter (BRS) attached to the collimator and a clinical nozzle mounted range shifter (CRS) placed at a distance of 72cm from the collimator. The Monte Carlo (MC) based dose calculation engine implemented in the clinical treatment planning system (TPS) was commissioned for these two additional hardware components. The study was conducted with a phantom and cylindrical target sizes between 2 and 25mm in diameter following a dosimetric end-to-end test concept.The setup with the CRS provided a uniform dose distribution across the target. An agreement of better than5% between the planned dose and the measurements was obtained for a target with 3mm diameter (collimator 5mm). A 2mm difference between the collimator and the target diameter (target being 2 mm smaller than the collimator) sufficed to cover the whole target with the planned dose in the setup with CRS. Using the BRS setup (target 8mm, collimator 12mm) resulted in non-homogeneous dose distributions, with a dose discrepancy of up to 10% between the planned and measured doses.The clinical proton infrastructure with adequate beam line adaptations and a state-of-the-art TPS based on MC dose calculations enables small animal irradiations with a high dosimetric precision and accuracy for target sizes down to 3mm.

Open access funding provided by University of Bern. The SEYLE project is supported by the European Union through the Seventh Framework Program (FP7), Grant agreement number HEALTH-F2-2009-223091. At the time of submission, N. S. was funded by the Swiss National Science Foundation (SNSF) Early Postdoc Mobility fellowship (Grant number: P2BEP3_181901)., Kaess, M., Schnyder, N., Michel, C., Brunner, R., Carli, V., Sarchiapone, M., Hoven, C.W., Wasserman, C., Apter, A., Balazs, J., Bobes, J., Cosman, D., Haring, C., Kahn, J.-P., Keeley, H., Kereszteny, A., Podlogar, T., Postuvan, V., Varnik, A., Resch, F., Wasserman, D.

Early life maltreatment can have severe and long-lasting consequences for the directly affected individual as well as for the next generation. Data from our research including mother-child dyads from Heidelberg and Berlin show that early life maltreatment is associated with behavioral and neural changes including personality traits and attachment style of the affected mothers that negatively affect their relationship with their child. The children of these mothers affected by early life maltreatment have an elevated risk to be maltreated and to develop mental disorders. They also show a heightened cortisol concentration and a reduced inhibition control. It seems to be of importance whether the mother has experienced early life maltreatment but is resilient, meaning that she has not developed a mental disorder (up to the time of examination) or whether in addition to the early life maltreatment she has developed a mental disorder later in life. Children of mothers with early life maltreatment and a lifetime mental disorder seem to be especially exposed to stress and show the greatest impairments and risks. Based on the existing data from our research practical and clinical implications are discussed and one possible intervention in the form of a training of mentalization competencies for parents is presented.

Oxygen ([Formula: see text]) ions are a potential alternative to carbon ions in ion beam therapy. Their enhanced linear energy transfer indicates a higher relative biological effectiveness and a reduced oxygen enhancement ratio. Due to the limited availability of [Formula: see text] ion beams, Monte Carlo (MC) transport codes are important research tools for investigating their potential. The purpose of this study was to validate GATE/Geant4 for [Formula: see text] ion beam therapy using experimental data from literature. Five hadron physics lists and two electromagnetic options were benchmarked against measured depth dose distributions (DDDs) and charge-changing cross sections. The simulated beam ranges deviated by less than 0.5% for all physics configurations and only a few points exceeded the gamma index criterion (2%/1 mm). However, the simulated partial charge-changing cross sections deviated considerably for some hadron physics configurations. Best agreement with the experimental values was obtained with the quantum molecular dynamics model (QMD), and we therefore suggest using this model in Geant4 to accurately describe the fragmentation of [Formula: see text] ion beams into lighter fragments ([Formula: see text]).

