Assemblage of benthic foraminifera in sediment core GIK23414-8

Marine isotope stage (MIS) 9 is one of the least investigated Pleistocene interglaciations. The present study describes reconstructions of deepwater conditions during this time interval based on benthic foraminiferal assemblages from sediment core M23414 (Rockall Plateau, North Atlantic). The results of faunal analysis were supported by planktic d18O, sea surface temperature reconstructions based on planktic foraminiferal assemblages and content of ice rafted debris. Statistical data processing using principal component analysis revealed five climaterelated benthic foraminiferal associations that changed in response to alterations of deepwater circulation.

Sea-surface reconstructions of the western Pacific Ocean during the last 5.3 million years

The late Neogene was a time of cryosphere development in the northern hemisphere. The present study was carried out to estimate the sea surface temperature (SST) change during this period based on the quantitative planktonic foraminiferal data of 8 DSDP sites in the western Pacific. Target factor analysis has been applied to the conventional transfer function approach to overcome the no-analog conditions caused by evolutionary faunal changes. By applying this technique through a combination of time-slice and time-series studies, the SST history of the last 5.3 Ma has been reconstructed for the low latitude western Pacific. Although the present data set is close to the statistical limits of factor analysis, the clear presence of sensible variations in individual SST time-series suggests the feasibility and reliability of this method in paleoceanographic studies. The estimated SST curves display the general trend of the temperature fluctuations and reveal three major cool periods in the late Neogene, i.e. the early Pliocene (4.7 3.5 Ma), the late Pliocene (3.1-2.7 Ma), and the latest Pliocene to early Pleistocene (2.2-1.0 Ma). Cool events are reflected in the increase of seasonality and meridional SST gradient in the subtropical area. The latest Pliocene to early Pleistocene cooling is most important in the late Neogene climatic evolution. It differs from the previous cool events in its irreversible, steplike change in SST, which established the glacial climate characteristic of the late Pleistocene. The winter and summer SST decreased by 3.3-5.4°C and 1.0 2.1C in the subtropics, by 0.9°C and 0.6C in the equatorial region, and showed little or no cooling in the tropics. Moreover, this cooling event occurred as a gradual SST decrease during 2.2 1.0 Ma at the warmer subtropical sites, while that at cooler subtropical site was an abrupt SST drop at 2.2 Ma. In contrast, equatorial and tropical western Pacific experienced only minor SST change in the entire late Neogene. In general, subtropics was much more sensitive to climatic forcing than tropics and the cooling events were most extensive in the cooler subtropics. The early Pliocene cool periods can be correlated to the Antarctic ice volume fluctuation, and the latest Pliocene early Pleistocene cooling reflects the climatic evolution during the cryosphere development of the northern hemisphere.

(Table 2) Seasonal flux data and percentages of major bulk components of total flux at the mesotrophic sediment trap site CB from 1988 - 2012

A more than two-decadal sediment trap record from the Eastern Boundary Upwelling Ecosystem (EBUE) off Cape Blanc, Mauritania, is analysed with respect to deep ocean mass fluxes, flux components and their variability on seasonal to decadal timescales. The total mass flux revealed interannual fluctuations which were superimposed by fluctuations on decadal timescales. High winter fluxes of biogenic silica (BSi), used as a measure of marine production (mostly by diatoms) largely correspond to a positive North Atlantic Oscillation (NAO) index (December-March). However, this relationship is weak. The highest positive BSi anomaly was in winter 2004-2005 when the NAO was in a neutral state. More episodic BSi sedimentation events occurred in several summer seasons between 2001 and 2005, when the previous winter NAO was neutral or even negative. We suggest that distinct dust outbreaks and deposition in the surface ocean in winter and occasionally in summer/autumn enhanced particle sedimentation and carbon export on short timescales via the ballasting effect. Episodic perturbations of the marine carbon cycle by dust outbreaks (e.g. in 2005) might have weakened the relationships between fluxes and large-scale climatic oscillations. As phytoplankton biomass is high throughout the year, any dry (in winter) or wet (in summer) deposition of fine-grained dust particles is assumed to enhance the efficiency of the biological pump by incorporating dust into dense and fast settling organic-rich aggregates. A good correspondence between BSi and dust fluxes was observed for the dusty year 2005, following a period of rather dry conditions in the Sahara/Sahel region. Large changes of all bulk fluxes occurred during the strongest El Niño-Southern Oscillation (ENSO) in 1997-1999 where low fluxes were obtained for almost 1 year during the warm El Niño and high fluxes in the following cold La Niña phase. For decadal timescales, Bakun (1990) suggested an intensification of coastal upwelling due to increased winds (''Bakun upwelling intensification hypothesis''; Cropper et al., 2014) and global climate change. We did not observe an increase of any flux component off Cape Blanc during the past 2 and a half decades which might support this. Furthermore, fluxes of mineral dust did not show any positive or negative trends over time which might suggest enhanced desertification or ''Saharan greening'' during the last few decades.

