Improved signal recovery for flow cytometry based on 'spatially modulated emission'.

Recently, the technique of 'spatially modulated emission' has been introduced (Baßler et al 2008 US Patent 0080181827A1; Kiesel et al 2009 Appl. Phys. Lett. 94 041107; Kiesel et al 2011 Cytometry A 79A 317-24) improving the signal-to-noise ratio (SNR) for detecting bio-particles in the field of flow cytometry. Based on this concept, we developed two advanced signal processing methods which further enhance the SNR and selectivity for cell detection. The improvements are achieved by adapting digital filtering methods from RADAR technology and mainly address inherent offset elimination, increased signal dynamics and moreover reduction of erroneous detections due to processing artifacts. We present a comprehensive theory on SNR gain and provide experimental results of our concepts.

[Evaluation of Contextual Factors in Psychosomatic Rehabilitation]. / Evaluation von Kontextfaktoren in der psychosomatischen Rehabilitation.

Objectives: Although individualized and ICF-oriented implementation of rehabilitation treatment requires knowledge of relevant contextual factors, there is a lack of operationalized documentation and measurement tools to evaluate these factors. Therefore, an ICF-oriented semi-structured interview was designed. Methods: 20 contextual factors were externally assessed whether they negatively affected mental functioning and participation of psychosomatic patients. Additionally, psychometric scales were applied. Results: Six relevant impairing contextual factors were identified. Contextual factors significantly correlated with psychometric scales. Patients with higher contextual impairment showed significantly higher psychological stress levels. Conclusions: Anamnesis of contextual factors at the beginning of psychosomatic rehabilitation yields important information for therapy planning. Further research on contextual factors in medical rehabilitation is needed.

[Symptom validity in psychosomatic rehabilitation]. / Beschwerdenvalidität im Rahmen stationärer psychosomatischer Rehabilitation.

OBJECTIVES: This study investigates how patients in psychosomatic rehabilitation are characterized, who show conspicuous response behavior in a symptom validation test. At the same time the question of whether patients with an unlikely response behavior may benefit from psychosomatic rehabilitation will be pursued. RESEARCH QUESTION: What proportion of patients in an inpatient psychosomatic rehabilitation clinic shows results in their symptom validation test that lack clear interpretability due to unlikely complaint representation? How can this group of patients be characterized? How effective is the psychosomatic rehabilitation treatment in patients who stand out by an unlikely response style? METHODS: Patients completed a questionnaire at the beginning and the end of their inpatient psychosomatic rehabilitation treatment. Questionnaire included socio-demographic information, Health49, SPE, DIAMO, FBTM and SIMS. Additionally, data from the discharge letter were considered. RESULTS: 24.6% of 329 patients showed conspicuous response behavior. Patients with conspicuous complaint representation were more likely to have an immigration background, rather belonged to the socio-economic underclass and more frequently showed a vulnerable gainful employment. There was no correlation between SIMS and the rehabilitation outcome. Patients with conspicuous response behavior and with high depression scores benefited significantly less from the inpatient treatment. Differences in the ability to work assessment were not found. CONCLUSION: Conspicuous response style is associated with high scores on the clinical symptom scales. About one quarter of patients in an inpatient psychosomatic rehabilitation clinic needs a more accurate diagnosis in order to reliably assess the clinical prognosis and the ability to work.

[Data sources for continual quality improvement in medical rehabilitation- the QS-Reha procedure of the statutory health insurance funds and the Eva-Reha documentation system of MDK Rhineland-palatinate]. / Datenquellen für eine kontinuierliche Qualitätsverbesserung in der medizinischen Rehabilitation-Das QS-Reha-Verfahren der gesetzlichen Krankenkassen und das Dokumentationssystem Eva-Reha des MDK Rheinland-Pfalz.