Background Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. Methods All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. Results International medical students scored significantly poorer than their local peers (p

The size distribution characteristics of the Saharan dust that is transported and deposited over many countries in the West African atmospheric environment (5°N) during the months of November to March, known locally as the Harmattan, have been determined over a 9-year period between 1996 and 2005, using a location in central Ghana (6° 40′N, 1° 34′W) as the reference geographical point. The particle size distributions and concentrations are discussed. Within the particle size range measured, the average inter-annual mass concentrations during the winter months ranged from 140 μg m − 3 to 1200 μg m − 3 while the average number concentrations varied between 24 cm − 3 and 63 cm − 3 . The measured particle concentrations outside the winter period were consistently less than 10 cm − 3 . The ground-based particle measuring equipment used did not provide for distinguishing the smoke fraction (due to bush fires and biomass burning) from the Saharan dust. These values therefore correspond to the total dust loads. The size range covered by the particle counter was 0.5 μm–25 μm. In spite of the strong daily and inter-annual variations in particle concentration, the overall dust mean particle diameter over the 9-year period was found to be 1.5 μm. The particle size distributions exhibited the typical distribution pattern for atmospheric aerosols with a coarse mode diameter situated at about 3.5 μm. The control exerted on the dust incursions and the particle concentrations by both the Inter-Tropical Convergence Zone (ITCZ) and the North Atlantic Oscillation (NAO) are highlighted. The experimental results reported in this study will be of value in validating satellite based observations and simulation models of the African dust plume during winter.

Einleitung: Die „Internetspielstorung“ wurde im Mai 2013 in die Sektion 3 des „Diagnostic and Statistical Manual of Mental Disorders“ (DSM-5) als Forschungsdiagnose aufgenommen. Andere pathologisch ausgeubte Internetaktivitaten wurden aufgrund von unzureichender Evidenz nicht berucksichtigt. Die vorliegenden Studien untersuchten komorbide Psychopathologie als Pradiktoren der Pathologischen Internetnutzung im Quer- und Langsschnitt. Methoden: Es wurden zwei europaische, reprasentative, longitudinale Studien mit identischem Studiendesign im Abstand von 3 Jahren durchgefuhrt, die beide von der Europaischen Union gefordert wurden. Die europaische Kohorte der SEYLE-Studie („Saving and Empowering Young Lives in Europe”) schloss 11956 Jugendliche mit einem mittleren Alter von 14,9 Jahren ein, die europaische WE-STAY-Kohorte („Working in Europe to Stop Truancy Among Youth) 8807 Jugendliche mit einem mittleren Alter von 15 Jahren. Die deutsche SEYLE-Kohorte wurde uber 2 Jahre prospektiv nachverfolgt. Ergebnisse: Pravalenz des Pathologischen Internetgebrauchs hat im Zeitraum von Oktober 2009 bis Oktober 2011 von 4,4% (SEYLE-Studie) auf 6,7% (WE-STAY-Studie) zugenommen. In den Querschnittsuntersuchungen bestand in beiden Studien ein signifikanter Zusammenhang von emotionalen Storungen, ADHS-Symptomen, Storungen des Sozialverhaltens und selbstschadigendem Verhalten mit dem Pathologischen Internetgebrauch. Prospektiv sagten zusatzlich zum fruheren Pathologischen Internetgebrauch noch emotionale Storungen einen spateren Pathologischen Internetgebrauch vorher. Diskussion: Emotionale Probleme und Pathologischer Internetgebrauch scheinen zu einem aufrechterhaltenden Teufelskreis bei Pathologischem Internetgebrauch beizutragen. Gefahrdete Jugendliche sollten fruhzeitig identifiziert werden, um individualisierte Interventionen initialisieren zu konnen.

A detailed analysis is made of some typical strong wind situations near the French Mediterranean coast. Special attention has been paid to the wind from the north-northwest in the Gulf of Lion, also called the mistral. The analysis is made from both the synoptic and mesoscale point of view with the aid of numerical simulations carried out with the Regional Atmospheric Modeling System (RAMS) to study the main atmospheric, climatic, and meteorological characteristics of this wind in the Gulf of Lion. Simulations were made with this model during the periods of 20–22 March and 24–26 March 1998. Afterward, a comparison was made with the meteorological measurements collected during the international Flux, Etat de la Mer et Teledetection en Condition de Fetch Variable (FETCH) campaign (Gulf of Lion, March–April 1998). The comparison between the simulated wind fields and the values measured by the coastal meteorological stations, an oceanographic buoy, and the ship Atalante at sea help to give full under...

