Pediatric computed tomography doses in Germany from 2016 to 2018 based on large-scale data collection.

PURPOSE: Accumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice. METHOD: Dosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS). RESULTS: We collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey. CONCLUSIONS: Directly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable.

Fate of trace organic compounds in the hyporheic zone: Influence of microbial metabolism.

The hyporheic zone (HZ) is considered a hydrodynamically-driven bioreactor with significant pollutant removal capacities and can therefore not only improve wholestream water quality but also preserve human and ecosystem health. Microbial metabolism is hypothesized to play a key role in pollutant transformation in hyporheic sediments of natural streams. However, previous work investigating the influence of microbial metabolism on pollutant transformation has been predominantly laboratory studies. The key challenge for field studies is the appropriate determination of net microbial metabolism, i.e. information on the actual exposure times to specific microbial processes in the investigated system. The present study uses reactive fluorescent tracers to determine microbial metabolism and ultimately its influence on pollutant transformation, e.g. for trace organic compounds, in hyporheic sediments under natural conditions. In particular, the reactive fluorescent tracers resazurin and its main transformation product resorufin were used to determine the microbial metabolism of facultative or obligate aerobes. The influence of the derived microbial metabolism on the transformation of 20 trace organic compounds, such as pharmaceuticals, including 3 parent-daughter pairs, was examined. The present findings validate laboratory results on the microbially-mediated transformation of the anticonvulsant gabapentin to its main transformation product gabapentin lactam under natural conditions. All other TrOCs investigated did not show a clear link between TrOC reactivity to the microbial metabolism informed by the resazurin-resorufin-system. Overall, the present study not only demonstrates the use of the fluorescent tracer-system resazurin and resorufin for determining microbial metabolism of facultative or obligate aerobes but also generally highlights the potential of reactive fluorescent tracers to disentangle specific reactive properties and ultimately their influence on the fate of pollutants in natural HZs.

Using Bayesian Belief Networks to Investigate Farmer Behavior and Policy Interventions for Improved Nitrogen Management.

Increasing farmers' adoption of sustainable nitrogen management practices is crucial for improving water quality. Yet, research to date provides ambiguous results about the most important farmer-level drivers of adoption, leaving high levels of uncertainty as to how to design policy interventions that are effective in motivating adoption. Among others, farmers' engagement in outreach or educational events is considered a promising leverage point for policy measures. This paper applies a Bayesian belief network (BBN) approach to explore the importance of drivers thought to influence adoption, run policy experiments to test the efficacy of different engagement-related interventions on increasing adoption rates, and evaluate heterogeneity of the effect of the interventions across different practices and different types of farms. The underlying data comes from a survey carried out in 2018 among farmers in the Central Valley in California. The analyses identify farm characteristics and income consistently as the most important drivers of adoption across management practices. The effect of policy measures strongly differs according to the nitrogen management practice. Innovative farmers respond better to engagement-related policy measures than more traditional farmers. Farmers with small farms show more potential for increasing engagement through policy measures than farmers with larger farms. Bayesian belief networks, in contrast to linear analysis methods, always account for the complex structure of the farm system with interdependencies among the drivers and allow for explicit predictions in new situations and various kinds of heterogeneity analyses. A methodological development is made by introducing a new validation measure for BBNs used for prediction.

Handling of Incidents in the Clinical Application of Ionizing Radiation in Diagnostic and Interventional Radiology - a Multi-center Study. / Umgang mit unbeabsichtigten Expositionen bei medizinischen Anwendungen ionisierender Strahlung in der Röntgendiagnostik und interventionellen Radiologie ­ eine Multi-Center-Studie.