Rehabilitation centers in Germany with a care supply contract according to section 111 Social Code Book Five - statutory health insurance (SGB V) are legally obligated to implement an internal quality management and to participate in comprehensive measures of external quality assurance which particularly aim at improving outcome quality ( section 135a SGB V). The legislator has left it to the central associations of health insurance funds and to the relevant umbrella organisations of care providers to develop these measures as well as the basic requirements on internal quality management in order to reach a joint agreement about it (cf. section 137d [1] and [1a] SGB V). The corresponding agreement was concluded on April 1, 2004. Whereas configuration of the internal quality management to a large extend lies in the discretion of the individual rehabilitation center, although it has to be geared to the objectives and principles set out in the agreement under section 137d SGB V, participation in the external quality assurance procedures of the central associations of health insurance funds (QS-Reha procedure) is obligatory for all rehabilitation centers with a care supply contract according to section 111 or 111a. The QS-Reha procedure comprises a survey of the central quality dimensions (structural, process and outcome quality as well as patient satisfaction) and permits related quality comparisons, which are utilized by the health insurance funds for quality oriented patient allocation and remuneration. The QS-Reha procedure had been developed to implement the legal requirements for external quality assurance in the field of medical rehabilitation ( section 135a in conjunction with section 137d SGB V) as well as to create a basis for quality focussed remuneration and patients allocation, whereas the Eva-Reha database had been developed by the Medical Service of Health Insurances in Rheinland-Pfalz for single case documentation with the objective of utilizing these data for internal quality management and, beyond this, also for various aspects of quality development across centers. The results generated in the framework of external quality assurance and internal management have to be integrated in the concept of internal quality management as they account for important sources of information with respect to the analysis of strengths or weaknesses of the facility. Irrespective of their origin quality relevant results should be integrated into a benchmarking system providing information to the operational and medical management of a rehabilitation center on the effectiveness and efficiency of the medical rehabilitation services provided. Up-to-date data, such as those generated by the Eva-Reha database, or sample survey data as those from the QS-Reha procedure can equally be used for such a benchmarking system and complement each another in a meaningful way. In this paper the main features of the QS-Reha procedure and the Eva-Reha database are described, with the objective of pointing out the particular perspectives of their data structure and results for continuous improvement in the framework of internal quality management.

Interference quenching of nu(")=1 vibrational line in resonant photoemission of N2: a possibility to obtain geometrical information on the core-excited state.

An interference quenching of the nu(")=1 vibrational line in the resonant Auger decay of N 1s-->pi(*) core-excited N2 is observed and analyzed. The intensity ratio between the nu(")=1 and nu(")=0 vibrational levels of the X2Sigma(+)(g) final state shows a surprising nonmonotonous variation as a function of frequency detuning, going through a minimum with a complete suppression of nu(")=1. We have developed a simple model which shows a linear relation between the value of the detuning frequency for this minimum and the equilibrium bond distance R(0)(c) of the core-excited state. A new way is thus established of determining the equilibrium bond distance for the core-excited state with a precision deltaR(0)(c)<10(-3) A.

[Evaluation of therapeutic success by patients with anxiety disorders after inpatient psychotherapy]. / Bewertung des Therapieerfolgs durch Patienten mit Angststörungen nach stationärer Psychotherapie.

OBJECTIVE: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. METHODS: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed. RESULTS: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance"). CONCLUSIONS: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

[A consecutive study of patients with irritable bowel disease in two tertiary referral centers]. / Eine vergleichende Untersuchung zum Reizdarmsyndrom bei konsekutiven Patienten zweier internistischer Ambulanzen.

OBJECTIVES: We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS). DATA: A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD). METHODS: The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB). RESULTS: We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc. CONCLUSIONS: Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

Treating onychomycosis.

Onychomycosis accounts for one third of fungal skin infections. Because only about one half of nail dystrophies are caused by fungus, the diagnosis should be confirmed by potassium hydroxide preparation, culture or histology before treatment is started. Newer, more effective antifungal agents have made treating onychomycosis easier. Terbinafine and itraconazole are the therapeutic agents of choice. Although the U.S. Food and Drug Administration has not labeled fluconazole for the treatment of onychomycosis, early efficacy data are promising. Continuous oral terbinafine therapy is most effective against dermatophytes, which are responsible for the majority of onychomycosis cases. Intermittent pulse dosing with itraconazole is as safe and effective as short-term continuous therapy but more economical and convenient. With careful monitoring, patients treated with the newer antifungal agents have a good chance of achieving relief from onychomycosis and its complications.

Doppler splitting of In-flight auger decay of dissociating oxygen molecules: the localization of delocalized core holes

By exploiting the core-excitation-induced dissociation of O2, we find that the Auger emission exhibits a Doppler-like energy shift. We show this to be a manifestation of localization of the core hole and propose that the problem of core-hole localization versus delocalization in core-hole spectroscopies may be resolved by considering the nature of the measurement.

Observation of a continuum-continuum interference hole in ultrafast dissociating core-excited molecules.

