[Current state of the Health Advisory Council of Munich: A Survey]. / Der Gesundheitsbeirat der Landeshauptstadt München: eine Bestandsaufnahme.

BACKGROUND: After over 27 years of existence, the executive board of the Health Advisory Council of the state capital Munich (HAC) decided to conduct an inventory. PURPOSE OF THE STUDY: The objective was to gather data on the perceptions of HAC participants regarding the structure of committees, issues addressed, their processing as well as the results of the projects, in addition to events organized, public relations activities and target achievement. The survey should be the basis for decisions regarding future directions or further developments of the HAC. METHOD: Between January 24 and March 28, 2017, a cross-sectional survey of HAC participants was carried out with participation on a voluntary basis, using a self-designed semi-standardized questionnaire. The answers were analysed descriptively. RESULTS: The survey involved 284 active participants. The net return rate was 46.5% (132 participants). The majority of respondents felt that the committee structure was appropriate. 85.6% of the respondents agreed that the communication and cooperation within the committee was positive. There was perceived potential for improvement in cooperation with the city council. The content alignment of the HAC was considered to be appropriate by 87.8%; however, sustainability was seen as an area with potential for improvement. Professional exchange of information was regarded by more than three-fifths of the participants as the most important objective of committee work. Organisation of events was seen as positive by 74.2%; 57.6% were of the opinion that the reporting of the results was transparent, but with potential for improvement in the area of public relations. About two-thirds of the respondents felt that HAC was successful in achieving its objectives. CONCLUSION: The HAC represents a successful institution in the health care system of Munich. Needs for improvement were identified in the following areas: networking with the city council, sustainability of results and in the implementation of a more intensified public relations effort.

Small-scale spatial variability in phylogenetic community structure during early plant succession depends on soil properties.

During early plant succession, the phylogenetic structure of a community changes in response to important environmental filters and emerging species interactions. We traced the development of temperate-zone plant communities during the first 7 years of primary succession on catchment soils to explore patterns of initial species assembly. We found pronounced small-scale differences in the phylogenetic composition of neighbouring plant assemblages and a large-scale trend towards phylogenetic evenness. This small-scale variability appears to be mediated by soil properties, particularly carbonate content. Therefore, abiotic environmental conditions might counteract or even supersede the effects of interspecific competition among closely related species, which are usually predicted to exhibit patterns of phylogenetic evenness. We conclude that theories on phylogenetic community composition need to incorporate effects of small-scale variability of environmental factors.

Species-driven phases and increasing structure in early-successional plant communities.

Successional phases describe changes in ecological communities that proceed in steps rather than continuously. Despite their importance for the understanding of ecosystem development, there still exists no reliable definition of phases and no quantitative measure of phase transitions. In order to obtain these data, we investigated primary succession in an artificial catchment (6 ha) in eastern Germany over a period of 6 years. The data set consists of records of plant species and their cover values, and initial substrate properties, both from plots in a regular grid (20 m × 20 m) suitable for spatial data analysis. Community assembly was studied by analyses of species co-occurrence and nestedness. Additionally, we correlated lognormal and log series distributions of species abundance to each community. We here introduce a new general method for detection of successional phases based on the degree of transient spatial homogeneity in the study system. Spatially coherent vegetation patterns revealed nonoverlapping partitions within this sequence of primary succession and were characterized as two distinct ecological phases. Patterns of species co-occurrence were increasingly less random, and hence the importance of demographic stochasticity and neutral community assembly decreased during the study period. Our findings highlight the spatial dimension of successional phases and quantify the degree of change between these steps. They are an element for advancing a more reliable terminology of ecological successions.

Monitoring the formation of structures and patterns during initial development of an artificial catchment.