PURPOSE: According to the German legislation and regulation of radiation protection, i. e. Strahlenschutzgesetz und Strahlenschutzverordnung (StrlSchG and StrlSchV), which came into force on 31st December 2018, significant unintended or accidential exposures have to be reported to the competent authority. Furthermore, facilities have to implement measures to prevent and to recognize unintended or accidental exposures as well as to reduce their consequences. We developed a process to register incidents and tested its application in the framework of a multi-center-study. MATERIALS AND METHODS: Over a period of 12 months, 16 institutions for x-ray diagnostics and interventions, documented their incidents. Documentation of the incidents was conducted using the software CIRSrad, which was developed, released for testing purposes and implemented in the frame of the study. Reporting criteria of the project were selected to be more sensitive compared to the legal criteria specifying "significant incidents". Reported incidents were evaluated after four, eight, and twelve months. Finally, all participating institutions were interviewed on their experience with the software and the correlated effort. RESULTS: The rate of reported incidents varied between institutions as well as between modalities. The majority of incidents were reported in conventional x-ray imaging, followed by computed tomography and therapeutic interventions. Incidents were attributed to several different causes, amongst others to the technical setup and patient positioning (19 %) and patient movement or insufficient cooperativeness of the patient (18 %). Most incidents were below corresponding thresholds stated in StrlSchV. The workload for documenting the incidents was rated as appropriate. CONCLUSION: It is possible to monitor and handle incidents complient with legal requirements with an acceptable effort. The number of reported incidents can be increased by frequent trainings on the detection and the processing workflow, on the software and legal regulation as well as by a transparent error handling within the institution. KEY POINTS: · The software CIRSrad was developed to enable the present study and as prototype platform for a future radiological incident management system.. · 586 exceedances of thresholds were recorded by 16 facilities in a period of one year.. · Frequent trainings of all users increase the number of reported cases.. CITATION FORMAT: · Müller BS, Singer J, Stamm G et al. Handling of Incidents in the Clinical Application of Ionizing Radiation in Diagnostic and Interventional Radiology - a Multi-center Study. Fortschr Röntgenstr 2022; 194: 400 - 408.

Informal risk-sharing between smallholders may be threatened by formal insurance: Lessons from a stylized agent-based model.

Microinsurance is promoted as a valuable instrument for low-income households to buffer financial losses due to health or climate-related risks. However, apart from direct positive effects, such formal insurance schemes can have unintended side effects when insured households lower their contribution to traditional informal arrangements where risk is shared through private monetary support. Using a stylized agent-based model, we assess impacts of microinsurance on the resilience of those smallholders in a social network who cannot afford this financial instrument. We explicitly include the decision behavior regarding informal transfers. We find that the introduction of formal insurance can have negative side effects even if insured households are willing to contribute to informal risk arrangements. However, when many households are simultaneously affected by a shock, e.g. by droughts or floods, formal insurance is a valuable addition to informal risk-sharing. By explicitly taking into account long-term effects of short-term transfer decisions, our study allows to complement existing empirical research. The model results underline that new insurance programs have to be developed in close alignment with established risk-coping instruments. Only then can they be effective without weakening functioning aspects of informal risk management, which could lead to increased poverty.

The dosimetric impact of stabilizing spinal implants in radiotherapy treatment planning with protons and photons: standard titanium alloy vs. radiolucent carbon-fiber-reinforced PEEK systems.