This investigation aimed to evaluate the German version of the BPQ as a screening instrument for borderline personality disorder (BPD) in a clinical sample. Furthermore, an association between self-esteem and BPD was examined. In a consecutive modus, 27 patients with BPD and 54 clinical controls (age range: 14 - 25 years) completed a self-report questionnaire and took part in a semi-structured interview. The German version of the BPQ revealed a high internal consistency (α = 0.95) and test-retest-reliability (r = 0.94). The criterion validity (r = 0.60) and the cut-off value (49) must be interpreted with caution due to the small sample size. BPD as well as 8 out of 9 subscales of the BPQ were significantly associated with lower self-esteem. A pre-screening using the BPQ within the clinical setting may facilitate early detection of BPD. In addition, building up self-esteem seems to be very important in the treatment of patients with BPD.

This paper presents the behaviour of aerosol size distributions and number concentrations with respect to specific meteorological conditions, deduced from experiments conducted over a period of 3 yr, in the Mediterranean coastal zone. Specific meteorological conditions, “East” wind and “Mistral” wind lead to specific size distributions and total number concentrations. In an “East” wind situation (steady winds, weak sunniness, high humidity), the size distributions are characterized by only accumulation and coarse particle modes. “Mistral” wind situations (gusty winds, strong sunniness, low humidity), lead to greater concentrations and the corresponding size distributions are often characterized by an Aitken peak but no accumulation peak. After a specific time-lag which depends on the particle size and meteorological conditions, the concentrations of coarse particles are well correlated with the wind velocity. In case of high “Mistral” winds, particles in the Aitken range and the wind velocity also are well correlated. It seems likely that the wind, by bursting small bubbles at the sea-air interface, is the major generation mechanism for these particles.

Three methods for prevention of perioperative spasm of the internal mammary artery were compared in 78 patients undergoing coronary artery bypass grafting. In group 1, internal mammary artery pedicles were divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (1.5 mg/ml). In group 2, as in group 1 but before clamping, 2 ml of heparinized blood with 1.5 mg/ml papaverine added was injected into the vessel lumen. In group 3 treatment was as in group 2, but heparinized blood with papaverine was injected a second time just before extracorporeal bypass was begun. In a univariate analysis free flow from dilated internal mammary arteries was not significantly different among the groups (group 1, 58 ml/min; group 2, 82 ml/min; group 3, 68 ml/min; p < 0.1). When free flow from dilated internal mammary arteries was the dependent variable in a regression analysis, the use of intraluminal papaverine, high blood pressure during flow measurement, and high initial blood flow were predictors of high flow (all p < 0.01). Morphometric measurements on the resected distal portion of the dilated internal mammary arteries disclosed less folding of the internal elastic lamina and a larger luminal area in groups 2 and 3 compared with respective findings in group 1 (1.21 mm2 and 1.42mm2 versus 0.77 mm2; p < 0.02). Mechanical vessel wall injury occurred in 8 of 52 internal mammary arteries treated with intraluminal papaverine. Intraluminal papaverine solution injected once or twice in addition to external papaverine exposure therefore provides a better blood flow rate and distal dilation than mere submersion in papaverine solution, but at a considerable risk of mechanical wall injury. (J THORAC CARDIOVASC SURG 1995;110: 697-703)

The synthesis of a series of tricyclic quinoxalines is described. These compounds exhibit good affinity for both the strychnine-insensitive glycine site of the NMDA receptor and the AMPA receptor.

The design and synthesis of a bifunctional reagent, 1 , is described. This compound binds to beta-pleated sheet protein structures, while providing a complexation site for ferrous ion. These immobilized ions may be used to generate reactive, diffusible chemical species at or near the protein surface.

