Eine gesetzliche Regulierung des Umgangs mit Opiaten und Sedativa bei medizinischen Entscheidungen am Lebensende?

Zusammenfassung: Der ärztliche Umgang mit Opiaten und Sedativa bei Patienten am Lebensende kann ethische Fragen aufwerfen. Entsprechende Entscheidungen blieben bisher in aller Regel der ärztlichen Berufskunst und -pflicht überantwortet. Heute aber gerät dieser Bereich zunehmend auch in den Blickwinkel des Rechts. Ausdruck davon sind Bestrebungen, die indirekte Sterbehilfe, allenfalls auch die terminale Sedierung gesetzlich zu regeln. Ausgehend von einer Ist-Analyse der ärztlichen Praxis sowie von bereits bestehenden Regulierungen untersucht diese Arbeit die Konsequenzen derartiger Bestrebungen. Es zeigt sich, dass der Versuch, die Thematik der indirekten Sterbehilfe für sich allein, also unter Vermeidung einer Regelung der direkt aktiven Sterbehilfe, zu behandeln, zu großen Schwierigkeiten führen würde. Ernüchternd sind aber auch die Erfahrungen aus den Niederlanden, derartige Fragen im Rahmen eines umfassenden Sterbehilfegesetzes anzugehen. Insgesamt ist somit zu befürchten, dass der Versuch einer detaillierten gesetzlichen Regelung dieses Bereiches mehr neue Grauzonen und Unsicherheiten schafft, als er zu beseitigen verma

Evaluation of 3D surface scanners for skin documentation in forensic medicine: comparison of benchmark surfaces

BACKGROUND: Two 3D surface scanners using collimated light patterns were evaluated in a new application domain: to document details of surfaces similar to the ones encountered in forensic skin pathology. Since these scanners have not been specifically designed for forensic skin pathology, we tested their performance under practical constraints in an application domain that is to be considered new. METHODS: Two solid benchmark objects containing relevant features were used to compare two 3D surface scanners: the ATOS-II (GOM, Germany) and the QTSculptor (Polygon Technology, Germany). Both scanners were used to capture and process data within a limited amount of time, whereas point-and-click editing was not allowed. We conducted (a) a qualitative appreciation of setup, handling and resulting 3D data, (b) an experimental subjective evaluation of matching 3D data versus photos of benchmark object regions by a number of 12 judges who were forced to state their preference for either of the two scanners, and (c) a quantitative characterization of both 3D data sets comparing 220 single surface areas with the real benchmark objects in order to determine the recognition rate's possible dependency on feature size and geometry. RESULTS: The QTSculptor generated significantly better 3D data in both qualitative tests (a, b) that we had conducted, possibly because of a higher lateral point resolution; statistical evaluation (c) showed that the QTSculptor-generated data allowed the discrimination of features as little as 0.3 mm, whereas ATOS-II-generated data allowed for discrimination of features sized not smaller than 1.2 mm. CONCLUSION: It is particularly important to conduct specific benchmark tests if devices are brought into new application domains they were not specifically designed for; using a realistic test featuring forensic skin pathology features, QT Sculptor-generated data quantitatively exceeded manufacturer's specifications, whereas ATOS-II-generated data was within the limits of the manufacturer's specifications. When designing practically constrained specific tests, benchmark objects should be designed to contain features relevant for the application domain. As costs for 3D scanner hardware, software and data analysis can be hundred times as high compared to high-resolution digital photography equipment, independent user driven evaluation of such systems is paramount. INDEX TERMS: Forensic pathology, Rough surfaces, Surface Scanning, Technology Assessmen

Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI

Objective: To investigate the performance of postmortem magnetic resonance imaging (pmMRI) in identification and characterization of lethal myocardial infarction in a non-invasive manner on human corpses. Materials and Methods: Before forensic autopsy, 20 human forensic corpses were examined on a 1.5-T system for the presence of myocardial infarction. Short axis, transversal and longitudinal long axis images (T1-weighted; T2-weighted; PD-weighted) were acquired in situ. In subsequent autopsy, the section technique was adapted to short axis images. Histological investigations were conducted to confirm autopsy and/or radiological diagnoses. Results: Nineteen myocardial lesions were detected and age staged with pmMRI, of which 13 were histologically confirmed (chronic, subacute and acute). Six lesions interpreted as peracute by pmMRI showed no macroscopic or histological finding. Five of the six peracute lesions correlated well to coronary pathology, and one case displayed a severe hypertrophic alteration. Conclusion: pmMRI reliably demonstrates chronic, subacute and acute myocardial infarction in situ. In peracute cases pmMRI may display ischemic lesions undetectable at autopsy and routine histology. pmMRI has the potential to substantiate autopsy and to counteract the loss of reliable information on causes of death due to the recent disappearance of the clinical autops

The Dirac operator on SU_q(2)

We construct a 3^+ summable spectral triple (A(SU_q(2)),H,D) over the quantum group SU_q(2) which is equivariant with respect to a left and a right action of U_q(su(2)). The geometry is isospectral to the classical case since the spectrum of the operator D is the same as that of the usual Dirac operator on the 3-dimensional round sphere. The presence of an equivariant real structure J demands a modification in the axiomatic framework of spectral geometry, whereby the commutant and first-order properties need be satisfied only modulo infinitesimals of arbitrary high order.Comment: v2: minor changes; to appear in CM

Severe bronchopulmonary dysplasia improved by noninvasive positive pressure ventilation: a case report