BACKGROUND: Throughout the last years, carbon-fibre-reinforced PEEK (CFP) pedicle screw systems were introduced to replace standard titanium alloy (Ti) implants for spinal instrumentation, promising improved radiotherapy (RT) treatment planning accuracy. We compared the dosimetric impact of both implants for intensity modulated proton (IMPT) and volumetric arc photon therapy (VMAT), with the focus on uncertainties in Hounsfield unit assignment of titanium alloy. METHODS: Retrospective planning was performed on CT data of five patients with Ti and five with CFP implants. Carbon-fibre-reinforced PEEK systems comprised radiolucent pedicle screws with thin titanium-coated regions and titanium tulips. For each patient, one IMPT and one VMAT plan were generated with a nominal relative stopping power (SP) (IMPT) and electron density (ρ) (VMAT) and recalculated onto the identical CT with increased and decreased SP or ρ by ±6% for the titanium components. RESULTS: Recalculated VMAT dose distributions hardly deviated from the nominal plans for both screw types. IMPT plans resulted in more heterogeneous target coverage, measured by the standard deviation σ inside the target, which increased on average by 7.6 ± 2.3% (Ti) vs 3.4 ± 1.2% (CFP). Larger SPs lead to lower target minimum doses, lower SPs to higher dose maxima, with a more pronounced effect for Ti screws. CONCLUSIONS: While VMAT plans showed no relevant difference in dosimetric quality between both screw types, IMPT plans demonstrated the benefit of CFP screws through a smaller dosimetric impact of CT-value uncertainties compared to Ti. Reducing metal components in implants will therefore improve dose calculation accuracy and lower the risk for tumor underdosage.

Endogenous Wnt/ß-catenin signaling in Müller cells protects retinal ganglion cells from excitotoxic damage.

Purpose: To analyze whether activation of endogenous wingless (Wnt)/ß-catenin signaling in Müller cells is involved in protection of retinal ganglion cells (RGCs) following excitotoxic damage. Methods: Transgenic mice with a tamoxifen-dependent ß-catenin deficiency in Müller cells were injected with N-methyl-D-aspartate (NMDA) into the vitreous cavity of one eye to induce excitotoxic damage of the RGCs, while the contralateral eye received PBS only. Retinal damage was quantified by counting the total number of RGC axons in cross sections of optic nerves and measuring the thickness of the retinal layers on meridional sections. Then, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay was performed to identify apoptotic cells in retinas of both genotypes. Western blot analyses to assess the level of retinal ß-catenin and real-time RT-PCR to quantify the retinal expression of neuroprotective factors were performed. Results: Following NMDA injection of wild-type mice, a statistically significant increase in retinal ß-catenin protein levels was observed compared to PBS-injected controls, an effect that was blocked in mice with a Müller cell-specific ß-catenin deficiency. Furthermore, in mice with a ß-catenin deficiency in Müller cells, NMDA injection led to a statistically significant decrease in RGC axons as well as a substantial increase in TUNEL-positive cells in the RGC layer compared to the NMDA-treated controls. Moreover, in the retinas of the control mice a NMDA-mediated statistically significant induction of leukemia inhibitory factor (Lif) mRNA was detected, an effect that was substantially reduced in mice with a ß-catenin deficiency in Müller cells. Conclusions: Endogenous Wnt/ß-catenin signaling in Müller cells protects RGCs against excitotoxic damage, an effect that is most likely mediated via the induction of neuroprotective factors, such as Lif.

Spatiotemporal dynamics of ecosystem services provision in a degraded ecosystem: A systematic assessment in the Lake Urmia basin, Iran.

Lake Urmia has experienced severe environmental degradation, mainly characterized by the enormous reduction of its surface area and water level. This issue has been mainly attributed to land-use and land-cover changes, in particular related to agricultural expansion and intensification. In this study, we used the DPSIR framework (D: driving forces, P: pressures, S: states, I: impacts, and R: responses) to systematically describe the ecosystem service dynamics related to anthropogenic activities and climatic parameters in the region. We reviewed the literature and used remote sensing, agricultural, climatic and hydrological data together with expert knowledge to assess the main driving forces and pressures, resulting land-use transitions and their spatiotemporal impacts on ecosystem services and biodiversity using a matrix-based assessment approach. We identified population growth, economic incentives and climate change as the most important driving forces, leading to altered agricultural activities, numerous dam constructions and droughts. Since 1987 cropland areas doubled at the expense of bare soils and natural vegetation, the lake hast lost more than half of its surface area, urban and freshwater areas increased threefold and by 50%, respectively. This favored crop and freshwater provision, while all other ecosystem services remained nearly constant or decreased, though spatial patterns were heterogeneous. For example, regulating and cultural services, and biodiversity mainly decreased at the shorelines of the lake, while provisioning services increased along the major rivers and close to cities. To address the land-use transitions with the most profound impact on ecosystem service provision, we recommend the following measures: increase the water supply to the lake, reduce cropland expansion, manage existing croplands more sustainably and protect natural vegetation. Our study provides a comprehensive overview of the regional ecosystem service dynamics and a valuable baseline for future research and environmental management in the basin.

