Internetbasierte psychologische Behandlung bei Depressionen

Depression ist die häufigste psychische Erkrankung, aber nur ein geringer Anteil der Betroffenen erhält eine angemessene Behandlung. Internetbasierte Interventionen stellen eine vielversprechende Ergänzung zu traditionellen Behandlungsformen dar, denn über das Internet können breite Bevölkerungsschichten mit wenig Aufwand erreicht werden. Die vorliegende Übersicht stellt den aktuellen Forschungsstand zu internetbasierten Interventionen bei Depressionen dar. Mehrere randomisierte kontrollierte Studien, Metaanalysen und Reviews legen nahe, dass mit strukturierten internetbasierten Interventionen, die regelmäßige Kontakte mit Therapeuten beinhalten (z.B. geleitete Selbsthilfeansätze, E-Mail- oder Chat-Therapien), Effekte erzielt werden können, die mit den Effekten von traditionellen Psychotherapien vergleichbar sind. Ungeleitete Selbsthilfeprogramme sind typischerweise mit hohen Abbrecherquoten und geringeren Effekten verbunden. Die zukünftige Forschung sollte sich vermehrt mit der Frage beschäftigen, wie internetbasierte Interventionen bei Depressionen optimal in die psychosoziale Versorgung integriert werden können. Mögliche Einsatzbereiche und die Einbettung internetbasierter Interventionen in das Versorgungssystem werden dargestellt und diskutiert.

Linking local knowledge, conservation practices and ecosystem diversity: comparing two communities in the Tunari National Park (Bolivia)

Combined approaches to conserve both biological and cultural diversity are seen as an alternative to classical nature conservation instruments. The objective of this study was to examine the influence of urbanization coupled with exclusive conservation measures, on land use, local knowledge and biodiversity in two Quechua speaking communities of Bolivia located within the Tunari National Park. We assessed and compared the links between land use, its transformation through conservation practices, local institutions and the worldviews of both communities and the implications they have for biodiversity at the level of ecosystems. Our results show that in both communities, people’s worldviews and environmental knowledge are linked with an integral and diversified use of their territory. However, the community most affected by urbanization and protected area regulations has intensified agriculture in a small area and has abandoned the use of large areas. This was accompanied by a loss of local environmental knowledge and a decrease in the diversity of ecosystems. The second community, where the park was not enforced, continues to manage their territory as a material expression of local environmental knowledge, while adopting community-based conservation measures with external support. Our findings highlight a case in which urbanization coupled with exclusive conservation approaches affects the components of both cultural and biological diversity. Actions that aim to enhance biocultural diversity in this context should therefore address the impact of factors identified as responsible for change in integrated social-ecological systems.

Opportunistic Routing for Multi-flow Video Dissemination over Flying Ad-Hoc Networks

A reliable and robust routing service for Flying Ad-Hoc Networks (FANETs) must be able to adapt to topology changes. User experience on watching live video sequences must also be satisfactory even in scenarios with buffer overflow and high packet loss ratio. In this paper, we introduce a Cross-layer Link quality and Geographical-aware beaconless opportunistic routing protocol (XLinGO). It enhances the transmission of simultaneous multiple video flows over FANETs by creating and keeping reliable persistent multi-hop routes. XLinGO considers a set of cross-layer and human-related information for routing decisions, as performance metrics and Quality of Experience (QoE). Performance evaluation shows that XLinGO achieves multimedia dissemination with QoE support and robustness in a multi-hop, multi-flow, and mobile network environments.

