Kreativität vs. Urheberrecht im digitalen Bereich

Die Arbeit geht der Fragestellung nach, inwiefern verschiedene Selbstregulierungsansätze wie Freie Lizenzen (z. B. Creative Commons oder Open Source Software), geduldete Werknutzung und Vereinbarungen zwischen Plattformanbietern und Rechtsinhabern (Stichwort: „Upload-Filter“) bei der (kreativen) Nutzung und Verbreitung digital verfügbarer, urheberrechtlich geschützter Werke zur Lösung einer durch den Verfasser festgestellten, wachsenden Divergenz zwischen der von Nutzern, Urhebern und Verwertern gelebten Realität, den gesetzlichen Regelungen und den urheberrechtlichen Rechtfertigungsnarrativen beitragen können. Die Beantwortung dieser Frage erfolgt durch eine weitaus stärkere Einbeziehung der Erkenntnisse anderer Disziplinen wie (Verhaltens-)Ökonomie, Psychologie und Kreativitätsforschung als in juristischen Arbeiten sonst üblich. Dies erlaubt es, ein Rechtsgebiet nicht nur aus juristisch-dogmatischer Sichtweise zu betrachten, sondern auch die tatsächlichen Ausübungsbedingungen und Auswirkungen des Rechts genauer in den Blick zu nehmen und zum Teil einer juristisch fundierten Gesamtanalyse zu machen

Kreativität vs. Urheberrecht im digitalen Bereich

Die Arbeit geht der Fragestellung nach, inwiefern verschiedene Selbstregulierungsansätze wie Freie Lizenzen (z. B. Creative Commons oder Open Source Software), geduldete Werknutzung und Vereinbarungen zwischen Plattformanbietern und Rechtsinhabern (Stichwort: „Upload-Filter“) bei der (kreativen) Nutzung und Verbreitung digital verfügbarer, urheberrechtlich geschützter Werke zur Lösung einer durch den Verfasser festgestellten, wachsenden Divergenz zwischen der von Nutzern, Urhebern und Verwertern gelebten Realität, den gesetzlichen Regelungen und den urheberrechtlichen Rechtfertigungsnarrativen beitragen können. Die Beantwortung dieser Frage erfolgt durch eine weitaus stärkere Einbeziehung der Erkenntnisse anderer Disziplinen wie (Verhaltens-)Ökonomie, Psychologie und Kreativitätsforschung als in juristischen Arbeiten sonst üblich. Dies erlaubt es, ein Rechtsgebiet nicht nur aus juristisch-dogmatischer Sichtweise zu betrachten, sondern auch die tatsächlichen Ausübungsbedingungen und Auswirkungen des Rechts genauer in den Blick zu nehmen und zum Teil einer juristisch fundierten Gesamtanalyse zu machen

Use of computed tomography and mechanical CPR in cardiac arrest to confirm pulmonary embolism: a case study

Precise therapeutic decision-making is vital in managing out-of-hospital cardiac arrest. We present an interesting approach where suspected pulmonary embolism could be confirmed by early computed tomography in cardiac arrest. Chest compressions were performed automatically by mechanical devices also during the acquisition of computed tomography data and subsequent thrombolysis. Resume La precision des decisions relatives au traitement est d'importance > dans la prise en charge des arrets cardiaques extrahospitaliers. Sera presentee ici une intervention interessante, qui a permis de confirmer, par une tomodensitometrie (TDM) precoce, une embolie pulmonaire presumee chez une patiente en etat d'arret cardiaque. Les compressions thoraciques, realisees automatiquement par un appareil mecanique se sont poursuivies durant l'acquisition des donnees de la TDM et le traitement thrombolytique qui s'en est suivi

How well do final year undergraduate medical students master practical clinical skills?