The objective of this paper is to present observations, results from monitoring measurements, and preliminary conclusions about the development of patterns and structures during the first 5 years of development of an artificial catchment starting from point zero. We discuss the high relevance of initial system traits and external events for the system development and draw conclusions for further research. These investigations as part of a Collaborative Research Center, aim to disentangle and understand the feedback mechanisms and interrelationships of processes and their co-development with spatial and temporal structures and patterns by studying an initial, probably less complex ecosystem. Therefore, intensive measurements were carried out in the catchment with regard to the development of surface structures, hydrological patterns, vegetation dynamics, water chemistry, and element budgets. During the first 5 years, considerable changes within the catchment were observed. Both internal and external factors could be identified as driving forces for the formation of structures and patterns in the artificial catchment. Initial structures formed by the construction process and initial substrate characteristics were decisive for the distribution and flow of water. External factors like episodic events triggered erosion and dissection during this initial phase, promoted by the low vegetation cover, and the unconsolidated sandy substrate. The transformation of the initial geosystem into areas with evolving terrestrial or aquatic characteristics and from a very episodic to a more permanent stream network and discharge, together with the observed vegetation dynamics increased site diversity and heterogeneity with respect to water and nutrient availability and transformation processes compared with the more homogenous conditions at point zero. The processes and feedback mechanisms in the initial development of a new landscape may deviate in rates, intensity, and dominance from those known from mature ecosystems. It is therefore crucial to understand these early phases of ecosystem development and to disentangle the increasingly complex interactions between the evolving terrestrial and aquatic, biotic, and abiotic compartments of the system. Long-term monitoring of initial ecosystems may provide important data and parameters on processes and the crucial role of spatial and temporal structures and patterns to solve these problems. Artificially created catchments could be a suitable tool to study these initial developments at the landscape scale under known, designed, and defined boundary conditions.

[Pre- and intraoperative ultrasound imaging in neurosurgery]. / Prä- und intraoperative Ultraschallbildgebung in der Neurochirurgie.

Advanced applications of ultrasound in neurosurgery have been evaluated in two projects of the Ruhr Center of Excellence for Medical Engineering (KMR), Bochum, Germany. Engineers, neurologists, and neurosurgeons are cooperating within an interdisciplinary project structure, in order to practically approach neurosurgical problems by elaborating novel ultrasound-based technologies. On one hand, procedures have been implemented for an ultrasound-based registration of bone structures, applicable, amongst others, to the high-accuracy navigation of pedicle screws. On the other hand, concepts have been developed regarding a pre- and intraoperative application of ultrasound contrast agents for the detection of cerebral tumors and for the monitoring of surgery. In this article, both projects are discussed on the basis of the results obtained thus far and, furthermore, potentials of these concepts are presented that may complement or extend the scopes of the neurosurgical practice.

Severity of depressive symptoms and quality of life in patients with amyotrophic lateral sclerosis.

OBJECTIVES: The authors aimed at investigating the occurrence of depression and the level of quality of life in patients with amyotrophic lateral sclerosis (ALS), an incurable neurodegenerative disease leading to progressive motor paralysis. They further wished to elucidate correlates of depression and quality of life, such as physical impairment, time since diagnosis, age, sex, and education. Additionally, the authors attempted to confirm previous studies that had shown quality of life to be underestimated by partners or caregivers. METHODS: To assess severity of depressive symptoms, the authors used Beck's Depression Inventory (BDI) and the ALS-Depression Inventory. To assess the patients' quality of life, they used the Scales to Assess Quality of Life. The same questionnaire was presented to partners or caregivers to estimate the patients' quality of life. RESULTS: Severity of depressive symptoms was everything from not depressed to clinically relevant depressed. On average, quality of life was rated as satisfactory. Severity of depressive symptoms and quality of life showed a moderate positive relation to physical impairment and a weak negative relation to time since diagnosis. Partners or caregivers rated patients' quality of life significantly lower than did the patients. CONCLUSIONS: Although depression occurs among ALS patients, it is not inevitable. Patients can remain free of depression and maintain a good quality of life. Depression should be treated, and patients have to be provided with unbiased information, including their medical and palliative care options.

Brain tumor classification on intraoperative contrast-enhanced ultrasound.

