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In the Federal Republic of Germany about 3 million people suffer from tinnitus/are hit by tinnitus, numerous of them depend on intensive medical care. The repetitive transcranial magnetic stimulation is considered to be an innovative and promising therapy in tinnitus treatment. Low frequency stimulation is meant to reduce the abnormal neural activity in the auditory cortex. This study focuses on the efficacy of rTMS with tinnitus patients in the course of a multi disciplinary / an interdisciplinary therapy concept.
From November 2008 to June 2009 29 outpatients with chronic tinnitus were treated by low frequency rTMS (1 Hz frequency, 2000 impulses, intensity 110%) for 10 proceedings, stimulating the sinistral auditory cortex with a figure-of-eight-coil. Prior to and afterwards the proceedings questionnaires and assessments of a psychologist took place, afterwards statistical analyses were conducted, the data was explored and systematically discussed.
The severity index of the tinnitus as well as the depression symptoms of the subjects improved significantly. The average reduction rate of the tinnitus score is set at 7 points. With a response criterion at the minimum of 5 points, 57% were declared as responder, 29% as non-responder and 4 patients (14%) described an increase of the tinnitus loudness/annoyance.
The results show that the rTMS works as a helpful treatment tool with tinnitus patients and should be considered as an option in the routine tinnitus treatment.
Patients with untreated obstructive sleep apnea often report depressive symptoms, such as low mood, loss of interest and reduction of drive. In this study we examined the frequency of significant depressive symptoms amongst patients with untreated obstructive sleep apnea over a one year period.
From January to December 2008 we screened 1260 consecutive patients with untreated obstructive sleep apnea (AHI > 9) seen at our Center for Sleep Medicine were screened for depression. Based on self-administered questionnaires, patients with significant depressive symptoms were defined as having either a BDI II score ≥ 14 or WHO-5 ≤ 13. Additionally, severity of depression was rated based on BDI II scores.
Depressive symptoms were reported frequently. Based on BDI-II, 27.9% of patients report significant depressive symptoms. Of these, 46.2% were mild, 35.9% moderate and 17.9% severe. In addition, 52.6% of patients self-reported feeling unwell based on their WHO-5 scores.
Significant depressive symptoms measured by standardised self-rating scales were detected in over a quarter of our patients with untreated sleep apnea. It remains unknown whether treatment of OSA alone abolishes depressive symptoms, or whether depressive mood may reduce the compliance with treatment. Patients may need an interdisciplinary approach to initial treatment.
The Clinic of Psychiatry and Psychotherapy of Nuremberg established rTMS as a standard tool in the treatment of patients with depressive disorder since 2001. The stimulation protocol was modified in October 2008 to match the current standard procedure reported in the literature. The pulse number was heightened form 800 to 2000 per proceeding. This study examines the effects of the modified stimulation protocol and contrasts the results with the former stimulation efficacy.
The authors compared patients suffering from depression, who were treated by rTMS with 800 pulses/day and with 2000 pulses/day. The results of psychological examinations (MADRS, HAMD, BDI, grading, cognitive screening) prior to and afterwards the three-weeks-rTMS-cycle were submitted. Variance analyses were used for statistical reason.
The subsamples were comparable by sex, age, premorbid intellectual level as well as by self- and other-rated depression severity at treatment beginning. Statistical analyses showed a significant reduction of the depression symptoms in both stimulation protocol groups. Solely the HAMD score reduction in the 2000 pulse sample exceeded the decrease in the 800 pulse sample. Analogically the grading of human functions partly differed depending on the sample affiliation. Concerning the screening of cognitive functioning neither group was impaired.
rTMS still seems to be a well-functioning tool in the treatment of depressive disorders in the bounds of daily psychiatric health care. Although the modified stimulation protocol didn’t show many advantages in respect to improving depression symptoms, the results indicate the continual adjustment of the stimulation parameter to meet the current standards.
The clinic of psychiatry and psychotherapy and the clinic of otolaryngology of the clinic of Nuremberg offer an interdisciplinary consultation for patients suffering from tinnitus aurium and comorbid major depression and/or insomnia.
Prediction variables are needed regarding the treatment of subjective ear noises by low frequency rTMS.
The aim of the present study was to examine
a) if rTMS responders and non-responders differ in significant parameters prior to the rTMS treatment
b) and if improvement of tinnitus complaints is associated with mood change.
From June 2008 to July 2010 109 outpatients with chronic tinnitus were treated with rTMS (1 Hz, 2000 impulses, intensity 110% motor-treshold, 10 proceedings, stimulation of left auditory cortex). Prior to and afterwards the proceedings clinical assessment regarding the severity of tinnitus (TQ) and depressive symptoms (BDI II, MADRS) took place.