Multicriteria plan optimization in the hands of physicians: a pilot study in prostate cancer and brain tumors.

BACKGROUND: The purpose of this study was to demonstrate the feasibility of physician driven planning in intensity modulated radiotherapy (IMRT) with a multicriteria optimization (MCO) treatment planning system and template based plan optimization. Exploiting the full planning potential of MCO navigation, this alternative planning approach intends to improve planning efficiency and individual plan quality. METHODS: Planning was retrospectively performed on 12 brain tumor and 10 post-prostatectomy prostate patients previously treated with MCO-IMRT. For each patient, physicians were provided with a template-based generated Pareto surface of optimal plans to navigate, using the beam angles from the original clinical plans. We compared physician generated plans to clinically delivered plans (created by dosimetrists) in terms of dosimetric differences, physician preferences and planning times. RESULTS: Plan qualities were similar, however physician generated and clinical plans differed in the prioritization of clinical goals. Physician derived prostate plans showed significantly better sparing of the high dose rectum and bladder regions (p(D1) < 0.05; D1: dose received by 1% of the corresponding structure). Physicians' brain tumor plans indicated higher doses for targets and brainstem (p(D1) < 0.05). Within blinded plan comparisons physicians preferred the clinical plans more often (brain: 6:3 out of 12, prostate: 2:6 out of 10) (not statistically significant). While times of physician involvement were comparable for prostate planning, the new workflow reduced the average involved time for brain cases by 30%. Planner times were reduced for all cases. Subjective benefits, such as a better understanding of planning situations, were observed by clinicians through the insight into plan optimization and experiencing dosimetric trade-offs. CONCLUSIONS: We introduce physician driven planning with MCO for brain and prostate tumors as a feasible planning workflow. The proposed approach standardizes the planning process by utilizing site specific templates and integrates physicians more tightly into treatment planning. Physicians' navigated plan qualities were comparable to the clinical plans. Given the reduction of planning time of the planner and the equal or lower planning time of physicians, this approach has the potential to improve departmental efficiencies.

Radiolucent Carbon Fiber-Reinforced Pedicle Screws for Treatment of Spinal Tumors: Advantages for Radiation Planning and Follow-Up Imaging.

OBJECTIVE: Surgical treatment of spinal tumors regularly includes spinal instrumentation with pedicle screws. Most modern pedicle screws are made of titanium alloy, which is associated with artifacts on postoperative imaging such as computed tomography and/or magnetic resonance imaging. These artifacts hamper radiation treatment planning and execution and follow-up imaging. Recently, carbon fiber-reinforced polyetheretherketone (CFRP) implants became available for posterior instrumentation with the aim to reduce imaging artifacts by implants. METHODS: Patients harboring spinal tumors underwent posterior stabilization using CFRP pedicle screws. Postoperative imaging was evaluated for implant artifacts. Radiation planning was assessed. RESULTS: Thirty-five patients with spinal tumors were assessed (metastases n = 30; lymphoma n = 2, myeloma n = 1, chordoma n = 1, fibrous dysplasia n = 1). Implantation of CFRP implants was feasible in all but 1 case. Postoperative images show reduced artifacts in comparison with standard titanium alloy implants. Implant position and integrity is sufficiently assessable despite reduced image contrast. Radiation planning is improved. CONCLUSIONS: Carbon fiber-reinforced PEEK pedicle screws reduce image artifacts on computed tomography and magnetic resonance imaging. Thereby, they are a valuable and feasible option for spinal instrumentations in patients harboring spinal tumors where postoperative imaging and radiation therapy planning are necessary and might be crucial for long-term outcome and overall survival.