The first results of three campaigns of measurements of marine and atmospheric aerosols realised on the Mediterranean coast are presented. The data obtained by two particle counters and the chemical analysis of the aerosols are studied in relation to meteorological data. The number of particles collected and their chemical composition are linked to the direction and the speed of the wind.

Am 1.10.2003 trat die neue deutsche Approbationsordnung fur Arzte (AAppO) in Kraft. Das klinische Lehrangebot sollte dabei in 22 Fachern, 12 Querschnittsbereichen und 5 Blockpraktika angeboten werden. Bereits 1998 begann die medizinische Fakultat der Universitat Heidelberg das medizinische Curriculum starker praktisch und interdisziplinar auszurichten. Dieses neue Curriculum erhielt den Namen HeiCuMed (Heidelberger Curriculum Medicinale). Planung und Organisation von HeiCuMed erfolgte in Kooperation mit verschiedenen universitaren und auswartigen Partnern. Dieser Artikel befasst sich mit der Umsetzung der neuen AAppO in HeiCuMed. Dabei wird auch dargestellt, inwiefern in der Literatur beschriebene Prinzipien erfolgreicher Curriculumsreform im Reformprozess beachtet wurden. 09.12.2008 | Soren Huwendiek, M. Kadmon, J. Junger, M. Kirschfink, H.M. Bosse & F. Resch

Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylphenidate preparation (Medikinet retard, MPH-MR), with equal portions of the immediate-release and the sustained-release active substance, and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology.Eighty five children and adolescents (6-16 years) were investigated in a double-blind, randomized, clinical trial over 5 weeks under a treatment with MPH-MR using symptom checklists for ADHD, oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).A total of 64.9% of the children showed oppositional defiant disorder/conduct disorder (ODD/CD) symptoms. A statistically significant effect was found in the group treated with MPH (verum-group). On the basis of Cohen's criteria, high effects were found for aggressive symptoms in school (d = 1.0), but not in the afternoon (d = 0.4). There were also lower effect sizes for more severe aggressive symptoms. We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention.Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior, especially concerning milder symptoms. The expected correlation between impulsivity and aggressiveness could be confirmed.

Recent evidence from epidemiological studies suggests that the prevalence of eating disorders is rising in adolescents and the age of onset has fallen. An average prevalence rate for anorexia nervosa of 0.5% and for bulimia nervosa of 0.5% was found for teenaged girls. For both disorders the highest incidence was found in females aged 10-19 years. Disordered eating attitudes and behaviors are common in a substantial proportion of adolescents and are associated with an increased risk of the manifestation of a full disorder or other forms of emotional or behavior problems (depression, anxiety, substance abuse, suicidal behavior). For both disorders a complex multifactorial aetiology has been postulated, involving the interaction of genetic predisposition and certain specific environmental risk factors, particularly social factors. Next to other comorbid psychiatric conditions medical complications resulting from semistarvation and purging often require an inpatient treatment. The multimodal therapeutic approach focus on controlled weight restoration in combination of specific psychoeducational and psychotherapeutic methods involving the patients and their families.

The mental structure provides every human with a potential repertoire of behavior. In every interaction a reactivation of past actualization- and representation processes concerning the particular prevailing context takes place. A child's mental structure should not be devaluated in comparison to a structure of an adult person. Levels of functioning depend on the developmental age. Structural dispositions consist of represented experiences of interaction. The so-called affect attenuement plays an important part in individual affect regulation. If the structural representation follows mechanisms of memory, procedural structural dispositions may be postulated, which affect the behavior besides iconic and symbolic representations. Within the structure affect dispositions are integrated. They are able to give value to certain contents of experience and reexperience. Disorders in the development of empathy are connected with impairments of the structural development. By inherent faintness of the regulation of affects or by sensitization and traumatization processes, which involve dissociative phenomena, the affective load of representations can be changed. This may result in structural deficits.

