Peptide receptor radionuclide therapy for patients with somatostatin receptor expressing tumours. German Guideline (S1).

This document describes the guideline for peptide receptor radionuclide therapy (PRRT) published by the German Society of Nuclear Medicine (DGN) and accepted by the Association of the Scientific Medical Societies in Germany (AWMF) to be included in the official AWMF Guideline Registry. These recommendations are a prerequisite for the quality management in the treatment of patients with somatostatin receptor expressing tumours using PRRT. They are aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRT and to deliver the treatment in a safe and effective manner. The recommendations are based on an interdisciplinary consensus. The document contains background information and definitions and covers the rationale, indications and contraindications for PRRT. Essential topics are the requirements for institutions performing the therapy, e. g. presence of an expert for medical physics, intense cooperation with all colleagues involved in the treatment of a patient, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how treatment has to be carried out technically. Here, quality control and documentation of labelling are of great importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with the involved medical disciplines. Generally, the decision for PRRT should be undertaken within the framework of a multi-disciplinary tumour board.

Sind die empirischen Ergebnisse zum Umweltverhalten Artefakte? Ein Beitrag zum Problem der Messung von Umweltverhalten

In Untersuchungen zum Umweltbewusstsein und Umweltverhalten werden die zentralen Variablen in der Regel auf der Basis von Selbstauskünften und mittels Itembatterien erhoben. Fraglich ist dabei, ob die Items zur Messung ökologischen Handelns mehr als nur \"symbolisches Verhalten\" erfassen. Bodenstein, Spiller und Elbers (1997) haben kürzlich einen Index vorgeschlagen, der sich am tatsächlichen Energie- und Materialverbrauch eines Haushalts orientiert. Wir vergleichen dieses Konzept mit anderen Skalen und untersuchen empirisch anhand der Daten des Surveys \"Umweltbewusstsein in Deutschland 1998\", in welchem Ausmaß die Ergebnisse von Regressionsmodellen des Umwelthandelns von den jeweils zugrunde gelegten Skalen abhängen. Es zeigt sich, dass gerade bezüglich der zentralen Determinanten \"Umweltbewusstsein\" und \"Einkommen\" beträchtliche Unterschiede bestehen.

Grenzen des Machbaren. Was Pilgerwege erfolgreich macht

Auch in Deutschland versuchen immer mehr Touristiker vom Pilgerboom zu profitieren. Die neuen Wege werden oft nur wenig genutzt. Wer versteht, was Pilgern ausmacht, kann auch erfolgreich agieren. Auf Basis eines empirischen Forschungsprojektes entfaltet der Beitrag das Spezifikum des Pilgerns als einen bestimmten Erfahrungsmodus: Pilger erfahren sich selbst eingebunden in den Zusammenhang des Seins, einen sie tragenden Grund. Es geht um ein Unverfügbares, dem sie sich überlassen, weil es Gewissheit stiftet. Dies setzt dem touristischen Inszenieren enge Grenzen. Werden diese beachtet, entstehen nachhaltige und erfahrungswirksame Pilgerwege. Schlagworte: Pilgern, Erfahrung, Körper, Natur

Effects of forest management on bryophyte communities on deadwood

Epixylic bryophytes are important components of forest vegetation but are currently endangered by increment of wood harvest and intensive forest management. In this paper we present a study about the relationship between forest management, deadwood abundance, deadwood attributes and species richness of epixylic bryophytes on 30 plots comprising three forest types (managed coniferous, managed deciduous and unmanaged deciduous forests) in three regions in Germany. Additionally we analyzed the relations between deadwood attributes (wood species, decay, deadwood type, size) and bryophytes on deadwood items (n = 799) and calculated species interaction networks of wood species and bryophytes. Overall, species richness of epixylic bryophytes was positively related to deadwood abundance and diversity. The mean deadwood abundance was lowest in unmanaged forests (9.7 m³ ha^-1) compared with 15.0 m³ ha^-1 in managed deciduous and 25.1 m³ ha^-1 in managed coniferous forests. Accordingly, epixylic bryophyte species richness per plot increased from 7 species per 400 m 2 in unmanaged, 10 in managed deciduous and 16 in managed coniferous forests. The interaction network provided evidence of importance of tree-species diversity for bryophyte diversity and the relevance of particular wood species for rare bryophytes.

Generally, the results demonstrate a considerable lack of deadwood in all forest types, even in unmanaged forests. Species richness of epixylic bryophytes was strongly limited by available substrates within the observed deadwood abundance ranging up to only 60 m³ ha^-1. Altogether, this suggests a high demand to increase both abundance and diversity of deadwood in forests.

