Zwischen Liebesideal und Realismus - Theologische Anthropologie als soziale Ressource bei Reinhold Niebuhr

What is there left to say about the human condition after the so-called „end of anthropology“? Never before have conceptions of what it means to be a human being been as diverse and fragmented as in the late modern age – with severe consequences for democratic discourse and liberal, „Western“ societies as a whole. Examining the work of American theologian Reinhold Niebuhr (1892–1971), the book presents new insights into the intersection of anthropological thought and ethical orientation. Niebuhr, motivated by his perception of profound political and social crises in „Western“ societies, develops an innovative, pragmatic and „realistic“ type of theological anthropology. His anthropological approach functions as the basis of a much larger endeavor: rescuing Christianity and democracy itself. Reading Niebuhr today opens up a refreshing perspective on current debates on public theology and the so-called „crisis of democracy“. In this context, the book argues, theological anthropology can be reclaimed as an essential social resource: It offers a comprehensive understanding of human nature both at its best and at its worst, providing the indispensable basis for the survival and vitality of democracy

Zwischen Liebesideal und Realismus

What is there left to say about the human condition after the so-called „end of anthropology“? Never before have conceptions of what it means to be a human being been as diverse and fragmented as in the late modern age – with severe consequences for democratic discourse and liberal, „Western“ societies as a whole. Examining the work of American theologian Reinhold Niebuhr (1892–1971), the book presents new insights into the intersection of anthropological thought and ethical orientation. Niebuhr, motivated by his perception of profound political and social crises in „Western“ societies, develops an innovative, pragmatic and „realistic“ type of theological anthropology. His anthropological approach functions as the basis of a much larger endeavor: rescuing Christianity and democracy itself. Reading Niebuhr today opens up a refreshing perspective on current debates on public theology and the so-called „crisis of democracy“. In this context, the book argues, theological anthropology can be reclaimed as an essential social resource: It offers a comprehensive understanding of human nature both at its best and at its worst, providing the indispensable basis for the survival and vitality of democracy

Late deterioration of left ventricular function after right ventricular pacemaker implantation

Objectives: Right ventricular (RV) pacing induces a left bundle branch block pattern on ECG and may promote heart failure. Patients with dual chamber pacemakers (DCPs) who present with progressive reduction in left ventricular ejection fraction (LVEF) secondary to RV pacing are candidates for cardiac resynchronization therapy (CRT). This study analyzes whether upgrading DCP to CRT with the additional implantation of a left ventricular (LV) lead improves LV function in patients with reduced LVEF following DCP implantation. Methods: Twenty-two patients (13 males) implanted with DCPs and a high RV pacing percentage (>90%) were evaluated in term of new-onset heart failure symptoms. The patients were enrolled in this retrospective single-center study after obvious causes for a reduced LVEF were excluded with echocardiography and coronary angiography. In all patients, DCPs were then upgraded to biventricular devices. LVEF was analyzed with a two-sided t-test. QRS duration and brain natriuretic peptide (BNP) levels were analyzed with the unpaired t-test. Results: LVEF declined after DCP implantation from 54±10% to 31±7%, and the mean QRS duration was 161±20 ms during RV pacing. NT-pro BNP levels were elevated (3365±11436 pmol/L). After upgrading to a biventricular device, a biventricular pacing percentage of 98.1±2% was achieved. QRS duration decreased to 108±16 ms and 106±20 ms after 1 and 6 months, respectively. There was a significant increase in LVEF to 38±8% and 41±11% and a decrease in NT- pro BNP levels to 3088±2326 pmol/L and 1860±1838 pmol/L at 1 and 6 months, respectively. Conclusion: Upgrading to CRT may be beneficial in patients with DCPs and heart failure induced by a high RV pacing percentage. (Anatol J Cardiol 2016; 16: 678-83