Incisión fluvial del río Darro durante el periodo 1890-2010 en el sector urbano de Granada (Alambra-Valparaíso, España) determinada a partir de fotografías históricas

En este trabajo se calcula la tasa media de incisión fluvial del río Darro (Granada, España) durante el periodo 1890-2010 en su tramo urbano (sector Alhambra-Valparaíso). Para ello se han utilizado fotografías históricas en las que aparece dicho río, a partir de las cuales se ha podido determinar la posición del cauce en el momento en el que se realizaron las fotografías. La comparación con los escenarios actuales de tales imágenes ha permitido determinar la diferencia de altura del cauce a través de medidas de cotas absolutas realizadas mediante teodolito. Esta metodología ha permitido estimar de modo cuantitativo un índice de encajamiento vertical medio del río de 1,05 cm/año para el periodo histórico considerado.

Graph analysis of verbal fluency test discriminate between patients with Alzheimer’s disease, Mild Cognitive Impairment and normal elderly controls

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment – subtypes amnestic(aMCI) and amnestic multiple domain (a+mdMCI) - and patients with Alzheimer’s disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGAs). The individuals were compared when divided in three (NC – MCI – AD) and four (NC – aMCI – a+mdMCI – AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Metodologias de planeamento e gestão de stocks numa empresa vinícola

O planeamento e gestão de stocks assume uma enorme relevância no contexto empresarial para que se possa responder de forma eficaz às flutuações do mercado e, consequentemente aumentar a produtividade e competitividade da empresa. O presente estudo foi desenvolvido numa empresa do setor vitivinícola português e tem como objetivo estudar os processos de gestão de stocks da mesma, de forma a melhorar os seus resultados operacionais. Mais especificamente, pretende-se elaborar um plano de gestão de stocks para que se possam definir políticas que se adequem a cada produto de forma a evitar quebras de stocks. Para alcançar os objetivos, considerou-se a seguinte metodologia: (1) análise da procura de produtos; (2) perceber de que forma se comporta a procura ao longo do ano; (3) definição do tipo de política de planeamento a ser adotada para cada grupo de produtos; (4) cálculo das quantidades de stock a produzir e o intervalo de tempo entre cada produção e (5) verificação da operacionalidade do plano de intervenção de modo a melhorar o planeamento da produção. As propostas de intervenção passaram pela implementação de políticas de gestão de stocks, nomeadamente a política de ponto de encomenda e a política de revisão cíclica. Passaram também pelo estudo da sazonalidade das vendas dos diferentes tipos de vinho de forma a facilitar o planeamento da preparação de espumantes. Embora as propostas não tenham sido postas em prática, são discutidas as vantagens e desvantagens das mesmas, bem como apresentadas propostas de melhoria.

Constructing strongly-MDS convolutional codes with maximum distance profile

This paper revisits strongly-MDS convolutional codes with maximum distance profile (MDP). These are (non-binary) convolutional codes that have an optimum sequence of column distances and attains the generalized Singleton bound at the earliest possible time frame. These properties make these convolutional codes applicable over the erasure channel, since they are able to correct a large number of erasures per time interval. The existence of these codes have been shown only for some specific cases. This paper shows by construction the existence of convolutional codes that are both strongly-MDS and MDP for all choices of parameters.