Introduction: The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills. Methods: We conducted a formative 4-station objective structured clinical examination (OSCE) focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray). Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance. Results: 214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n= 20) scored insufficiently (<60%). We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%), whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively. Discussion: Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year

Influence of female sex and fertile age on neuromyelitis optica spectrum disorders

Background: Gender and age at onset are important epidemiological factors influencing prevalence, clinical presentation, and treatment response in autoimmune diseases. Objective: To evaluate the impact of female sex and fertile age on aquaporin-4-antibody (AQP4-ab) status, attack localization, and response to attack treatment in patients with neuromyelitis optica (NMO) and its spectrum disorders (neuromyelitis optica spectrum disorder (NMOSD)). Methods: Female-to-male ratios, diagnosis at last visit (NMO vs NMOSD), attack localization, attack treatment, and outcome were compared according to sex and age at disease or attack onset. Results: A total of 186 NMO/SD patients (82% female) were included. In AQP4-ab-positive patients, female predominance was most pronounced during fertile age (female-to-male ratio 23:1). Female patients were more likely to be positive for AQP4-abs (92% vs 55%; p40years. Conclusion: Our data suggest an influence of sex and age on susceptibility to AQP4-ab-positive NMO/SD. Genetic and hormonal factors might contribute to pathophysiology of NMO/SD

Platelet mitochondrial membrane depolarization reflects disease severity in patients with sepsis and correlates with clinical outcome

Introduction: Sepsis is still a leading cause of morbidity and mortality, even in modern times, and thrombocytopenia has been closely associated with unfavorable disease outcome. Decreases in mitochondrial membrane potential (depolarization) were found in different tissues during sepsis. Previous work suggests that mitochondrial dysfunction of platelets correlates with clinical disease activity in sepsis. However, platelet mitochondrial membrane potential (Mmp) has not been investigated in a clinical follow-up design and not with regard to disease outcome. Methods: In this study, platelet mitochondrial membrane depolarization was assessed by means of a fluorescent Mmp-Index with flow cytometry in 26 patients with sepsis compared with control patients. Platelet Mmp-Index on admission was correlated with the clinical disease scores Acute Physiology and Chronic Health Evaluation Score II (APACHE II), Sequential Organ Failure Score (SOFA), and Simplified Acute Physiology Score II (SAPS II). Finally, platelet Mmp-Index on admission and follow-up were compared in the group of sepsis survivors and nonsurvivors. Expression of the prosurvival protein Bcl-xL in platelets was quantified by immunoblotting. Results: Platelet mitochondrial membrane depolarization correlated significantly with the simultaneously assessed clinical disease severity by APACHE II (r = -0.867; P < 0.0001), SOFA (r = -0.857; P < 0.0001), and SAPS II score (r = -0.839; P < 0.0001). Patients with severe sepsis showed a significant reduction in platelet Mmp-Index compared with sepsis without organ failure (0.18 (0.12 to 0.25) versus 0.79 (0.49 to 0.85), P < 0.0006) or with the control group (0.18 (0.12 to 0.25) versus 0.89 (0.68 to 1.00), P < 0.0001). Platelet Mmp-Index remained persistently low in sepsis nonsurvivors (0.269 (0.230 to 0.305)), whereas we observed recovery of platelet Mmp-Index in the survivor group (0.9 (0.713 to 1.017)). Furthermore, the level of prosurvival protein Bcl-xL decreased in platelets during severe sepsis. Conclusion: In this study, we demonstrated that mitochondrial membrane depolarization in platelets correlates with clinical disease severity in patients with sepsis during the disease course and may be a valuable adjunct parameter to aid in the assessment of disease severity, risk stratification, and clinical outcome

Very late-onset neuromyelitis optica spectrum disorder beyond the age of 75

Aquaporin-4 antibody (AQP4-Ab)-positive neuromyelitis optica spectrum disorder (NMOSD) is a rare but often severe autoimmune disease with median onset around 40 years of age. We report characteristics of three very-late-onset NMOSD (including complete NMO) patients >75 years of age, in whom this diagnosis initially seemed unlikely because of their age and age-associated concomitant diseases, and briefly review the literature. All three patients, aged 79, 82 and 88 years, presented with a spinal cord syndrome as the first clinical manifestation of AQP4-Ab-positive NMOSD. They all had severe relapses unless immunosuppressive therapy was initiated, and one untreated patient died of a fatal NMOSD course. Two patients developed side effects of immunosuppression. We conclude that a first manifestation of NMOSD should be considered even in patients beyond the age of 75 years with a compatible syndrome, especially longitudinally extensive myelitis. Early diagnosis and treatment are feasible and highly relevant. Special attention is warranted in the elderly to recognize adverse effects of immunosuppressive therapies as early as possible