The present study focuses on the possibilities and effects of training dyslexic children in tone and phoneme discrimination tasks.A computer program was developed to train dyslexic children to discriminate between tone and speech stimuli. The correlation between auditory discrimination and reading and orthography performance was then tested in a preliminary study of n = 63 children. In a prospective study 44 children were assigned to one of three paralyzed groups: tone training, phoneme training or a control group. Upon completion of the initial diagnostics for all groups, the two training groups received four weeks of discrimination training, after which all three groups were immediately re-tested for the first time. Parallel thereto all children underwent specific training in reading and orthography at their school. Six months later all were re-tested a second time.Both test methods showed a high reliability (rn = .94; .95). Significant correlations between auditory discrimination and reading and orthography performance were confirmed. Auditory discrimination was significantly trainable. Specific training effects, as well as independent developmental effects were found. While the training effects of phoneme discrimination were stable over six months, those of tone discrimination were not.The central auditory discrimination between tone and phoneme stimuli can be trained successfully in dyslexic children and might also affect their reading and orthography performance.

Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stress management, etc.) as well as medication can be applied for prophylaxis. Minimal therapeutic interventions have been shown to be equally effective in a remarkable number of patients. Chronic Headache shows relevant comorbidity with anxiety and depression and is associated with somatization and school disorders. A careful investigation and an adequate therapy of eventual psychiatric comorbidity is therefore strongly recommended.

The purpose of this review is to analyse nature, degree and consequences of attentional biases in patients with borderline personality disorder based on existing literature. The clinical importance of these phenomena in patients with borderline personality disorder is strengthened and the link between theoretical models, empirical findings and therapeutic interventions is elaborated. This link between selective attention and borderline personality disorder is demonstrated on the basis of studies, which indicate a context between borderline pathology, affective disorders, anxiety disorders, and attention-deficit/hyperactivity disorders and also give evidence to neuropsychological deficits in patients with borderline personality disorder. The present article comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimuli in connection with deficits regarding affect regulation. The cognitive approach assumes that rigid dysfunctional schemata initiate a cognitive-emotional circuit, which leads to a reinforcement of the symptomatology as a result of a biased perception and memory. Additionally the present article specifies the trauma approach which emphasizes the relation between borderline pathology and childhood trauma with recourse to theories of attentional biases in patients with traumatic experiences. Preliminary empiricial findings suggest that patients with borderline personality disorder demonstrate a general attentional bias for any emotional negative stimuli and not a selective attentional bias to borderline-specific stimuli. Further studies should clarify, whether therapeutical interventions with the aim to influence attentional processes represent a useful complement to established therapies in patients with borderline personality disorder.

Der Begriff Pubertat kennzeichnet die biologischen Reifungsschritte, die den Ubergang vom Kind zum Erwachsenen bewirken. Diese vielfaltigen biologischen Veranderungen werden auch von einer Reihe psychosozialer Problemstellungen und Wandlungsschritte begleitet, die den Menschen als Subjekt und Gemeinschaftswesen in die Erwachsenenwelt einfuhren. Dafur hat sich der Begriff Adoleszenz durchgesetzt. Der Jugendliche befindet sich an einem Ubergang mit allen Risiken und Chancen, die solche tiefgreifenden Veranderungen korperlicher Attribute, Veranderungen von Denkstilen, Meinungen und Haltungen, Veranderungen des Selbstbezugs und Veranderungen sozialer Rollen und Verantwortlichkeiten mit sich bringen (Resch und Koch, 1995). Mit dem Eintritt in diese Entwicklungsphase besteht auch die erhohte Gefahrdung, eine psychische Storung aus dem grosen Spektrum der adulten Krankheitsbilder selbst zu entwickeln. Risikoverhaltensweisen, Entwicklungskrisen und jugendliche Anpassungsprobleme konnen dabei eine Rolle spielen, wobei das Zusammenspiel einzelner Faktoren im folgenden naher beleuchtet werden soll.

This paper presents first results of a research project aimed at improving co-operative work initiatives in hospitals. A holistic analysis of the treatment process is presented as a precondition for process reengineering, quality measurements and improvement of multi-professional co-operation. Treatment process modelling attempts within the last years have concentrated on specialised points of views, such as business process modelling or communication modelling. In contrast, we have developed a framework consisting of several views of the treatment process. We tested our framework in a broad system analysis within the Department of Child and Adolescent Psychiatry of the Heidelberg University Hospitals. Our preliminary results support the framework. Weaknesses were described precisely in both the field of organisational procedures and information management.