The femtosecond dissociation of HCl after core excitation has been studied through the resonant Auger decay. The spectra contain contributions from decay occurring at both "molecular" and "atomic" internuclear distances. We have observed a new interference mechanism in these spectra: An atomic spectral line develops into a negative spectral contribution, a "hole," when detuning the excitation energy from the maximum of the Cl2p(-1)sigma(*) resonance. Resonant x-ray scattering theory quantitatively explains this behavior as due to a novel destructive continuum-continuum interference between molecular and atomic contributions to the Auger decay.

[State of empirical research in psychotherapy]. / Zum empirischen Forschungsstand von Psychotherapie.

At present nearly 1200 psychotherapeutic treatments are offered on the market with all of them claiming to be helpful and effective. However many of them are not able to even fulfil minimal standards of scientifically substantiated evidence for effectiveness. Modern psychotherapy research has disclosed perspectives to adequately explore the complicated course of therapeutic process. The same way efforts for standardized judgement criteria of empirical studies offer the chance for meaningful evaluating the scientific quality of therapy studies. As shown by several meta-analyses the scientifically substantiated psychotherapy proved to be very effective in the treatment of mental disorders.

[The randomization problem in psychotherapy studies]. / Das Problem der Randomisierung bei Psychotherapiestudien.

In a research project comparing inpatient and outpatient psychotherapeutic treatment for patients suffering from anxiety disorders, 132 subjects were allocated to both treatments by means of randomisation. Because of the patients' voluntary agreement or refusal of the proposed treatment, the subsamples are markedly affected in their homogeneity. It seems that more disturbed patients agreed to inpatient psychotherapy, whereas less disturbed patients refused that form of treatment. Bias toward or against a given form of treatment turned out to be the most potent predictor in multivariate analysis. The influence of this distortion of the samples is discussed with regard to the generalisation of the results. Proposed countermeasures have their shortcomings, and in the end it seems that randomisation should be avoided in psychotherapeutic research.

[Evaluation of the therapeutic process in inpatient psychotherapy with the Repertory Grid technique]. / Zur Evaluation des therapeutischen Prozesses von stationärer Psychotherapie mit der Repertory-Grid-Technik.

With a sample of 155 patients undergoing psychoanalytic inpatient psychotherapy, the clinical relevance of nomethetic measures derived from Repertory Grids (Role Construct Repertory Test; Kelly 1955) shall be demonstrated. Results lead to the conclusion that valuable findings concerning the psychotherapeutic process can be obtained from the grid without necessarily recurring to the framework of Personal Construct Psychology. In general, cognitive differentiation seems to diminish as therapy goes on. Successful patients start to deal with their parental imagines earlier in the therapeutic process than less successful ones. Moreover, they adapt the construction of their Self to the one of their Ideal Self, just as they construe the treating therapist increasingly similar to their Ideal Self. This points to the eminence of the therapeutic relationship for successful therapy outcome. Finally, the paper presents some possibilities to demonstrate transference processes within the scope of inpatient psychotherapy by means of grid measures. All in all, we consider the repertory grid technique as a promising tool for the evaluation of therapeutic processes, but it requires considerable expenditure to fit into clinical routine.

[Psychodynamics and psychotherapy of anxiety disorders]. / Psychodynamik und Psychotherapie von Angsterkrankungen.

Three main concepts in the development of anxiety are important in psychoanalysis: 1. the conflict model assuming that anxiety is initiated by the Ego in dangerous situations, when usual coping strategies fail, 2. the structural model that essentially describes that with general weakness of the adaptive Ego-functions even common conflicts cannot be mastered adequately and, therefore, anxiety as an affect arises quickly, and 3. the ethological model assuming that anxiety is closely connected with ethologically founded needs of binding: with threat of loss of binding, the child reacts anxiously, mobilising care impulses of the parents and, thus, counteracting this threat. It is essential for the psychotherapy of anxiety disorders whether the patient exhibits an Ego-structural weakness requiring an active strengthening of the coping abilities of the Ego, or whether a more conflictual genesis of his anxiety should be assumed-in this case, the disclosure of the frequently unconscious background of the conflicts promises to be successful. Altogether, a more active and encouraging attitude of the therapist is preferable for the psychotherapeutic treatment of anxiety disorders to motivate the patient to directly confront himself with his anxiety symptoms.

[Which factors modify the duration of inpatient psychotherapy?]. / Welche Faktoren beeinflussen die Dauer von stationärer Psychotherapie?