Prioritized efficiency optimization for intensity modulated proton therapy.

A high dosimetric quality and short treatment time are major goals in radiotherapy planning. Intensity modulated proton therapy (IMPT) plans obtain dose distributions of great conformity but often result in long delivery times which are typically not incorporated into the optimization process. We present an algorithm to optimize delivery efficiency of IMPT plans while maintaining plan quality, and study the potential trade-offs of these interdependent objectives. The algorithm is based on prioritized optimization, a stepwise approach to implemented objectives. First the quality of the plan is optimized. The second step of the prioritized efficiency optimization (PrEfOpt) routine offers four alternatives for reducing delivery time: minimization of the total spot weight sum (A), maximization of the lowest spot intensity of each energy layer (B), elimination of low-weighted spots (C) or energy layers (D). The trade-off between dosimetric quality (step I) and treatment time (step II) is controlled during the optimization by option-dependent parameters. PrEfOpt was applied to a clinical patient case, and plans for different trade-offs were calculated. Delivery times were simulated for two virtual facilities with constant and variable proton current, i.e. independent and dependent on the optimized spot weight distributions. Delivery times decreased without major degradation of plan quality; absolute time reductions varied with the applied method and facility type. Minimizing the total spot weight sum (A) reduced times by 28% for a similar plan quality at a constant current (changes of minimum dose in the target <1%). For a variable proton current, eliminating low-weighted spots (C) led to remarkably faster delivery (16%). The implementation of an efficiency-optimization step into the optimization process can yield reduced delivery times with similar plan qualities. A potential clinical application of PrEfOpt is the generation of multiple plans with different trade-offs for a multicriteria optimization setting. Then, the planner can select the preferred compromise between treatment time and quality for each individual patient.

Norrin mediates angiogenic properties via the induction of insulin-like growth factor-1.

Norrin is an angiogenic signaling molecule that activates canonical Wnt/ß-catenin signaling, and is involved in capillary formation in retina and brain. Moreover, Norrin induces vascular repair following an oxygen-induced retinopathy (OIR), the model of retinopathy of prematurity in mice. Since insulin-like growth factor (IGF)-1 is a very potent angiogenic molecule, we investigated if IGF-1 is a downstream mediator of Norrin's angiogenic properties. In retinae of transgenic mice with an ocular overexpression of Norrin (ßB1-Norrin), we found at postnatal day (P)11 a significant increase of IGF-1 mRNA compared to wild-type littermates. In addition, after treatment of cultured Müller cells or dermal microvascular endothelial cells with Norrin we observed an increase of IGF-1 and its mRNA, an effect that could be blocked with DKK-1, an inhibitor of Wnt/ß-catenin signaling. When OIR was induced, the expression of IGF-1 was significantly suppressed in both transgenic ßB1-Norrin mice and wild-type littermates when compared to wild-type animals that were housed in room air. Furthermore, at P13, one day after the mice had returned to normoxic conditions, IGF-1 levels were significantly higher in transgenic mice compared to wild-type littermates. Finally, after intravitreal injections of inhibitory α-IGF-1 antibodies at P12 or at P12 and P14, the Norrin-mediated vascular repair was significantly attenuated. We conclude that Norrin induces the expression of IGF-1 via an activation of the Wnt/ß-catenin signaling pathway, an effect that significantly contributes to the protective effects of Norrin against an OIR.

Impact of interfractional changes in head and neck cancer patients on the delivered dose in intensity modulated radiotherapy with protons and photons.