PURPOSE: Contrast-enhanced ultrasound (CEUS) imaging of tissue perfusion is based on microbubble echo detection. CEUS can visualize tumors based on local perfusion variations. The acquired video data are qualitatively interpreted by subjective visualization in clinical practice. An automated CEUS classifier was developed for intraoperative identification of tumor tissue and especially tumor borders. METHODS: Support vector machines (SVM) were trained using CEU data sets to differentiate tumor and non-tumor tissue in glioblastoma patients. The classification was based on features derived from model functions approximated to time courses for each pixel in the video data. Classification performance was evaluated with single and cross- patient training data sets. RESULTS: The minimum mean classification error (14.6 %) with single patient data set training was achieved by SVM training using a sigmoid combination of model function parameter sets. A comparison of different model functions showed that the minimum average classification error (17.4 %) in a cross-validation study with 13 patients was achieved with the sigmoid model using an automatic relevance detection kernel. CONCLUSION: CEUS-based classification map images derived from approximated model functions can be generated with moderate accuracy and have significant potential to support intraoperative decisions concerning glioblastoma tumor borders.

Modulation of slow cortical potentials by transcranial magnetic stimulation in humans.

We studied the effects of transcranial magnetic stimulation (TMS) on slow cortical potentials (SCPs) of the brain elicited during performance of a feedback and reward task. Ten healthy participants were trained to self-regulate their SCP amplitude using visual feedback and reward for increased or decreased amplitudes. Subjects participated in 27 runs (each comprising 70 trials) under three different conditions: single-pulse TMS delivered with the coil centered over Cz (vertex), over a lateral scalp position (LSP), which increased task difficulty, and in the absence of stimulation. Cz stimulation led to a non-significant enhancement of negative SCPs, while LSP stimulation led to a significant increase of positive SCPs. These results are consistent with the idea that enhanced task difficulty, as in LSP stimulation, enhances cognitive processing load leading to an increase of positive SCPs. Additionally, the data raise the hypothesis that TMS delivered to bilateral midcentral regions could modulate the amplitude of negative SCPs.

System architecture for intraoperative ultrasound registration in image-based medical navigation.

Medical navigation systems for orthopedic surgery are becoming more and more important with the increasing proportion of older people in the population, and hence the increasing incidence of diseases of the musculoskeletal system. The central problem for such systems is the exact transformation of the preoperatively acquired datasets to the coordinate system of the patient's body, which is crucial for the accuracy of navigation. Our approach, based on the use of intraoperative ultrasound for image registration, is capable of robustly registering bone structures for different applications, e.g., at the spine or the knee. Nevertheless, this new procedure demands additional steps of preparation of preoperative data. To increase the clinical acceptance of this procedure, it is useful to automate most of the data processing steps. In this article, we present the architecture of our system with focus on the automation of the data processing steps. In terms of accuracy, a mean target registration error of 0.68 mm was achieved for automatically segmented and registered phantom data where the reference transformation was obtained by performing point-based registration using artificial structures. As the overall accuracy for subject data cannot be determined non-invasively, automatic segmentation and registration were judged by visual inspection and precision, which showed a promising result of 1.76 mm standard deviation for 100 registration trials based on automatic segmentation of magnetic resonance imaging data of the spine.

Toward registration of 3D ultrasound and CT images of the spine in clinical praxis: design and evaluation of a data acquisition protocol.

Recent work has demonstrated the accuracy and operational viability of an algorithm proposed by the authors that successfully registers 3-D ultrasound data with CT or MRI data. The successful application of this method to intraoperative navigation, however, depends critically on the quality of the acquired ultrasound data. This gives rise to two questions concerning the usability of the algorithm in clinical praxis. First, how can one guarantee high-quality, user-independent ultrasound registration data with this procedure? Second, can this approach work reliably in clinical practice, namely within the operating theater? To address both of these questions, we present an ultrasound data acquisition protocol that leads the user through the data acquisition process and also provides the criteria to adjust the relevant ultrasound parameters. We also evaluated criteria for the visual inspection of the suitability of the ultrasound data for the registration process. Results for this evaluation show that these visual criteria can be used to decide preoperatively if an ultrasound registration will be successful in a patient. The intraoperative evaluation of the protocol showed that high-quality registrations can be achieved under realistic conditions. This protocol and the visual inspection criteria, together with the ultrasound registration algorithm, provide a surgical team with a means of performing precise, cost-effective navigation in patients for whom a navigated intervention was previously impossible. We evaluated the proposed procedure in clinical practice.