Dispelling the Myth: What Parents Really Think about Sex Education in Schools

Background: School-based sex education is effective in reducing risky sexual behavior among adolescents that may lead to unintended pregnancies and sexually transmitted infections. However, most sex education policies in the US do not support evidence-based programs. Understanding parental attitudes around sex education is crucial to overcoming perceived barriers to implementing school-based sex education. Little research has been published on the opinions of parents in Texas, which accounts for 12% of the nation’s teen births. Purpose: The purpose of this study was to examine whether Texas parents favor teaching sex education in schools, in what grades they think sex education should be taught, what content they think should be taught, and who they think should make decisions regarding sex education. Methods: We commissioned a telephone survey of parents of children 18 years or younger in Harris County, Texas. Survey questions assessed demographic characteristics and opinions about sex education. We used chi-square tests to examine differences across sociodemographic characteristics. Results: 1,201 parents completed the survey. The majority of parents (80%) responded that sex education should begin in middle school or earlier, and two-thirds said that it should include information about condoms and contraception. Hispanic parents showed the highest support for teaching sex education and providing medically accurate information on condoms and contraception in middle school or earlier. Conclusion: Parents in Harris County overwhelmingly support sex education that includes medically accurate information about condoms and contraception beginning before high school. These data provide evidence to change sex education policies to better reflect parental opinions.

BRAIN ACTIVATION AND CONNECTIVITY IN NON-DISABLED MULTIPLE SCLEROSIS PATIENTS

Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. There is no cure for MS and current therapies have limited efficacy. While the majority of individuals with MS develop significant clinical disability, a subset experiences a disease course with minimal impairment even in the presence of significant apparent tissue damage on magnetic resonance imaging (MRI). The current studies combined functional MRI and diffusion tensor imaging (DTI) to elucidate brain mechanisms associated with lack of clinical disability in patients with MS. Recent evidence has implicated cortical reorganization as a mechanism to limit the clinical manifestation of the disease. Functional MRI was used to test the hypothesis that non-disabled MS patients (Expanded Disability Status Scale ≤ 1.5) show increased recruitment of cognitive control regions (dorsolateral prefrontal and anterior cingulate cortex) while performing sensory, motor and cognitive tasks. Compared to matched healthy controls, patients increased activation of cognitive control brain regions when performing non-dominant hand movements and the 2-back working memory task. Using dynamic causal modeling, we tested whether increased cognitive control recruitment is associated with alterations in connectivity in the working memory functional network. Patients exhibited similar network connectivity to that of control subjects when performing working memory tasks. We subsequently investigated the integrity of major white matter tracts to assess structural connectivity and its relation to activation and functional integration of the cognitive control system. Patients showed substantial alterations in callosal, inferior and posterior white matter tracts and less pronounced involvement of the corticospinal tracts and superior longitudinal fasciculi (SLF). Decreased structural integrity within the right SLF in patients was associated with decreased performance, and decreased activation and connectivity of the cognitive control system when performing working memory tasks. These studies suggest that patient with MS without clinical disability increase cognitive control system recruitment across functional domains and rely on preserved functional and structural connectivity of brain regions associated with this network. Moreover, the current studies show the usefulness of combining brain activation data from functional MRI and structural connectivity data from DTI to improve our understanding of brain adaptation mechanisms to neurological disease.

Generalized resistance resources of informal caregivers: A study of demands for care, competing demands, perception of burden and cognitive stress

This study examines the relationship among psychological resources (generalized resistance resources), care demands (demands for care, competing demands, perception of burden) and cognitive stress in a selected population of primary family caregivers. The study utilizes Antonovsky's Salutogenic Model of Health, specifically the concept of generalized resistance resources (GRRs), to analyze the relative effect of these resources on mediating cognitive stress, controlling for other care demands. The study is based on a sample of 784 eligible caregivers who (1) were relatives, (2) had the main responsibility for care, defined as a primary caregiver, and (3) provided a scaled stress score for the amount of overall care given to the care recipient (family member). The sample was drawn from the 1982 National Long-Term Care Survey (NLTCS) of individuals who assisted a given NLTCS sample person with ADL limitations.^ The study tests the following hypotheses: (a) There will be a negative relationship between generalized resistance resources (GRRs) and cognitive stress controlling for care demands (demands for care, competing demands, and perceptions of burden); (b) of the specific GRRs (material, cognitive, social, cultural-environmental) the social domain will represent the most significant factor predicting a decrease in cognitive stress; and (c) the social domain will be more significant for the female than the male primary family caregiver in decreasing cognitive stress.^ The study found that GRRs had a statistically significant mediating effect on cognitive stress, but the GRRs were a less significant predictor of stress than perception of burden and demands for care. Thus, although the analysis supported the underlying hypothesis, the specific hypothesis regarding GRRs' greater significance in buffering cognitive stress was not supported. Second, the results did not demonstrate the statistical significance or differences among the GRR domains. The hypothesis that the social GRR domain was most significant in mediating stress of family caregivers was not supported. Finally, the results confirmed that there are differences in the importance of social support help in mediating stress based on gender. It was found that gender and social support help were related to cognitive stress and gender had a statistically significant interaction effect with social support help. Implications for clinical practice, public health policy, and research are discussed. ^