Response to rTMS was defined as reduction in the TQ score of ≥ 5 points (54 responder, 18 female, 36 male; 55 non-responder, 16 female, 39 male). The samples did not differ in age (MR = 56,4, SDR = 13,3; MNR = 57,3, SDNR = 12,2). The subsamples differed significantly regarding depression symptoms before rTMS, as non-responder being more depressive than rTMS-responder (table 1; MADRS: p = 0.008 **; BDI II: p = 0.01**).
Furthermore there is a significant interaction between BDI and the response/non-response criterion indicating a higher decrease of depression symptoms in rTMS responders.
Anoplocephalid tapeworms of the genus Bertiella Stiles and Hassall, 1902 and Anoplocephala Blanchard, 1848, found in the Asian, African and American non-human primates are presumed to sporadic ape-to-man transmissions. Variable nuclear (5.8S-ITS2; 28S rRNA) and mitochondrial genes (cox1; nad1) of isolates of anoplocephalids originating from different primates (Callicebus oenanthe, Gorilla beringei, Gorilla gorilla, Pan troglodytes and Pongo abelii) and humans from various regions (South America, Africa, South-East Asia) were sequenced. In most analyses, Bertiella formed a monophyletic group within the subfamily Anoplocephalinae, however, the 28S rRNA sequence-based analysis indicated paraphyletic relationship between Bertiella from primates and Australian marsupials and rodents, which should thus be regarded as different taxa. Moreover, isolate determined as Anoplocephala cf. gorillae from mountain gorilla clustered within the Bertiella clade from primates. This either indicates that A. gorillae deserves to be included into the genus Bertiella, or, that an unknown Bertiella species infects also mountain gorillas. The analyses allowed the genetic differentiation of the isolates, albeit with no obvious geographical or host-related patterns. The unexpected genetic diversity of the isolates studied suggests the existence of several Bertiella species in primates and human and calls for revision of the whole group, based both on molecular and morphological data.
I offer a reading Sara Ruddick's account of feminist solidarity as grounded in her reconceptualization of “work” in order to suggest that she provides a framework for transnational feminist solidarity that offers an important augmentation to other contemporary theories of transnational feminist solidarity. Feminist solidarity, according to Ruddick, forms through struggles to work. But what she means by work has not been fully appreciated in the literature on Ruddick. Scholars who focus solely on maternal thinking or even the work of mothering obscure the fact that such work is just her prime example of the reconceptualized notion of work she develops. I unpack her notion of work and show how it functions in a theoretical account of transnational feminist solidarity and feminist resistance movements.
The ability to accurately measure body or carcass composition is important for performance testing, grading and finally selection or payment of meat-producing animals. Advances especially in non-invasive techniques are mainly based on the development of electronic and computer-driven methods in order to provide objective phenotypic data. The preference for a specific technique depends on the target animal species or carcass, combined with technical and practical aspects such as accuracy, reliability, cost, portability, speed, ease of use, safety and for in vivo measurements the need for fixation or sedation. The techniques rely on specific device-driven signals, which interact with tissues in the body or carcass at the atomic or molecular level, resulting in secondary or attenuated signals detected by the instruments and analyzed quantitatively. The electromagnetic signal produced by the instrument may originate from mechanical energy such as sound waves (ultrasound – US), ‘photon’ radiation (X-ray-computed tomography – CT, dual-energy X-ray absorptiometry – DXA) or radio frequency waves (magnetic resonance imaging – MRI). The signals detected by the corresponding instruments are processed to measure, for example, tissue depths, areas, volumes or distributions of fat, muscle (water, protein) and partly bone or bone mineral. Among the above techniques, CT is the most accurate one followed by MRI and DXA, whereas US can be used for all sizes of farm animal species even under field conditions. CT, MRI and US can provide volume data, whereas only DXA delivers immediate whole-body composition results without (2D) image manipulation. A combination of simple US and more expensive CT, MRI or DXA might be applied for farm animal selection programs in a stepwise approach.
The B fields in OB stars (BOB) survey is an ESO large programme collecting spectropolarimetric observations for a large number of early-type stars in order to study the occurrence rate, properties, and ultimately the origin of magnetic fields in massive stars. As of July 2014, a total of 98 objects were observed over 20 nights with FORS2 and HARPSpol. Our preliminary results indicate that the fraction of magnetic OB stars with an organised, detectable field is low. This conclusion, now independently reached by two different surveys, has profound implications for any theoretical model attempting to explain the field formation in these objects. We discuss in this contribution some important issues addressed by our observations (e.g., the lower bound of the field strength) and the discovery of some remarkable objects.