A survey of warning colours of pesticides

Pesticides are used to protect plants all over the world. Their increasing specificity has been due to utilization of differences in biochemical processes, and has been accompanied by lower human toxicity. Nevertheless cases of poisoning are still observed. While certain toxic substances are provided with characteristic dyes or pigments to facilitate easy identification, no overview of pesticide colors exists. The lack of available product information prompted us to explore the colors and dyes of pesticides registered in Germany, most of which are commercially available worldwide. A compilation of the colors and odors of 207 pesticide products is presented. While some of the substances can be identified by their physical characteristics, in other cases, the range of possibilities can be narrowed by their nature and color.

Good intents but low impacts: Various determinants for different indicators of overall energy use

Energy consumption in industrialized countries by far exceeds a sustainable level. Previous research on determinants of overall consumption levels has yielded contradictory results as to what the main drivers are. While research on the relationship of environmental concerns and pro-environmental behavior emphasizes the importance of motivational aspects, more impact-oriented research challenges these findings and underlines the impacts of a person’s social standing. The aim of our research was to determine which amount of per-capita energy consumption can be explained by structural, socio-demographic, and pro-environmentally motivational variables. Data come from standardized interviews with a representative sample (N=1014) in Germany. Different indicators of per-capita use were collected and will provide the basis for calculating the overall consumption level. In addition, person variables, lifestyle milieus, self-reported energy use, and motivational variables were assessed. First regression analyses show various patterns of determinants for different indicators of overall energy use. While variance in self-reported use is mainly explained by environmental concern, more impact-oriented indicators, such as the size of personal living space and distances of vacation trips, predominantly correlate with status-relevant predictors. These preliminary results support the suspicion that although environmentally aware people intend to reduce their energy use, they rarely go beyond low-impact actions.

Value Priorities and Content of Religiosity - New Research Perspectives

In this study the relationship of religiosity and value priorities is differentiated, based on a multidimensional measurement of different contents of religiosity. The structure of values is conceptualized using Schwartz’ (1992) two orthogonal dimensions of Self-transcendence vs. Self-enhancement and Openness to change vs. Conservation. The relations between these two dimensions and eight religious contents, ranging from open-minded to more close-minded forms of religiosity, were tested in a sample of church attenders (N = 685), gathered in Germany. The results show, that depending on the content of religiosity, different values are preferred (self-direction, universalism, benevolence, tradition and security values). The results indicate the importance of the content of religiosity for predicting value-loaded behaviors.

A new universal, standardized implant database for product identification: a unique tool for arthroplasty registries.

INTRODUCTION Every joint registry aims to improve patient care by identifying implants that have an inferior performance. For this reason, each registry records the implant name that has been used in the individual patient. In most registries, a paper-based approach has been utilized for this purpose. However, in addition to being time-consuming, this approach does not account for the fact that failure patterns are not necessarily implant specific but can be associated with design features that are used in a number of implants. Therefore, we aimed to develop and evaluate an implant product library that allows both time saving barcode scanning on site in the hospital for the registration of the implant components and a detailed description of implant specifications. MATERIALS AND METHODS A task force consisting of representatives of the German Arthroplasty Registry, industry, and computer specialists agreed on a solution that allows barcode scanning of implant components and that also uses a detailed standardized classification describing arthroplasty components. The manufacturers classified all their components that are sold in Germany according to this classification. The implant database was analyzed regarding the completeness of components by algorithms and real-time data. RESULTS The implant library could be set up successfully. At this point, the implant database includes more than 38,000 items, of which all were classified by the manufacturers according to the predefined scheme. Using patient data from the German Arthroplasty Registry, several errors in the database were detected, all of which were corrected by the respective implant manufacturers. CONCLUSIONS The implant library that was developed for the German Arthroplasty Registry allows not only on-site barcode scanning for the registration of the implant components but also its classification tree allows a sophisticated analysis regarding implant characteristics, regardless of brand or manufacturer. The database is maintained by the implant manufacturers, thereby allowing registries to focus their resources on other areas of research. The database might represent a possible global model, which might encourage harmonization between joint replacement registries enabling comparisons between joint replacement registries.