PURPOSE: To investigate the influence of interfractional changes on the delivered dose of intensity modulated proton (IMPT) and photon plans (IMXT). METHODS AND MATERIALS: Five postoperative head and neck cancer patients, previously treated with tomotherapy at our institute, were analyzed. The planning study is based on megavoltage (MV) control images. For each patient one IMPT plan and one IMXT plan were generated on the first MV-CT and recalculated on weekly control MV-CTs in the actual treatment position. Dose criteria for evaluation were coverage and conformity of the planning target volume (PTV), as well as mean dose to parotids and maximum dose to spinal cord. RESULTS: Considerable dosimetric changes were observed for IMPT and IMXT plans. Proton plans showed a more pronounced increase of maximum dose and decrease of minimum dose with local underdosage occurring even in the center of the PTV (worst IMPT vs. IMXT coverage: 66.7% vs. 85.0%). The doses to organs at risk (OARs) increased during the treatment period. However, the OAR doses of IMPT stayed below corresponding IMXT values at any time. For both modalities treatment plans did not necessarily worsen monotonically throughout the treatment. CONCLUSIONS: Although absolute differences between planned and reconstructed doses were larger in IMPT plans, doses to OARs were higher in IMXT plans. Tumor coverage was more stable in IMXT plans; IMPT dose distributions indicated a high risk for local underdosage during the treatment course.

Differential angiogenic properties of lithium chloride in vitro and in vivo.

Wnt/ß-catenin signaling induced by the Norrin/Frizzled-4 pathway has been shown to improve capillary repair following oxygen induced retinopathy (OIR) in the mouse, a model for retinopathy of prematurity. Here we investigated if treatment with the monovalent cation lithium that has been shown to augment Wnt/ß-catenin signaling in vitro and in vivo has similar effects. In cultured human microvascular endothelial cells, LiCl as well as SB 216763, another small molecule that activates Wnt/ß-catenin signaling, induced proliferation, survival and migration, which are all common parameters for angiogenic properties in vitro. Moreover, treatment with both agents caused an increase in the levels of ß-catenin and their translocation to nuclei while quercetin, an inhibitor of Wnt/ß-catenin signaling, completely blocked the effects of LiCl on proliferation. In mice with OIR, intraperitonal or intravitreal treatment with LiCl markedly increased the retinal levels of ß-catenin, but did not improve capillary repair. In contrast, repair was significantly improved following intravitreal treatment with Norrin. The effects of LiCl on HDMEC in vitro have minor relevance for OIR in vivo, and the influence of the Norrin/Frizzled-4 pathway on capillary repair in OIR is not reproducible upon enhancing Wnt/ß-catenin signaling by LiCl treatment strongly indicating the presence of additional and essential mechanisms.

Simulation models for socioeconomic inequalities in health: a systematic review.

BACKGROUND: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. OBJECTIVE: To explore how simulation models were used in the field of socioeconomic inequalities in health. METHODS: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified. As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed. RESULTS: We found 61 studies published between 1989 and 2013. Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly. DISCUSSION AND CONCLUSIONS: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks.

Reinstatement of fear in humans: autonomic and experiential responses in a differential conditioning paradigm.

The present study investigated reinstatement of fear in humans using an aversive differential conditioning paradigm. Two neutral human face pictures were presented during habituation, acquisition, extinction, and postreinstatement phases. One picture served as a conditioned stimulus (CS) reinforced by an unconditioned stimulus (US) in the form of electrical stimulation (CS+) and the second picture as a control stimulus that was never reinforced (CS-). The prediction that in a reinstatement manipulation a previously extinguished fear response in humans can be reinstated in a reinstatement group by the mere presentation of three unpredicted electrical stimulations (USs) was tested. Participants in the control group were not exposed to unpredicted USs and no reinstatement effect was expected. Outcome measures included subjective US expectancy ratings and skin conductance responses. Results showed non-selective return of the fear response due to fear recovery associated with both CSs (CS+/CS-) in the reinstatement group. Unexpected fear recovery was observed for both CSs (CS+/CS-) in control participants. Results are discussed with respect to context conditioning, fear generalisation, and anxiety-related cognitive mechanisms underlying fear recovery after extinction.