We present near-infrared spectro-interferometric studies of red supergiant (RSG) stars using the VLTI/AMBER instrument, which are compared to previously obtained similar observations of AGB stars. Our observations indicate spatially extended atmospheric molecular layers of water vapor and CO, similar as previously observed for Mira stars. Data of VY~CMa indicate that the molecular layers are asymmetric, possibly clumpy. Thanks to the spectro-interferometric capabilities of the VLTI/AMBER instrument, we can isolate continuum bandpasses, estimate fundamental parameters of our sources, locate them in the HR diagram, and compare their positions to recent evolutionary tracks. For the example of VY CMa, this puts it close to evolutionary tracks of initial mass 25-32 M⊙. Comparisons of our data to hydrostatic model atmospheres, 3d simulations of convection, and 1d dynamic model atmospheres based on self-excited pulsation models indicate that none of these models can presently explain the observed atmospheric extensions for RSGs. The mechanism that levitates the atmospheres of red supergiant is thus a currently unsolved problem.
This chapter provides an overview of Earth system models, the various model ‘flavours’, their state of development including model evaluation, benchmarking and optimization against observational data and their application to climate change issues.
The Earth system can be conceptualized as a suite of interacting physical, chemical, biological and anthropogenic processes that regulate the planet’s low of matter and energy. Earth system models (ESMs; Box 5.1 ) are built to mirror these processes. In fact, ESMs are the only tool available to the scientific community to investigate the system properties of the Earth, as we do not have an alternative planet to manipulate that could serve as a scientist’s laboratory.
The term ‘Earth system model’ is commonly used to describe coupled land–ocean–atmosphere models that include interactive biogeochemical components. Such models have developed progressively from the physical climate models first created in the 1960s and 1970s. Conventional climate models apply physical laws to simulate the general circulation of atmosphere and ocean. As our understanding of the natural and anthropogenic controls on climate has grown, and given the steady advances in computing power, global climate models have been extended to include more comprehensive representations of biological and geochemical processes, involving the addition of the various interacting components of the Earth system with their own feedback mechanisms. Figure 5.1 shows the conceptual differences between a conventional global coupled atmosphere–ocean general circulation model (AOGCM) and an ESM. In terms of the coupling between components, ESMs are more complex, and they have correspondingly higher computational demands.
This chapter provides a high-level summary of the state of knowledge regarding observations, processes and models of climate, terrestrial ecosystems and the global carbon cycle. We focus strongly on observations (at various timescales, including palaeo timescales as appropriate), and what can be learned from their interpretation in the light of the established principles of climate science and terrestrial ecosystem science. The field is very broad and therefore we have had to be highly selective. We discuss aspects pertinent to understanding recent and contemporary changes in climate and the global carbon cycle, with emphasis on the terrestrial component.
Observing and studying climate
Background and history of climate science
Like the weather, everyone has an interest in climate and knows something about it. Climate is generally understood as ‘average weather’. By definition, climate cannot change from year to year; but it can (and does) change over decades and centuries.
Until the 1970s, the study of climate was largely descriptive. The data were concentrated in certain regions, and often anecdotal. Nonetheless, as Lamb (1982) and others described, these data already showed the existence of a great deal of variability in climate on many timescales, and that this variability has had a pervasive impact on human societies.
Climate also has a dominant effect on ecosystems. The patterns of terrestrial biomes, from dense tropical forests to high-latitude and mountain tundra and deserts, reflect spatial patterns of average temperature and rainfall and show that climate has had a profound role in shaping the ecology and evolution of land plants. Relationships between vegetation and climate formed the basis for Köppen’s (1918) classification of world climates, which allowed climate to be inferred from vegetation at a time when direct climate observations were sparse.
In the spirit of cultivating environmental literacy we present the human–environment systems (HES) framework as a practical way to cope with the complexity of human–environment relationships. Its design and our suggestions for its use assume that most environmental problems are caused largely by human activities, a view that could be called the anthropocenic redefinition of the environment.
Our unveiling of the HES framework describes how it is a structure–process template or methodological guide for research about HES. The HES framework highlights how the HES Postulates offer principles that foster a comprehensive analysis of HES.
Next we describe how the HES framework offers principles for environmental research and transdisciplinary processes. After an initial phase of formulating a guiding question and defining system boundaries, a first step is to conduct an analysis of the environmental situation (as stated by the Environment-first Postulate P7), which is a typical subject of transdisciplinary processes.
Environmental literacy and coping with complex environmental problems can be viewed as knowledge- and experience-based artwork.
A major challenge of research on human–environment systems (HES) is to define the guiding question and system boundaries adequately, to reduce complexity by identifying the relevant actors and the relevant human and environmental system, gaining access to potentially conflicting drivers in and between human systems, and identifying with and coping feedback loops linked to decisions. This chapter shows by four exemplary cases how the HES framework can be utilized for this venture.