Effekte des generischen Maskulinums und alternativer Sprachformen auf den gedanklichen Einbezug von Frauen

In der feministischen Linguistik wird angenommen, daß maskuline Bezeichnungen, die generisch benutzt werden (Bezeichnungen von Personen beiderlei Geschlechts durch die maskuline Form, wie z.B. die Wissenschaftler, die Studenten), weibliche Personen weniger vorstellbar oder sichtbar machen als männliche Personen. Verschiedene experimentelle Untersuchungen konnten diese Annahme für den englischen Sprachraum bestätigen. Für die deutsche Sprache existieren dagegen bislang sehr wenige Studien zu dieser Frage. Es werden vier Experimente vorgestellt, die untersuchen, ob unterschiedliche Sprachversionen - ,Beidnennung‘ (Studentinnen und Studenten), ,Neutral‘ (Studierende), ,Generisches Maskulinum‘ (Studenten) und “Großes I“ (StudentInnen) - den gedanklichen Einbezug von Frauen beeinflussen. Über alle Experimente hinweg zeigte sich, daß bei Personenreferenzen im generischen Maskulinum ein geringerer gedanklicher Einbezug von Frauen zu beobachten war als bei alternativen Sprachformen wie der Beidnennung oder dem “Großen I“ (z.B. seltenere Nennungen von beliebten weiblichen Persönlichkeiten oder von politischen Kandidatinnen für das Amt des Bundeskanzlers/der Bundeskanzlerin der BRD).

Sexual harassment over the telephone: Occupational risk at call centers

The phenomenon of sexually harassing telephone calls in the workplace has been studied only marginally. In the present study 106 employees working in call centres in Germany answered a questionnaire regarding their experiences of sexual harassment over the telephone. The following data are presented: description of the phenomenon, i.e. prevalence and characteristics, stress reactions of the victims, behavioural reactions and coping strategies, consequences and anticipated consequences; prediction of the stress reactions by characteristics of the situation; and employees' recommendations for coping with sexually harassing calls. It was found that the female employees were more often sexually harassed over the telephone at work than their male colleagues. Three out of four female employees had experienced sexually harassing telephone calls; in the majority of cases the harassers were men. Characteristic patterns of harassment included groaning, sexual insults, silence, and threats of sexual violence. Some 16% of the harassed female employees described these experiences as extremely stressful. If the harassment contained threats of sexual violence and groaning, the perceived physical response was stronger. Being subjected to sexual harassment over the telephone both at home and at work was a more severe stress than having the experience only in the workplace. In conclusion, employees' recommendations for coping with the occurrence of sexually harassing calls are described.

Sexuelle Belästigung am Telefon: Definition, Prävalenz, Formen und Verarbeitung

Sexuelle Belästigung am Telefon ist ein in der bisherigen sozialwissenschaftlichen Forschung vernachlässigtes Alltagsphänomen. Die vorliegende Studie zur Analyse dieses Phänomens wurde repräsentativ für Deutschland durchgeführt. In der ersten Phase der Studie wurde eine Ausgangsstich-probe von mehr als 3000 Personen mündlich mittels eines Fragebogens zu unerwünschten Ereignissen am Telefon im vorangegangenen Jahr befragt. Die Ergebnisse zeigen, welche verschiedenen Formen von Belästigung in welchem Umfang vorkommen (Stöhnanrufe, sexuelle Beleidigungen etc.). Dabei wurden die Häufigkeit sowie das Ausmaß der durch die sexuelle Belästigung hervorgerufenen Belastung analysiert. In der zweiten Phase wurde den Personen, die im vorangegangenen Jahr oder jemals in ihrem Leben ein Ereignis am Telefon als sexuell belästigend erlebt hatten, ein ausführlicher Fragebogen zu der von ihnen erlebten Belästigung zur schriftlichen Beantwortung vorgegeben. Schwerpunkt war dabei die Analyse des Verarbeitungsprozesses. Die Ergebnisse zeigen, welches (verbreitete) unmittelbare emotionale und kognitive Reaktionen auf sexuelle Belästigung am Telefon sind (Angst, Ärger etc.) und welche Copingstrategien angewandt werden (Vermeidung, positive Selbstinstruktion, Informationssuche, Suche nach sozialer Unterstützung etc.). Dabei wurde untersucht, inwieweit attributions-, kontroll- und streßtheoretische Ansätze Vorhersagen für die Bewältigung dieser Erfahrung ermöglichen.

Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women.

Fertility-preservation techniques for medical reasons are increasingly offered in national networks. Knowledge of the characteristics of counselled patients and techniques used are essential. The FertiPROTEKT network registry was analysed between 2007 and 2013, and included up to 85 university and non-university centres in Germany, Austria and Switzerland; 5159 women were counselled and 4060 women underwent fertility preservation. In 2013, fertility-preservation counselling for medical reasons increased significantly among nullipara and women aged between 21 and 35 years (n = 1043; P < 0.001). Frequency of GnRH applications slowly decreased, whereas tissue, oocytes and zygote cryopreservation increased. In 2013, women with breast cancer mainly opted for tissue freezing, whereas women with lymphoma opted for GnRH agonist. Women younger than 20 years predominantly opted for GnRH agonists and ovarian tissue cryopreservation; women aged between 20 and 40 years underwent a variety of techniques; and women over 40 years opted for GnRH agonists. The average number of aspirated oocytes per stimulation cycle decreased as age increased (< 30 years: 12.9; 31-35 years: 12.3; 36-46: 9.0; > 41 years: 5.7). For ovarian tissue cryopreservation, removal and cryopreservation of fewer than one ovary was preferred and carried out in 97% of cases in 2013.