Internet-based individually versus group guided self-help treatment for social anxiety disorder: protocol of a randomized controlled trial

BACKGROUND: Social anxiety disorder (SAD) is one of the most common mental disorders and causes subjective suffering and economic burden worldwide. Although effective treatments are available, a lot of cases go untreated. Internet-based self-help is a low-threshold and flexible treatment alternative for SAD. Various studies have already shown that internet-based self-help can be effective to reduce social phobic symptoms significantly. Most of the interventions tested include therapist support, whereas the role of peer support within internet-based self-help has not yet been fully understood. There is evidence suggesting that patients' mutual exchange via integrated discussion forums can increase the efficacy of internet-based treatments. This study aims at investigating the added value of therapist-guided group support on the treatment outcome of internet-based self-help for SAD. METHODS/DESIGN: The study is conducted as a randomized controlled trial. A total of 150 adults with a diagnosis of SAD are randomly assigned to either a waiting-list control group or one of the active conditions. The participants in the two active conditions use the same internet-based self-help program, either with individual support by a psychologist or therapist-guided group support. In the group guided condition, participants can communicate with each other via an integrated, protected discussion forum. Subjects are recruited via topic related websites and links; diagnostic status will be assessed with a telephone interview. The primary outcome variables are symptoms of SAD and diagnostic status after the intervention. Secondary endpoints are general symptomology, depression, quality of life, as well as the primary outcome variables 6 months later. Furthermore, process variables such as group processes, the change in symptoms and working alliance will be studied. DISCUSSION: The results of this study should indicate whether group-guided support could enhance the efficacy of an internet-based self-help treatment for SAD. This novel treatment format, if shown effective, could represent a cost-effective option and could further be modified to treat other conditions, as well.

Context-aware Adaptation Mechanism for Video Dissemination over Flying Ad-Hoc Networks

The user experience on watching live video se- quences transmitted over a Flying Ad-Hoc Networks (FANETs) must be considered to drop packets in overloaded queues, in scenarios with high buffer overflow and packet loss rate. In this paper, we introduce a context-aware adaptation mechanism to manage overloaded buffers. More specifically, we propose a utility function to compute the dropping probability of each packet in overloaded queues based on video context information, such as frame importance, packet deadline, and sensing relevance. In this way, the proposed mechanism drops the packet that adds the minimum video distortion. Simulation evaluation shows that the proposed adaptation mechanism provides real-time multimedia dissemination with QoE support in a multi-hop, multi-flow, and mobile network environments.

Cardiac lipid levels show diurnal changes and long-term variations in healthy human subjects