<p>Abstract</p> <p>Introduction</p> <p>This is the first report to describe the feasibility and effectiveness of noninvasive positive pressure ventilation in the secondary treatment of bronchopulmonary dysplasia.</p> <p>Case presentation</p> <p>A former male preterm of Caucasian ethnicity delivered at 29 weeks gestation developed severe bronchopulmonary dysplasia. At the age of six months he was in permanent tachypnea and dyspnea and in need of 100% oxygen with a flow of 2.0 L/minute via a nasal cannula. Intermittent nocturnal noninvasive positive pressure ventilation was then administered for seven hours daily. The ventilator was set at a positive end-expiratory pressure of 6 cmH₂O, with pressure support of 4 cmH₂O, trigger at 1.4 mL/second, and a maximum inspiratory time of 0.7 seconds. Over the course of seven weeks, the patient's maximum daytime fraction of inspired oxygen via nasal cannula decreased from 1.0 to 0.75, his respiratory rate from 64 breaths/minute to 50 breaths/minute and carbon dioxide from 58 mmHg to 44 mmHg.</p> <p>Conclusion</p> <p>Noninvasive positive pressure ventilation may be a novel therapeutic option for established severe bronchopulmonary dysplasia. In the case presented, noninvasive positive pressure ventilation achieved sustained improvement in ventilation and thus prepared our patient for safe home oxygen therapy.</p

First principles high throughput screening of oxynitrides for water-splitting photocatalysts

In this paper, we present a first principles high throughput screening system to search for new water-splitting photocatalysts. We use the approach to screen through nitrides and oxynitrides. Most of the known photocatalytic materials in the screened chemical space are reproduced. In addition, sixteen new materials are suggested by the screening approach as promising photocatalysts, including three binary nitrides, two ternary oxynitrides and eleven quaternary oxynitrides.United States. Dept. of Energy (contract DE-FG02-96ER4557)National Science Foundation (U.S.) (TeraGrid resources under Grant No. TG-DMR970008S)Pittsburgh Supercomputing CenterUniversity of Texas at Austin. Texas Advanced Computing CenterEni-MIT Solar Frontiers Cente

Low relapse risk in poor risk AML after conditioning with 10-day decitabine, fludarabine and 2 Gray TBI prior to allogeneic hematopoietic cell transplantation.

Patients with poor risk acute myeloid leukemia (AML) have a dismal outcome. We hypothesized that combining decitabine with a standard non-myeloablative (NMA) conditioning regimen prior to allogeneic hematopoietic cell transplantation (allo HCT), might decrease the relapse incidence. We conducted a multicenter prospective phase II study (NCT02252107) with 10-day decitabine (20 mg/m(2)/day) integrated in a standard non-myeloablative conditioning regimen (3 days fludarabine 30 mg/m(2) with 2 Gray total body irradiation (TBI)). Patients with AML ≥ 18 years in 1st (in)complete remission (CR/CRi) with a poor or very poor risk profile, as defined by the HOVON-132 protocol, were eligible. Results: Forty-six patients (median age 60; range 23-74) were included. Median follow up time was 44 months (range 31-65 months). The cumulative 1-year incidence of relapse and NRM were respectively 23% and 11%. Incidence of grade III-IV acute graft-vs-host-disease (GVHD) and severe chronic GVHD were 13% and 20%, respectively. One-year OS was 70%. Application of ELN 2017 risk classification to the study cohort revealed a cumulative one-year relapse rate of respectively 31% and 13% for the adverse and intermediate risk patients. To conclude, the 10-day DEC/FLU/TBI conditioning regimen prior to allo HCT in poor risk AML patients is effective and feasible

The 2018 European heatwave led to stem dehydration but not to consistent growth reductions in forests

Publisher Copyright: © 2022, The Author(s).Heatwaves exert disproportionately strong and sometimes irreversible impacts on forest ecosystems. These impacts remain poorly understood at the tree and species level and across large spatial scales. Here, we investigate the effects of the record-breaking 2018 European heatwave on tree growth and tree water status using a collection of high-temporal resolution dendrometer data from 21 species across 53 sites. Relative to the two preceding years, annual stem growth was not consistently reduced by the 2018 heatwave but stems experienced twice the temporary shrinkage due to depletion of water reserves. Conifer species were less capable of rehydrating overnight than broadleaves across gradients of soil and atmospheric drought, suggesting less resilience toward transient stress. In particular, Norway spruce and Scots pine experienced extensive stem dehydration. Our high-resolution dendrometer network was suitable to disentangle the effects of a severe heatwave on tree growth and desiccation at large-spatial scales in situ, and provided insights on which species may be more vulnerable to climate extremes.Peer reviewe

Evaluation a of a layered approach to question answering over linked data

Walter S, Unger C, Cimiano P, Bär D. Evaluation a of a layered approach to question answering over linked data. Presented at the The 11th International Semantic Web Conference (ISWC 2012), Boston, USA.We present a question answering system architecture which processes natural language questions in a pipeline consisting of five steps: i) question parsing and query template generation, ii) lookup in an inverted index, iii) string similarity computation, iv) lookup in a lexical database in order to find synonyms, and v) semantic similarity computation. These steps are ordered with respect to their computational effort, following the idea of layered processing: questions are passed on along the pipeline only if they cannot be answered on the basis of earlier processing steps, thereby invoking computationally expensive operations only for complex queries that require them. In this paper we present an evaluation of the system on the dataset provided by the 2nd Open Challenge on Question Answering over Linked Data (QALD-2). The main, novel contribution is a systematic empirical investigation of the impact of the single processing components on the overall performance of question answering over linked data