One-session computer-based exposure treatment for spider-fearful individuals--efficacy of a minimal self-help intervention in a randomised controlled trial.

Computer-based self-help treatments have been proposed to provide greater access to treatment while requiring minimum input from a therapist. The authors employed a randomised controlled trial to investigate the efficacy of one-session computer-based exposure (CBE) as a self-help treatment for spider-fearful individuals. Spider-fearful participants in a CBE group underwent one 27-min session of standardised exposure to nine fear-eliciting spider pictures. Treatment outcome was compared to spider-fearful control participants exposed to nine neutral pictures. Fear reduction was quantified on a subjective level by the Fear of Spiders Questionnaire (FSQ) and complemented with a behavioural approach test (BAT). Results demonstrate that compared to control participants, CBE participants showed greater fear reduction from pre- to posttreatment on both the subjective level (FSQ) and the behavioural level (BAT). Moreover, in contrast to the control group, the obtained subjective fear reduction effect remained stable in the CBE group at 1-month follow-up. These findings highlight the role of computer-based self-help as a minimal but effective intervention to reduce fear of spiders.

Learning from local knowledge: modeling the pastoral-nomadic range management of the Himba, Namibia.

It is widely accepted that successful grazing management strategies in semiarid ecosystems need to be adapted to the highly temporal and spatially heterogeneous forage production. Nevertheless, a full understanding of the key factors and processes for sustainable adaptive management has yet to be reached. The investigation of existing, successful range management systems by simulation models may help to derive general understanding and basic principles. The semi-nomadic Himba in northern Namibia applied a sophisticated management system until the mid-1990s which combined season-dependent pasture use (resulting in rainy-season pastures and dry-season pastures), preservation of reserves for drought and sanctions for rule breaking. A stochastic ecological simulation model has been developed here which represents the main aspects of this management system. With this model we analyze (1) which components of the traditional Himba strategy are essential for sustainability and (2) what happens to the state of the rangeland system under socioeconomic changes. This study shows that temporally and spatially heterogeneous pasture use yields higher productivity and quality of a pasture area than the pressure of homogeneous permanent grazing. Two aspects are of importance: (1) intra-annual heterogeneous use (resting of the dry-season pastures during the rainy season) and (2) interannual heterogeneous use (spatial extension of grazing in years of drought). This management system leads to an effective build-up and use of a buffer in the system: the reserve biomass (the non-photosynthetic reserve organs of the plants), an indicator for grazing and management history. Analyzing purchase as one form of socioeconomic change, we demonstrate that easier market access to purchase livestock may lead to a decline in vegetation quality. However, cattle production increases as long as rest periods on parts of the pasture during the rainy season are granted. Methodologically, we emphasize that simulation models offer an excellent framework for analyzing and depicting basic principles in sustainable range management derived from local knowledge. They provide the opportunity of testing whether these basic principles are also valid under different ecological and socioeconomic settings.

[Family sense of coherence and resilience. A study on families with children with mental and physical disabilities]. / Kohärenz und Resilienz in Familien mit geistig und körperlich behinderten Kindern.

Drawing from concepts from family stress theory, resilience theory, Rolland's model of family adaptation to disability, and Antonovsky's salutogenetic model, this study explores the relationship between family sense of coherence and measures of family functioning, levels of stress, severity of the handicaps levels of functional impairment and demographic indicators. Participants were 37 families with children under 18 years with mental retardation and physical-neurological disorders that consulted the Department of Pediatric Neurology. With a discriminant analysis, measures contributing to the separation into subgroups of families with high, medium and low family cohesion were identified. The measures permitted a satisfactory discrimination into groups in this clinical sample. The highest discriminatory power held sociodemographic variables, severity of impairment, as well as levels of family functioning and measures of family coping, which are potentially amenable to therapeutic change. The results indicate that family coherence can be regarded as a global resource contributing to family resilience, and therapeutic implications are being discussed.