The indication for differential duration of inpatient psychotherapy is a difficult question to answer, especially when the possible outcome-success of more severely disturbed patients (e.g. with borderline-personality disorder) is considered. Our own results showed no relevant correlation between the degree of patients' disturbance and treatment duration, neither any relevant correlation between treatment duration and therapists' evaluation of symptomatic or ego-structural improvement. The only marked effect on treatment duration was found for the patients' evaluation of their therapeutic relationship: the better they judged this relationship, the more their therapists tended to elongate inpatient psychotherapy. This finding supports a paradigm, which has been already well confirmed for outpatient psychotherapy: the specific importance of the therapeutic relationship for the therapeutic process even within the scope of inpatient psychotherapy. Another finding of our study indicates that more severely disturbed patients probably need a modified setting of inpatient psychotherapy: favorably a focus oriented interval treatment with short duration periods and alternating focus if necessary.

[Prognostic factors for the success of psychoanalytically founded inpatient psychotherapy]. / Prognosefaktoren für den Erfolg von psychoanalytisch fundierter stationärer Psychotherapie.

In the scope of our study for evaluation of the differential effect of inpatient psychotherapy we investigated by retrospective analysis of data at admission and 6. week of treatment, which factors were prognostic relevant for therapy success. We defined therapy-success as an equally weighted combination of patients' assessment of satisfaction with treatment success, which was evaluated by the Helping Relationship Questionnaire of Luborsky (1984), and the therapists' assessment of symptomatic and ego-structural improvement of the patients. For the variables, which were related to the patients or therapists, especially the therapists' judgement of the ego-structural disturbance of the patients (r = -.43, N = 218, p < 0.1) and motivation for psychotherapy (r = .27, N = 70, p < .01) exhibited relevant prognostic potency. The variables concerning the therapeutic relationship however gained increased prognostic value first after six weeks of treatment duration.

[Inpatient psychotherapy with chronic psychogenic pain patients]. / Stationäre Psychotherapie bei psychogenen chronischen Schmerzpatienten.

The efficacy of inpatient psychosomatic psychotherapy was proved by a naturalistic prospective study with 50 psychogenic pain patients over an average time period of 12 weeks. At the end of inpatient psychotherapy about 60% of all patients achieved pain mitigation. According to the aim of our therapeutic concept to specially improve the perception and verbalization of their own conflicts or affects about 86% of all patients judged to have an enhanced competence in problem solving. The hypothesis that depression may often occur as a consequence of several years lasting chronic pain, could not be confirmed in our study. In contrast no remarkable correlation was found between symptom duration and depressive or anxious mood respectively. Concerning prognosis it seems to be significant that an increased tendency for rationalization or intellectualization diminished clinical outcome success as well as it occurred with enhanced acute pain sensation.

[Inpatient psychotherapy of anxiety disorders--a comparison of therapeutic effectiveness in patients with generalized anxiety disorder, agoraphobia and panic disorder]. / Stationäre Psychotherapie bei Angststörungen--ein Vergleich ihrer therapeutischen Wirksamkeit bei Patienten mit generalisierter Angststörung, Agoraphobie und Panikstörung.

We investigated the effect of psychoanalytically oriented inpatient psychotherapy on three essential forms of anxiety disorders (classified according ICD-10): 1. generalized anxiety disorder (n = 23), agoraphobia (n = 38) and panic disorder (n = 24). Examinations with psychometric test instruments were performed at beginning of inpatient psychotherapy, at dismissal and 6 weeks after dismissal. At the end of inpatient psychotherapy we judged four clinically relevant criteria of therapy success: at the one side the therapist's judgement of symptomatic and structural improvement of the patients, at the other side the patients' judgement of anxiety and depression diminuation. The results demonstrate that summing up these four success criteria 1.) 40.0% of the patients with anxiety disorders improved, 21.2% failed; 2.) 61.4% of the patients with agoraphobia improved, 6.3% failed and 3.) 52.5% of the patients with panic disorder improved, 6.5% failed. An additional analysis of these results showed that the patients with generalized anxiety disorder were significantly (p < 0.01) more disturbed (according clinical assessment) compared to the other two diagnostic groups. About 60% of these patients exhibited increased anxiety symptoms during the course of inpatients psychotherapy, nevertheless relative to the other success criteria these patients achieved satisfactory outcome results. In the paper the consequences of these findings are discussed especially for inpatient psychotherapy of severely disturbed patients with anxiety disorders.