(1) H-MRS is regularly applied to determine lipid content in ectopic tissue - mostly skeletal muscle and liver - to investigate physiological and/or pathologic conditions, e.g. insulin resistance. Technical developments also allow non-invasive in vivo assessment of cardiac lipids; however, basic data about methodological reliability (repeatability) and physiological variations are scarce. The aim of the presented work was to determine potential diurnal changes of cardiac lipid stores in humans, and to put the results in relation to methodological repeatability and normal physiological day-to-day variations. Optimized cardiac- and respiratory-gated (1) H-MRS was used for non-invasive quantification of intracardiomyocellular lipids (ICCL), creatine, trimethyl-ammonium compounds (TMA), and taurine in nine healthy young men at three time points per day on two days separated by one week. This design allowed determination of (a) diurnal changes, (b) physiological variation over one week and (c) methodological repeatability of the ICCL levels. Comparison of fasted morning to post-absorptive evening measurements revealed a significant 37 ± 19% decrease of ICCL during the day (p = 0.0001). There was a significant linear correlation between ICCL levels in the morning and their decrease during the day (p = 0.015). Methodological repeatability for the ICCL/creatine ratio was excellent, with a coefficient of variance of ~5%, whereas physiological variation was found to be considerably higher (22%) in spite of a standardized physiological preparation protocol. In contrast, TMA levels remained stable over this time period. The proposed (1) H-MRS technique provides a robust way to investigate relevant physiological changes in cardiac metabolites, in particular ICCL. The present results suggest that ICCL reveal a diurnal course, with higher levels in the morning as compared to evening. In addition, a considerable long-term variation of ICCL levels, in both the morning and evening, was documented. Given the high methodological repeatability, these effects should be taken into account in studies investigating the metabolic role of ICCL.

Adaptive Beaconless Opportunistic Routing for Multimedia Distribution

User experience on watching live videos must be satisfactory even under the inuence of different network conditions and topology changes, such as happening in Flying Ad-Hoc Networks (FANETs). Routing services for video dissemination over FANETs must be able to adapt routing decisions at runtime to meet Quality of Experience (QoE) requirements. In this paper, we introduce an adaptive beaconless opportunistic routing protocol for video dissemination over FANETs with QoE support, by taking into account multiple types of context information, such as link quality, residual energy, buffer state, as well as geographic information and node mobility in a 3D space. The proposed protocol takes into account Bayesian networks to define weight vectors and Analytic Hierarchy Process (AHP) to adjust the degree of importance for the context information based on instantaneous values. It also includes a position prediction to monitor the distance between two nodes in order to detect possible route failure.

An unusual stroke-like clinical presentation of Creutzfeldt-Jakob disease: acute vestibular syndrome

INTRODUCTION Vertigo and dizziness are common neurological symptoms in general practice. Most patients have benign peripheral vestibular disorders, but some have dangerous central causes. Recent research has shown that bedside oculomotor examinations accurately discriminate central from peripheral lesions in those with new, acute, continuous vertigo/dizziness with nausea/vomiting, gait unsteadiness, and nystagmus, known as the acute vestibular syndrome. CASE REPORT A 56-year-old man presented to the emergency department with acute vestibular syndrome for 1 week. The patient had no focal neurological symptoms or signs. The presence of direction-fixed, horizontal nystagmus suppressed by visual fixation without vertical ocular misalignment (skew deviation) was consistent with an acute peripheral vestibulopathy, but bilaterally normal vestibuloocular reflexes, confirmed by quantitative horizontal head impulse testing, strongly indicated a central localization. Because of a long delay in care, the patient left the emergency department without treatment. He returned 1 week later with progressive gait disturbance, limb ataxia, myoclonus, and new cognitive deficits. His subsequent course included a rapid neurological decline culminating in home hospice placement and death within 1 month. Magnetic resonance imaging revealed restricted diffusion involving the basal ganglia and cerebral cortex. Spinal fluid 14-3-3 protein was elevated. The rapidly progressive clinical course with dementia, ataxia, and myoclonus plus corroborative neuroimaging and spinal fluid findings confirmed a clinicoradiographic diagnosis of Creutzfeldt-Jacob disease. CONCLUSIONS To our knowledge, this is the first report of an initial presentation of Creutzfeldt-Jacob disease closely mimicking vestibular neuritis, expanding the known clinical spectrum of prion disease presentations. Despite the initial absence of neurological signs, the central lesion location was differentiated from a benign peripheral vestibulopathy at the first visit using simple bedside vestibular tests. Familiarity with these tests could help providers prevent initial misdiagnosis of important central disorders in patients presenting vertigo or dizziness.

