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Fresh groundwater lenses on karstic oceanic islands form a vital resource sustaining local populations. However, this resource is susceptible to saltwater intrusion through human drivers (over-abstraction) and natural processes (variable precipitation and storm surges). There is a paucity of means to assess the risks that freshwater lenses are exposed to. This is partly driven by a poor understanding of the root causes of saltwater intrusion, which leads to potentially inappropriate freshwater management strategies. Thus, effective management of these freshwater lenses requires a baseline understanding of the processes that drive saltwater intrusion and the degradation of freshwater lenses, and the temporal and spatial variability of these processes. Dynamics of such freshwater lenses involve an interplay between physical, chemical, and socio-economic processes; therefore, finding a solution necessitates an interdisciplinary approach and a range of data collection strategies. This approach was formalized in a Freshwater Lens Assessment Protocol (FLAP). Results from the research developed and tested on Bantayan Island in the Philippines reveals a sufficient freshwater lens to support the current and projected population; however, local officials are operating abstraction wells from the wrong locations on the island. Such locations are utilized due to ease of access to existing infrastructure and government boundaries, but do not consider technical factors that influence saltwater intrusion. FLAP is an appropriate, cost-effective, interdisciplinary tool that uses a pragmatic approach to data collection, interpretation, and integration into an observational model. Continuous adjustments are possible through ongoing monitoring of the model, offering opportunities to evaluate the efficacy of resource management strategies.

Karst islands such as those found in the Philippine Archipelago present challenges for local stakeholders to manage their water resources sustainably. Anthropogenic climate change, an increasing population and changes in land use and industry have all combined to altering the water balance on these islands. The freshwater lens is susceptible to saltwater intrusion through human drivers (such as over-abstraction) and natural processes (including variable precipitation and storm surges). The dynamics of such freshwater lenses involve an interplay between physical, chemical and socio-economical processes; therefore, finding a solution necessitates an interdisciplinary approach and a range of data collection strategies. This approach was formalized in a Freshwater Lens Assessment Protocol (FLAP) and expanded through the application of a Vulnerability Indicator Assessment (VIA). The VIA provides an accessible framework for data integration and an improved knowledge base, from which it is possible to make better decisions and establish effective management programs to protect and maintain this vital resource. The FLAP approach and VIA analysis were developed and tested on Bantayan Island (Cebu Province) in the Philippines. The results of the analysis reveal areas of saltwater intrusion vulnerability located along coastal boundary margins, mapped structural discontinuities and zones of upconing due to over-pumping. We infer that the VIA forms an appropriate, cost-effective interdisciplinary tool that synthesizes data sets through hazard characterization, integrates stakeholder knowledge pertaining to water resource management and operational policy, assesses the risk and assigns a risk designation for groundwater vulnerability to saltwater intrusion.