Ectomycorrhizas and cadmium toxicity in Norway spruce seedlings.

We studied the effects of ectomycorrhizal colonization by Laccaria bicolor (Maire) Orton S238 and Paxillus involutus (Batsch) Fr. 533 on cadmium (Cd) toxicity in Norway spruce seedlings (Picea abies (L.) Karst.). Both mycorrhizal and nonmycorrhizal seedlings were exposed to 0 (control), 0.5 or 5 &mgr;M CdSO(4) for 9 weeks in a sand culture system with frequent addition of nutrient solutions. In pure culture, P. involutus and L. bicolor showed similar Cd tolerance. However, in symbiosis, the Cd treatments decreased colonization by L. bicolor but not by P. involutus. Paxillus involutus ameliorated the negative effects of 0.5 &mgr;M Cd on shoot and root growth and chlorophyll content of old needles, whereas L. bicolor did not. Mycorrhizal colonization did not affect Cd concentrations of old needles and roots of seedlings. Despite differences between the ectomycorrhizal fungi in colonization and ability to alleviate Cd toxicity of seedlings, both species reduced Cd concentrations of young needles to a similar degree compared with nonmycorrhizal seedlings. However, in the 0.5 &mgr;M Cd treatment, the Cd content of needles of seedlings colonized by P. involutus was increased, whereas the Cd content of needles of seedlings colonized by L. bicolor was similar to that of needles of nonmycorrhizal seedings. When the amount of Cd translocated to needles was expressed on a root length basis to account for differences in the size of the root systems, the amount of Cd translocated to the needles was similar in seedlings mycorrhizal with P. involutus and in nonmycorrhizal seedlings. All mycorrhizal seedlings were similarly affected by 5 &mgr;M Cd, indicating that the amelioration efficiency of ectomycorrhizal fungi is dependent on the metal concentration to which the roots are exposed. Concentrations of P, K, Ca, Mg and Mn were decreased by 5 &mgr;M Cd to a similar extent in both nonmycorrhizal and mycorrhizal seedlings. In contrast to L. bicolor, P. involutus increased P uptake and altered patterns of root branching. We conclude that mycorrhizas alleviate Cd-induced reductions in growth of Picea abies seedlings. Although the two mycorrhizal fungi examined differed in their ability to alleviate Cd toxicity, these differences were not related to differences in Cd uptake or translocation to the shoot of the mycorrhizal seedlings. We suggest that amelioration of Cd toxicity by P. involutus may be a result of improved P nutrition or changes in root morphology, or both.

Longitudinal effects of noninvasive positive-pressure ventilation in patients with amyotrophic lateral sclerosis.

OBJECTIVE: To evaluate the duration of benefit on symptoms, quality of life, and survival derived from the use of noninvasive positive-pressure ventilation by patients with amyotrophic lateral sclerosis. DESIGN: In this prospective, cohort study, 30 of 36 consecutively referred symptomatic patients tolerated nightly noninvasive positive-pressure ventilation and undertook pulmonary function testing and 12 symptom and quality-of-life instruments concerning sleep quality, daytime sleepiness, physical fatigue, mental fatigue, and depression that were administered during a 10-mo period. RESULTS: With treatment, there was a significant improvement in the majority of patients in sleep quality, daytime sleepiness, physical fatigue, and depression; however, significant improvements lasted for up to 10 mo only in sleep quality. Partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, and oxyhemoglobin saturation remained stable or even improved for up to 7 mo during use of part-time noninvasive positive-pressure ventilation. A total of 14 patients had survival prolonged by continuous dependence on noninvasive positive-pressure ventilation. CONCLUSIONS: Noninvasive positive-pressure ventilation provides a long-lasting benefit on symptoms and quality of life indicators for amyotrophic lateral sclerosis patients and should be offered to all patients with symptoms of sleep disordered breathing or inspiratory muscle dysfunction. It can also prolong tracheostomy-free survival.