The parallel solution of early-exercise Asian options with stochastic volatility

This paper describes an parallel semi-Lagrangian finite difference approach to the pricing of early exercise Asian Options on assets with a stochastic volatility. A multigrid procedure is described for the fast iterative solution of the discrete linear complementarity problems that result. The accuracy and performance of this approach is improved considerably by a strike-price related analytic transformation of asset prices. Asian options are contingent claims with payoffs that depend on the average price of an asset over some time interval. The payoff may depend on this average and a fixed strike price (Fixed Strike Asians) or it may depend on the average and the asset price (Floating Strike Asians). The option may also permit early exercise (American contract) or confine the holder to a fixed exercise date (European contract). The Fixed Strike Asian with early exercise is considered here where continuous arithmetic averaging has been used. Pricing such an option where the asset price has a stochastic volatility leads to the requirement to solve a tri-variate partial differential inequation in the three state variables of asset price, average price and volatility (or equivalently, variance). The similarity transformations [6] used with Floating Strike Asian options to reduce the dimensionality of the problem are not applicable to Fixed Strikes and so the numerical solution of a tri-variate problem is necessary. The computational challenge is to provide accurate solutions sufficiently quickly to support realtime trading activities at a reasonable cost in terms of hardware requirements.

A concepção estrutural como expressão plástica: um olhar tectônico sobre arquitetura em madeira

This work regards to the structural conception as a formal element of design in wood architecture. On this approach, the group of projects studied is formed by some realized works of two important Brazilian architects: Severiano Porto and Marcos Acayaba. The time interval comprises the period from 1971 to 1997, which correspond respectively to the years of the creation of first and the last of the analyzed constructions. The research perspective concerns to the relationship between the parts, the whole and the building techniques adopted in each project. Moreover, the analysis focuses on the structure as the link among the different projectual ideas. Thus, the research method firstly includes a survey of specific bibliographies and documents which refer to the structural conception in wood architecture. Secondly,the buildings are analyzed according to the methods of architectural composition discussed through this work.

Cimentos convencionais e adesivos na cimentação final em prótese fixa

Os cimentos dentários na função de preencher a interface entre a superfície dentária e superfície interna da prótese nos coloca frente a uma diversidade de substratos e técnicas. O presente trabalho visou rever conceitos associados aos cimentos dentários, a evolução destes materiais junto aos diferentes sistemas cerâmicos e suas limitações no seu universo bem como a estratégia da sua aplicação em superfícies resistentes ou não ao ácido condicionante. Para alcançar a resposta de qual o melhor método na escolha de um material para cimentação de próteses fixas, este trabalho também apresenta uma comparação entre os cimentos dentários convencionais e resinosos. Este trabalho consiste numa revisão bibliográfica de forma a pesquisar de forma geral os cimentos de uso na medicina dentária. Foi realizada uma pesquisa, em abril de 2016, nas bases de dados da PubMed e B-on e em obras de caráter científico com o intuito de recolher informações sobre o assunto em um intervalo temporal de 10 anos. Os critérios escolhidos foram casos clínicos, revisão de literatura e estudos in vitro, segundo o seu rigor científico e interesse para o tema. O resultado sobre os testes de resistência utilizados nos estudos, os testes de aderência do cimento ao dente podem variar amplamente. O tratamento de superfícies e a evolução tecnológica podem ser eficazes na escolha desses materiais, bem como a comparação dos tipos de falhas que ocorrem na interface adesivas. A conclusão que se obteve é que os materiais raramente são comparados com um padrão e muitas vezes as condições experimentais variam.

DISPATCHING AND RELOCATION OF EMERGENCY VEHICLES ON FREEWAYS: THEORIES AND APPLICATIONS

Resource allocation decisions are made to serve the current emergency without knowing which future emergency will be occurring. Different ordered combinations of emergencies result in different performance outcomes. Even though future decisions can be anticipated with scenarios, previous models follow an assumption that events over a time interval are independent. This dissertation follows an assumption that events are interdependent, because speed reduction and rubbernecking due to an initial incident provoke secondary incidents. The misconception that secondary incidents are not common has resulted in overlooking a look-ahead concept. This dissertation is a pioneer in relaxing the structural assumptions of independency during the assignment of emergency vehicles. When an emergency is detected and a request arrives, an appropriate emergency vehicle is immediately dispatched. We provide tools for quantifying impacts based on fundamentals of incident occurrences through identification, prediction, and interpretation of secondary incidents. A proposed online dispatching model minimizes the cost of moving the next emergency unit, while making the response as close to optimal as possible. Using the look-ahead concept, the online model flexibly re-computes the solution, basing future decisions on present requests. We introduce various online dispatching strategies with visualization of the algorithms, and provide insights on their differences in behavior and solution quality. The experimental evidence indicates that the algorithm works well in practice. After having served a designated request, the available and/or remaining vehicles are relocated to a new base for the next emergency. System costs will be excessive if delay regarding dispatching decisions is ignored when relocating response units. This dissertation presents an integrated method with a principle of beginning with a location phase to manage initial incidents and progressing through a dispatching phase to manage the stochastic occurrence of next incidents. Previous studies used the frequency of independent incidents and ignored scenarios in which two incidents occurred within proximal regions and intervals. The proposed analytical model relaxes the structural assumptions of Poisson process (independent increments) and incorporates evolution of primary and secondary incident probabilities over time. The mathematical model overcomes several limiting assumptions of the previous models, such as no waiting-time, returning rule to original depot, and fixed depot. The temporal locations flexible with look-ahead are compared with current practice that locates units in depots based on Poisson theory. A linearization of the formulation is presented and an efficient heuristic algorithm is implemented to deal with a large-scale problem in real-time.