Fertility preservation for non-medical reasons: controversial, but increasingly common.

BACKGROUND Fertility-preserving measures for women are increasingly being performed for non-medical reasons in Germany. This is now a controversial matter. METHODS The authors searched the PubMed database for pertinent publications on the basis of their clinical and scientific experience and evaluated relevant data from the registry of the German FertiPROTEKT network (www.fertiprotekt. com). The various fertility-preserving measures that are available are described and critically discussed. RESULTS In most cases, the creation of a fertility reserve currently involves the cryopreservation of unfertilized oocytes, rather than of ovarian tissue. Most of the women who decide to undergo this procedure are over 35 years old. According to data from the FertiPROTEKT registry, most such procedures carried out in the years 2012 and 2013 involved a single stimulation cycle. The theoretical probability of childbirth per stimulation is 40% in women under age 35 and 30% in women aged 35 to 39. If the oocytes are kept for use at a later date, rather than at once, the maternal risk is higher, because the mother is older during pregnancy. The risk to the child may be higher as well because of the need for in vitro fertilization (IVF). Pregnancy over age 40 often leads to complications such as gestational diabetes and pre-eclampsia. IVF may be associated with a higher risk of epigenetic abnormalities. Ethicists have upheld women's reproductive freedom while pointing out that so-called social freezing merely postpones social problems, rather than solving them. CONCLUSION Fertility preservation for non-medical reasons should be critically discussed, and decisions should be made on a case-by-case basis.

Efficacy and safety of non-hormonal remedies for vaginal dryness: open, prospective, randomized trial

OBJECTIVES To prove non-inferiority of the first non-hormonal vaginal cream in Germany, Vagisan(®) Moisturising Cream (CREAM), compared to a non-hormonal vaginal gel (GEL) for vulvovaginal atrophy (VVA) symptom relief. METHOD This was a 12-week multicenter, open-label, prospective, randomized, two-period, cross-over phase-III trial. The primary endpoint was the cumulative VVA subjective symptom score of the respective treatment period. Secondary endpoints were assessment of single VVA subjective and objective symptoms, VVA objective symptom score, vaginal pH, safety parameters, overall assessment of efficacy, tolerability and evaluation of product properties. In total, 117 women were randomly allocated to either one of the two treatments, each administered for 4 weeks; 92 women were included in the per-protocol analysis (primary analysis). The main outcome measure was cumulative VVA subjective symptom score. RESULTS Regarding VVA symptom relief, results confirmed non-inferiority of CREAM compared to GEL and even indicated superiority of CREAM. Frequency and intensity of subjective symptoms and objective findings were clearly reduced, with CREAM showing better results compared to GEL. Mean VVA objective symptom score significantly decreased; improvement was significantly greater with CREAM. Vaginal pH decreased only following CREAM treatment. Tolerability was superior for CREAM: burning and itching, mostly rated as mild, occurred markedly less often with CREAM than with GEL. Overall satisfaction with treatment efficacy, tolerability and most product properties were rated significantly superior for CREAM. CONCLUSIONS Subjective and objective VVA symptoms were reliably and safely reduced by both non-hormonal topical products. However, efficacy and tolerability of CREAM were shown to be superior to GEL.

Less Oxygen, Later Intubation and Reduced Respiratory Pressures for ELBW Infants from 1997 to 2011.

INTRODUCTION Evidence concerning delivery room management in extremely low birth weight infants (ELBW) has grown substantially within the last 20 years, leading to several guidelines and recommendations. However, it is unknown in which extent local treatment strategies have changed and if they reflect current recommendations. METHODS A detailed questionnaire about treatment strategies for ELBW infants was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria and Switzerland. RESULTS on delivery room management were compared to the first survey. RESULTS In 1997 and 2011, 63.6 and 66.2% of the approached hospitals responded. In 2011 similar results were observed between university and non-university hospitals as well as NICUs of different size. Differences between Germany, Austria and Switzerland were minimal. Changes over time were a lower initially applied fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PiP) in 2011 compared to 1997. A longer time of apnea was tolerated before tracheal intubation is performed; the time of apnea was less frequently a sole criterion for intubation and surfactant was applied at lower FiO2 in 2011. The time of no thorax excursions and transport of the infant were considered an indication for intubation in 30.2 and 22.5%, and did not change in the observation period. CONCLUSION Treatment strategies for delivery room management in ELBW infants changed significantly between 1997 and 2011 and largely reflect current recommendations.