A sorrow shared is a sorrow halved? Internet-based group therapy versus individual therapy for social anxiety disorder: A randomized controlled trial

Purpose: Social anxiety disorder is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. The present study aims at investigating the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD. Methods: A total of 150 adults with a diagnosis of SAD are randomly assigned to either a wait-list control group or one of two active treatment conditions. Participants in the two active conditions use the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of 6 individuals. In the group condition, participants communicate with each other via an integrated, protected discussion forum. The primary outcome variables are symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at 6-month follow-up. Secondary endpoints are general symptomatology, depression, quality of life and adherence to treatment. Furthermore, process variables such as group processes and the working alliance are studied. Results: Results are currently being analyzed. Results at post-treatment will be presented and discussed. Potential moderating and mediating variables of treatment success will be addressed. Conclusion: The results of this study should indicate whether therapist-guided group support could enhance the efficacy of an internet based self-help treatment for SAD. This novel treatment format, if shown efficacious, could represent a cost-effective option and could be further modified to treat other conditions.

The Discontinuous Nature of Kriging Interpolation for Digital Terrain Modeling

Kriging is a widely employed method for interpolating and estimating elevations from digital elevation data. Its place of prominence is due to its elegant theoretical foundation and its convenient practical implementation. From an interpolation point of view, kriging is equivalent to a thin-plate spline and is one species among the many in the genus of weighted inverse distance methods, albeit with attractive properties. However, from a statistical point of view, kriging is a best linear unbiased estimator and, consequently, has a place of distinction among all spatial estimators because any other linear estimator that performs as well as kriging (in the least squares sense) must be equivalent to kriging, assuming that the parameters of the semivariogram are known. Therefore, kriging is often held to be the gold standard of digital terrain model elevation estimation. However, I prove that, when used with local support, kriging creates discontinuous digital terrain models, which is to say, surfaces with “rips” and “tears” throughout them. This result is general; it is true for ordinary kriging, kriging with a trend, and other forms. A U.S. Geological Survey (USGS) digital elevation model was analyzed to characterize the distribution of the discontinuities. I show that the magnitude of the discontinuity does not depend on surface gradient but is strongly dependent on the size of the kriging neighborhood.

THE DEVELOPMENT OF COMMUNITY COMPETENCE THROUGH A NEIGHBORHOOD ORGANIZATION (LOS ANGELES, MEXICAN-AMERICAN)

This investigation focused on how people cope with the demands of their environment in a competent manner. It sought to assess the effects of learning competent coping behaviors on self-reported well-being. The study chose a community-evolved, organized effort on the part of a group of neighborhoods to build competence in the Mexican-American community of East Los Angeles. This network was a citizen-action organization called the United Neighborhoods Organization. UNO was selected because it concentrated on developing community leaders by using spiritual beliefs and family values as shared community resources. Neighborhood leaders were encouraged to engage in risk-taking and confrontation maneuvers. They were also taught problem-solving skills and provided with social support.^ A survey instrument was developed to assess sociodemographic characteristics, acculturation history and status, willingness to engage in risk-taking and confrontation and self-perceived general well-being. The study relied on eight months of daily participant-observation of the organization, the East Los Angeles environment and the interaction between the two. At the end of the observation period, a sample of 150 UNO participants were given the survey questionnaire as was a matched group of 150 non-UNO participants who were ELA residents.^ The study sample was mostly women, in their middle age years who had lived in the area from 5 to more than 30 years. Significantly more single persons were found in the UNO group. The sample was almost equally divided into English and Spanish speaking respondents. Acculturatively almost all the sample fell in the Very Mexican and Mostly Mexican types. The survey found a trend of association between participating in UNO and reporting feeling well. A statistically significant association was found among UNO participants between taking risks and reporting feeling well, regardless of a tendency for all the sample to minimize risk. A trend was seen for married UNO participants to report feeling well. Slightly more UNO participants were willing to engage in confrontation and a substantial proportion of the participants who were confronters reported feeling well in comparison to their counterparts. Ethnic pride was positively associated with participation in UNO and showed a trend in the expected direction with reported self-perceived well-being. ^

Perspective from the Ed Tech Field

Dr. Karen Billings discusses how working at a non-profit trade association has provided a unique perspective on how schools are using technology to support the teaching and learning process.