Iron mineral structure, reactivity, and isotopic composition in a South Pacific Gyre ferromanganese nodule over 4 Ma

Deep-sea ferromanganese nodules accumulate trace elements from seawater and underlying sediment porewaters during the growth of concentric mineral layers over millions of years. These trace elements have the potential to record past ocean geochemical conditions. The goal of this study was to determine whether Fe mineral alteration occurs and how the speciation of trace elements responds to alteration over ∼3.7 Ma of marine ferromanganese nodule (MFN) formation, a timeline constrained by estimates from 9Be/10Be concentrations in the nodule material. We determined Fe-bearing phases and Fe isotope composition in a South Pacific Gyre (SPG) nodule. Specifically, the distribution patterns and speciation of trace element uptake by these Fe phases were investigated. The time interval covered by the growth of our sample of the nodule was derived from 9Be/10Be accelerator mass spectrometry (AMS). The composition and distribution of major and trace elements were mapped at various spatial scales, using micro-X-ray fluorescence (μXRF), electron microprobe analysis (EMPA), and inductively coupled plasma mass spectrometry (ICP-MS). Fe phases were characterized by micro-extended X-ray absorption fine structure (μEXAFS) spectroscopy and micro-X-ray diffraction (μXRD). Speciation of Ti and V, associated with Fe, was measured using micro-X-ray absorption near edge structure (μXANES) spectroscopy. Iron isotope composition (δ56/54Fe) in subsamples of 1-3 mm increments along the radius of the nodule was determined with multiple-collector ICP-MS (MC-ICP-MS). The SPG nodule formed through primarily hydrogeneous inputs at a rate of 4.0 ± 0.4 mm/Ma. The nodule exhibited a high diversity of Fe mineral phases: feroxyhite (δ-FeOOH), goethite (α-FeOOH), lepidocrocite (γ-FeOOH), and poorly ordered ferrihydrite-like phases. These findings provide evidence that Fe oxyhydroxides within the nodule undergo alteration to more stable phases over millions of years. Trace Ti and V were spatially correlated with Fe and found to be adsorbed to Fe-bearing minerals. Ti/Fe and V/Fe ratios, and Ti and V speciation, did not vary along the nodule radius. The δ56/54Fe values, when averaged over sample increments representing 0.25 to 0.75 Ma, were homogeneous within uncertainty along the nodule radius, at -0.12 ± 0.07 ‰ (2sd, n=10). Our results indicate that the Fe isotope composition of the nodule remained constant during nodule growth and that mineral alteration did not affect the primary Fe isotope composition of the nodule. Furthermore, the average δ56/54Fe value of -0.12 ‰ we find is consistent with Fe sourced from continental eolian particles (dust). Despite mineral alteration, the trace element partitioning of Ti and V, and Fe isotope composition, do not appear to change within the sensitivity of our measurements. These findings suggest that Fe oxyhydroxides within hydrogenetic ferromanganese nodules are out of geochemical contact with seawater once they are covered by subsequent concentric mineral layers. Even though Fe-bearing minerals are altered, trace element ratios, speciation and Fe isotope composition are preserved within the nodule.