We would like to introduce several aspects of the analysis and modeling of the treatment process characterizing the cooperation within multi-professional treatment teams. We will determine what is meant by a treatment process in order to then look at five views and four levels of their description. We will introduce possible methods for surveying and describing it. Currently an extensive analysis of the current state of the treatment process and of the weaknesses is underway in the Department of Child and Adolescent Psychiatry of the Heidelberg University Medical Center.

An attempt to define "psychic structure" leads to the conclusion, that "structure" provides adaptive behavioral strategies for the interaction of the person with a physical and social world by representing experiences of earlier interactions in memory processes. Compatibility of different definitions of "structure" in psychopathology and psychoanalysis is being discussed. Developmental aspects of a "theory of mind" in children and of different modes of representation have to be addressed. A "multiple code theory" of W. Bucci is introduced. Conclusions for diagnosis and therapy in psychodynamic approaches will be drawn. It has to be faced, that children represent optimal structures in each level of psychic development, noting the importance of age-relevant normative measures.

Quality management for screening programmes of preschool children is a valuable tool to manage the process of investigation, data computing and evaluation of data and its systemic biases. As an example the quality of structure and processing of the system was evaluated for selected criteria in order to prove plausibility. Results identify computing process as a main criterion for quality management since it includes individuality of the investigator as well as the several factors due to the setting of investigation process (time, premises, computing, plausibility and individual factors). As a main influencing factor could be identified the time-span for investigation and commitment of the investigator. Selected training facilities for the investigators could improve quality and commitment and are qualified as an instrument for quality protection.

276 treatment records of patients who were undergoing high-frequent, outpatient, individual, psychoanalytic therapy were analysed with respect to the prevalence and patterns of childhood sexual abuse in the history of these patients. 22.8% of all patients experienced narrowly defined sexual abuse during childhood (the end of the 17th year); additionally, 35.2% of all patients reported minor forms of sexually abusive experiences. The gender distribution, the age at onset of sexual abuse, and the relationship to the perpetrator were analysed. Looking at psychoanalytic diagnoses, a significant correlation between a history of childhood sexual abuse and a diagnosis of hysterical neurosis was found.

The provisional trial was carried out in a sample of 133 second- and 139 fourth-graders from the Heidelberg area. The HD-LT was subjected to an item selection, test criteria were ascertained and temporary percentile norms for the second and fourth grades were established. High item difficulty resulted for both grades, i.e. the test was relatively easy. Test criteria were generally satisfactory. Significant correlations were found in both grades between the HD-LT and the children's spelling ability. The HD-LT accounted for 30% of the spelling variance among second-graders as compared to 10% of that among fourth-graders. This reflects the specific significance of phonetic discrimination ability in the first years of elementary school. Children with spelling difficulties were compared to those with good spelling abilities in respect to their ability to discriminate sound. Spelling-impaired children in both grades exhibited a significantly lower overall HD-LT score. No significant sex differences were found with regard to the auditory and kinesthetic phonetic discrimination ability. Since the HD-LT turns out to be well-suited to indicate a phonetic discrimination disability during the initial phases of acquisition of written language, its further development and extension of its application to the pre-school level are recommended.

In the inpatient treatment of acute psychiatric episodes in children and adolescents, the psychiatrist must set up an initial treatment plan incorporating one or more psychotherapeutic modalities and adapt this plan to the patient's clinical course. This article summarises the clinical experience of a model unit at the University of Heidelberg, the result of a collaboration between the Department of General Psychiatry and the Department of Child and Adolescent Psychiatry at the Clinic of Psychiatry. A series of 116 adolescent admissions was reviewed for clinical diagnosis, the nature and frequency of psychotherapeutic modalities, and the role of family involvement in patient care. Differential and adaptative approaches to the selection of treatment modalities in the context of an acute care setting are emphasised.

Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high level of psychic organisation in all developmental stages. Reports of the ongoing work are being given.

With reference to an epidemiological sample of adolescents and young adults the impact of different models on the number of children classified as having specific spelling problems is investigated.Using the same set of data, the effect of alternative definitions and methodological procedures on the prevalence of specific spelling retardation is shown. The virtual consequences of various norm-orientated definitions of cases is discussed with reference to external empirical criteria.Particularly, obsolete norms lead to a large overestimation of cases. In the present study case definitions of specific spelling retardation based on substantial criteria result in prevalence rates between 6 and 9 percent. Academic achievement is considerably affected by persisting specific spelling problems and the attendance of secondary schools is rare, in spite of sufficient nonverbal intelligence.Because of the high impact of spelling ability for educational success, dyslexic children need help by early intervention. Furthermore scholastic promotion is necessary to enable a school carer appropriate to the intellectual possibilities of the child.

The sense of shame seems to vanish for more than a decade now, manifested e.g. by an increasing tolerance toward the naked female body. However, it is supposed that shame has still its significance especially during female puberty. Psychological considerations referring to shame and to the puberty of girls are reported and the significance of feeling ashamed in this salient segment of female development is delineated. Finally a concept is proposed within which the feeling of shame is understood as a possibility to create accordance between the positive aspects of being ashamed and the tendency of going beyond the borders of shame usually guaranteed by social rules.

Handedness and cognitive abilities in a representative sample of adolescents and young adults. The relationship between laterality and cognitive ability was examined in a representative sample of adolescents and young adults between 16 and 30 years of age. The study was designed as a possible replication of Annett's data supporting her right-shift theory (rst), but included other measures of laterality as well. We found, as Annett did, that strong right-handedness was associated with a weak left hand rather than a strong right hand. However, we could not confirm two other predictions of the rst with our data: The nonverbal IQ was significantly lower in both extreme groups of handedness than in the two middle groups. Because of the sample size this rather small effect, explaining only 1.9% of the variance, is significant, but it disappears with other kinds of grouping for handedness. We could not find the linear decline in nonverbal IQ from the left to the right extreme of handedness as predicted by the rst. In spelling, too, there was a rather small, but significant effect of handedness, explaining 2.4% of the variance. Spelling in the first (left most) quartile of handedness was worse than in quartiles two and four. The predicted poorer spelling in the extreme groups than in the middle groups (inverted U) was not found in our sample. In multivariate analysis with variables explaining larger proportions of the variance in spelling (education, nonverbal IQ and sex) the small effect of handedness on spelling completely disappeared. A weak relationship between left-handedness and dyslexia was evident only with the strictest definition of dyslexia, regardless of how handedness was defined. The implications of these data for the rst are discussed.

Inspiratory muscle weakness has been demonstrated in ambulatory, stable chronic heart failure (CHF) and may contribute to dyspnea during daily living. However, the mechanisms underlying this weakness are unknown. Malnutrition and electrolyte depletion are recognized complications of CHF that may impair skeletal muscle function, and limb muscle weakness and myopathic changes have also been demonstrated in CHF. We examined whether nutrition and electrolyte status contribute to the reduced skeletal muscle strength and whether inspiratory muscle weakness in CHF is part of general skeletal muscle weakness. We measured maximum inspiratory and expiratory mouth pressures as indices of respiratory muscle strength, maximum hand-grip strength as an index of limb muscle strength, anthropometric indices, serum albumin, and total lymphocyte count as indices of nutritional status, and serum electrolytes in 15 stable patients with chronic cardiac pump failure who had no evidence of primary lung disease, and in 15 age-and-sex-matched healthy controls. As compared with the matched controls, the CHF patients had reduced inspiratory muscle strength (p < 0.0025), but their expiratory and limb muscle strength were not significantly reduced. CHF patients were not malnourished; they were heavier than matched controls because of increased body fat (p < 0.05). Serum sodium was significantly lower in the CHF patients than in the controls (p < 0.01), but was within the normal range in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)