Background The cerebellum is frequently used as the reference region for amyloid PET analysis. However, this reference region has been shown to demonstrate longitudinal variability, particularly with [18F]florbetapir (FBP) PET (Landau, JNM 2015). For investigations in individuals with Down syndrome (DS), cerebellar atrophy and rapid disease progression may increase these longitudinal variabilities. Although white matter possesses different non‐displaceable uptake properties, the relative lack of specific binding makes white matter a suitable reference region for longitudinal studies. This work compares the observed longitudinal change when using whole cerebellum and white matter reference regions in [18F]FBP and [11C]PiB scans of adults with DS. Method Participants with DS, recruited through the ABC‐DS study, underwent longitudinal PiB or FBP PET imaging and T1w MRIs (Table 1 lists cohort differences). PET images were smoothed to 8mm resolution, summed 50‐70 min, co‐registered with the MRI, and normalized to a common DS MRI template (LeMerise, 2022). GAINN whole cerebellum (WC) VOI was applied to create SUVRWC. Whole brain white matter was segmented in native space using SPM, smoothed to PET resolution, and eroded to 90% tissue probability. The resulting eroded white matter (EWM) mask was used as reference to create SUVREWM. Average SUVR was calculated for GAINN global cortex (CTX). Longitudinal scans were assessed for correlations between reference region strategies and average rate of SUVR change: % Change/year = (SUVR2‐SUVR1)/(SUVR1*Δt). Result Figure 1 displays the averaged EWM reference template. Figure 2 displays longitudinal PET data and regressions between SUVRs. Across participants, SUVRWC shows 78/90 (PiB) and 50/83 (FBP) between‐scan increases. SUVREWM shows 66/90 (PiB) and 71/83 (FBP) between‐scan increases. For A+ individuals (18CL cutoff), the average difference (% ChangeEWM ‐ % ChangeWC)/year is ‐0.5%/year [‐1.2,0.3] (PiB) and 1.9%/yr [0.5,3.3]** (FBP). FBP group SD in % Change/year decreases from 5.6% (WC) to 2.9% (EWM). Conclusion As observed in LOAD, SUVREWM demonstrates lower group variability and greater longitudinal change in FBP. SUVREWM shows strong agreement with SUVRWC in PiB. These data suggest that an EWM reference region can reduce variability in longitudinal FBP studies in DS.

Background The cerebellum is frequently used as the reference region for amyloid PET analysis. However, this reference region has been shown to demonstrate longitudinal variability, particularly with [18F]florbetapir (FBP) PET (Landau, JNM 2015). For investigations in individuals with Down syndrome (DS), cerebellar atrophy and rapid disease progression may increase these longitudinal variabilities. Although white matter possesses different non‐displaceable uptake properties, the relative lack of specific binding makes white matter a suitable reference region for longitudinal studies. This work compares the observed longitudinal change when using whole cerebellum and white matter reference regions in [18F]FBP and [11C]PiB scans of adults with DS. Method Participants with DS, recruited through the ABC‐DS study, underwent longitudinal PiB or FBP PET imaging and T1w MRIs (Table 1 lists cohort differences). PET images were smoothed to 8mm resolution, summed 50‐70 min, co‐registered with the MRI, and normalized to a common DS MRI template (LeMerise, 2022). GAINN whole cerebellum (WC) VOI was applied to create SUVRWC. Whole brain white matter was segmented in native space using SPM, smoothed to PET resolution, and eroded to 90% tissue probability. The resulting eroded white matter (EWM) mask was used as reference to create SUVREWM. Average SUVR was calculated for GAINN global cortex (CTX). Longitudinal scans were assessed for correlations between reference region strategies and average rate of SUVR change: % Change/year = (SUVR2‐SUVR1)/(SUVR1*Δt). Result Figure 1 displays the averaged EWM reference template. Figure 2 displays longitudinal PET data and regressions between SUVRs. Across participants, SUVRWC shows 78/90 (PiB) and 50/83 (FBP) between‐scan increases. SUVREWM shows 66/90 (PiB) and 71/83 (FBP) between‐scan increases. For A+ individuals (18CL cutoff), the average difference (% ChangeEWM ‐ % ChangeWC)/year is ‐0.5%/year [‐1.2,0.3] (PiB) and 1.9%/yr [0.5,3.3]** (FBP). FBP group SD in % Change/year decreases from 5.6% (WC) to 2.9% (EWM). Conclusion As observed in LOAD, SUVREWM demonstrates lower group variability and greater longitudinal change in FBP. SUVREWM shows strong agreement with SUVRWC in PiB. These data suggest that an EWM reference region can reduce variability in longitudinal FBP studies in DS.

Using a roundtable discussion format, the editor and new members of the editorial board for the Journal of Contemporary Psychotherapy exchange ideas about how they envision the future of psychotherapy, anticipate likely positive and negative outcomes, identify key issues to be confronted today in order to maximize future success, and clarify the role of the individual psychotherapist in protecting psychotherapy as a viable field of study and practice. The discussion closes with recommendations for the next generation of psychotherapists and general conclusions about the future of psychotherapy.