Graph analysis of verbal fluency test discriminate between patients with Alzheimer’s disease, Mild Cognitive Impairment and normal elderly controls

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment – subtypes amnestic(aMCI) and amnestic multiple domain (a+mdMCI) - and patients with Alzheimer’s disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGAs). The individuals were compared when divided in three (NC – MCI – AD) and four (NC – aMCI – a+mdMCI – AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Study of the development and evolution of seasonal thermocline and turbulent processes in the northern parts of Persian Gulf using numerical modeling

The Persian Gulf (PG) is a semi-enclosed shallow sea which is connected to open ocean through the Strait of Hormuz. Thermocline as a suddenly decrease of temperature in subsurface layer in water column leading to stratification happens in the PG seasonally. The forcing comprise tide, river inflow, solar radiation, evaporation, northwesterly wind and water exchange with the Oman Sea that influence on this process. In this research, analysis of the field data and a numerical (Princeton Ocean Model, POM) study on the summer thermocline development in the PG are presented. The Mt. Mitchell cruise 1992 salinity and temperature observations show that the thermocline is effectively removed due to strong wind mixing and lower solar radiation in winter but is gradually formed and developed during spring and summer; in fact as a result of an increase in vertical convection through the water in winter, vertical gradient of temperature is decreased and thermocline is effectively removed. Thermocline development that evolves from east to west is studied using numerical simulation and some existing observations. Results show that as the northwesterly wind in winter, at summer transition period, weakens the fresher inflow from Oman Sea, solar radiation increases in this time interval; such these factors have been caused the thermocline to be formed and developed from winter to summer even over the northwestern part of the PG. The model results show that for the more realistic monthly averaged wind experiments the thermocline develops as is indicated by summer observations. The formation of thermocline also seems to decrease the dissolved oxygen in water column due to lack of mixing as a result of induced stratification. Over most of PG the temperature difference between surface and subsurface increases exponentially from March until May. Similar variations for salinity differences are also predicted, although with smaller values than observed. Indeed thermocline development happens more rapidly in the Persian Gulf from spring to summer. Vertical difference of temperature increases to 9 centigrade degrees in some parts of the case study zone from surface to bottom in summer. Correlation coefficients of temperature and salinity between the model results and measurements have been obtained 0.85 and 0.8 respectively. The rate of thermcline development was found to be between 0.1 to 0.2 meter per day in the Persian Gulf during the 6 months from winter to early summer. Also it is resulted from the used model that turbulence kinetic energy increases in the northwestern part of the PG from winter to early summer that could be due to increase in internal waves activities and stability intensified through water column during this time.

Medizinische und gesundheitsökonomische Bewertung der Radiochirurgie zur Behandlung von Hirnmetastasen

Hintergrund: Für die Therapie maligner Neubildungen stellt die Strahlentherapie wichtige Behandlungsmöglichkeiten dar, die sich in den vergangenen Jahrzehnten deutlich weiterentwickelt haben. Hierzu gehört unter anderem die stereotaktische Radiochirurgie (SRS), die durch eine einmalige Applikation fokussierter hoher Strahlendosen in einem klar definierten Zeitraum gekennzeichnet ist. Von besonderer Bedeutung ist die SRS für die Behandlung von Hirnmetastasen. Fragestellung: Ziel dieses HTA-Berichts ist die Erstellung einer umfassenden Übersicht der aktuellen Literatur der Behandlung von Hirnmetastasen, um die Radiochirurgie als alleinige Therapie oder in Kombination mit Therapiealternativen bezüglich der medizinischen Wirksamkeit, Sicherheit und Wirtschaftlichkeit sowie ethischer, sozialer und juristischer Aspekte zu vergleichen. Methodik: Relevante Publikationen deutscher und englischer Sprache werden über eine strukturierte Datenbank- sowie mittels Handrecherche zwischen Januar 2002 und August 2007 identifiziert. Die Zielpopulation bilden Patienten mit einer oder mehreren Hirnmetastasen. Eine Beurteilung der methodischen Qualität wird unter Beachtung von Kriterien der evidenzbasierten Medizin (EbM) durchgeführt. Ergebnisse: Von insgesamt 1.495 Treffern erfüllen 15 Studien die medizinischen Einschlusskriterien. Insgesamt ist die Studienqualität stark eingeschränkt und mit Ausnahme von zwei randomisierte kontrollierte Studien (RCT) und zwei Metaanalysen werden ausschließlich historische Kohortenstudien identifiziert. Die Untersuchung relevanter Endpunkte ist uneinheitlich. Qualitativ hochwertige Studien zeigen, dass die Ergänzung der Ganzhirnbestrahlung (WBRT) zur SRS sowie der SRS zur WBRT mit einer verbesserten lokalen Tumorkontrolle und Funktionsfähigkeit einhergeht. Nur im Vergleich zur alleinigen WBRT resultiert die Kombination von SRS und WBRT jedoch bei Patienten mit singulären Hirnmetastasen, RPA-Klasse 1 (RPA = Rekursive Partitionierungsanalyse) und bestimmten Primärtumoren in verbesserter Überlebenszeit. Die Therapiesicherheit zeigt in beiden Fällen keine deutlichen Unterschiede zwischen den Interventionsgruppen. Methodisch weniger hochwertige Studien finden keine eindeutigen Unterschiede zwischen SRS und WBRT, SRS und Neurochirurgie (NC) sowie SRS und hypofraktionierter Strahlentherapie (HCSRT). Die Lebensqualität wird in keiner Studie untersucht. Durch die Datenbankrecherche werden 320 Publikationen für den ökonomischen Bereich identifiziert. Insgesamt werden fünf davon für den vorliegenden Health Technology Assessment (HTA)-Bericht verwendet. Die Qualität der Publikationen ist dabei unterschiedlich. Bezüglich der Wirtschaftlichkeit verschiedener Gerätealternativen ergibt sich, unter der Annahme gleicher Wirksamkeit, eine starke Abhängigkeit von der Anzahl der behandelten Patienten. Im Fall, dass die beiden Gerätealternativen nur für die SRS verwandt werden, liegen Hinweise vor, dass das Gamma Knife kostengünstiger sein kann. Andernfalls ist es sehr wahrscheinlich, dass der flexiblere modifizierte Linearbeschleuniger kostengünstiger ist. Nach einem HTA sind die Gesamtkosten für ein Gamma Knife und einen dedizierten Linearbeschleuniger ungefähr gleich, während ein modifizierter Linearbeschleuniger günstiger ist. Für ethische, juristische und soziale Fragestellungen werden keine relevanten Publikationen identifiziert. Diskussion: Insgesamt sind sowohl die Qualität als auch die Quantität identifizierter Studien stark reduziert. Es zeigt sich jedoch, dass die Prognose von Patienten mit Hirnmetastasen auch unter modernsten therapeutischen Möglichkeiten schlecht ist. Ausreichend starke Evidenz gibt es lediglich für die Untersuchung ergänzender WBRT zur SRS und der ergänzenden SRS zur WBRT. Ein direkter Vergleich von SRS und WBRT, SRS und NC sowie SRS und HCSRT ist hingegen nicht möglich. Die Wirtschaftlichkeit verschiedener Gerätealternativen hängt von der Patientenzahl und den behandelten Indikationen ab. Für ausgelastete dedizierte Systeme, liegen Hinweise vor, dass sie kostengünstiger sein können. Bei flexibler Nutzung scheinen modifizierte Systeme wirtschaftlich vorteilhafter. Diese Aussagen erfolgen unter der nicht gesicherten Annahme gleicher Wirksamkeit der Alternativen. Die Behandlungspräzision der Geräte kann Einfluss auf die Gerätewahl haben. Zu neueren Gerätealternativen wie z. B. dem CyberKnife liegen bisher keine Untersuchungen vor. Aus der wirtschaftlich vorteilhaften hohen Auslastung folgt aber eine begrenzte Geräteanzahl in einem vorgegebenen Gebiet, was evtl. einen gleichberechtigten, wohnortnahen Zugang zu dieser Technik erschwert. Schlussfolgerungen: Die Kombination SRS und WBRT geht mit einer verbesserten lokalen Tumorkontrolle und Funktionsfähigkeit gegenüber der jeweils alleinigen Therapie einher. Nur für Patienten mit singulärer Metastase resultiert dies in Vorteilen der Überlebenszeit. Qualitativ hochwertige Studien sind notwendig um die SRS direkt mit WBRT und NC zu vergleichen. Weiterhin sollte besonders die Lebensqualität in zukünftigen Studien mitberücksichtigt werden. Bei der Art des verwendeten Gerätes zeichnet sich eine deutliche Abhängigkeit der Wirtschaftlichkeit der Geräte von der erreichbaren Auslastung ab. Hohe Patientenzahlen bieten Vorteile für spezialisierte Systeme und bei geringeren Patientenzahlen ist die Flexibilität modifizierter System vorteilhaft. Weitere Studien z. B. zum CyberKnife sind wünschenswert. Insgesamt ist die Studienlage insbesondere für das deutsche Gesundheitssystem sehr mangelhaft.