Theologische Anthropologie als soziale Ressource bei Reinhold Niebuhr

Softcover, 17x24Was lässt sich nach dem vielbeschworenen „Ende der Anthropologie“ noch vom Menschsein sagen? Wie lässt sich angesichts der zunehmenden anthropologischen Sprachlosigkeit noch ethische Orientierung gewinnen? Welche Folgen hat die Fragmentierung von Menschenbildern für den demokratischen Diskurs? Dieses Problemfeld bearbeitet die Autorin unter Rückgriff auf das Denken des hierzulande wenig bekannten US-amerikanischen Theologen Reinhold Niebuhr (1892–1971). Auf breiter Quellenbasis werden Genese, Funktion und Profil seiner theologischen Anthropologie herausgearbeitet, die sich als pragmatisch orientiertes, zentral um die Sündenlehre kreisendes Denkmodell präsentiert. Die Wahrnehmung tiefgreifender politischer und sozialer Krisen regt Niebuhr dazu an, die Anthropologie zum Fundament eines großangelegten gesellschaftlichen Rettungsprogramms auszubauen. Aus der einsichtsvollen historischen wie theologischen Aufarbeitung des Niebuhrschen Werkes leitet die Autorin gewichtige Impulse für die Debatten der Gegenwart ab. Sie zeigt auf, wie eine „realistische“ Anthropologie im Sinne Niebuhrs nicht nur einen innovativen Ansatz einer public theology begründet, sondern darüber hinaus als „soziale Ressource“ in der Debatte um die „Krise der Demokratie“ neue Wege aufzuzeigen vermag.What is there left to say about the human condition after the so-called „end of anthropology“? Never before have conceptions of what it means to be a human being been as diverse and fragmented as in the late modern age – with severe consequences for democratic discourse and liberal, „Western“ societies as a whole. Examining the work of American theologian Reinhold Niebuhr (1892–1971), the book presents new insights into the intersection of anthropological thought and ethical orientation. Niebuhr, motivated by his perception of profound political and social crises in „Western“ societies, develops an innovative, pragmatic and „realistic“ type of theological anthropology. His anthropological approach functions as the basis of a much larger endeavor: rescuing Christianity and democracy itself. Reading Niebuhr today opens up a refreshing perspective on current debates on public theology and the so-called „crisis of democracy“. In this context, the book argues, theological anthropology can be reclaimed as an essential social resource: It offers a comprehensive understanding of human nature both at its best and at its worst, providing the indispensable basis for the survival and vitality of democracy

Velocity characteristics of atrial fibrillation sources determined by electrographic flow mapping before and after catheter ablation

Background: Electrographic-Flow-(EGF)-Mapping is a novel method to identify Atrial Fibrillation (AF) drivers. Sources of excitation during AF can be characterized and monitored. Objective: The aim of this study was to evaluate the correlation between velocity of EGF around a respective AF source and its spatial variability (SV) and stability (SST). Methods: 25 patients with AF were included in this study (persistent: n = 24, long-standing persistent: n = 1; mean age 70 +/- 8.3 years, male: n = 17). Focal impulse and Rotor-Mapping (FIRM) was performed in addition to pulmonary vein isolation. One-minute epochs of unipolar electrograms recorded via a 64-pole basket catheter in both atria were re-analyzed with EGF-Mapping. SST was calculated as the percentage of time in which a source was detected. Results: AF sources identified with EGF-Mapping show a wide range of SV during 1 min covering between 0.12% and 38% of the recorded basket-catheter surface. The 12 atria where the sources showed highest temporal stability (TS; between 34% and 97% of 1 min recorded) and those 12 with the lowest TS (between 11 and 20%) differed significantly in their velocities (17.8 el/s vs 12.2 el/s; p < 0.01). In 11 atria ablation caused an average decrease of TS by 47% and of velocity by 27% while SV more than doubled. Conclusion: Less stable AF-sources with high spatial variability showed reduced excitation propagation velocity while stable AF sources displayed a high average velocity in their vicinity. Importantly, catheter ablation reduced stability of sources and velocity suggesting a role of these parameters in guidance of ablation. Condensed abstract: Electrographic Flow(EGF)-Mapping is a novel method to identify Atrial Fibrillation (AF) drivers based on modeling of an electrical potential surface and subsequent flow analysis. Sources of excitation during AF can be characterized and monitored. The aim of this study was to evaluate the correlation between velocity of EGF around a respective AF source and its spatial variability and stability. Less stable AF sources with high spatial variability showed reduced excitation propagation velocity while very stable AF sources displayed a high average velocity in their vicinity. Catheter ablation reduced stability of sources and velocity. Crown Copyright (C) 2019 Published by Elsevier B.V. All rights reserved

Left atrial appendage angiography is associated with the incidence and number of magnetic resonance imaging-detected brain lesions after percutaneous catheter-based left atrial appendage closure

BACKGROUND Percutaneous catheter-based left atrial appendage closure (LAAC) is a procedure being increasingly performed in patients with atrial fibrillation and high bleeding risk. OBJECTIVE The purpose of this study was to evaluate the incidence of magnetic resonance imaging (MRI)-detected acute brain lesions (ABLs) as well as potential changes in neurocognitive function after percutaneous LAAC in patients with atrial fibrillation. METHODS Brain MRI at 3 T was performed within 24 hours before and after LAAC along with neurologic (National Institutes of Health Stroke Scale [NIHSS] score) and cognitive (Montreal Cognitive Assessment [MoCA] test) assessment. Acquired MRI sequences included high-resolution diffusion-weighted imaging as well as fluid-attenuated inversion recovery. RESULTS Successful device implantation was achieved in all 23 patients (age 74.1 ± 10.5 years; 16 male) using the Amulet (n = 18), Occlutech (n = 3), or LAmbre (n = 2) device. Thirty-seven ABLs were detected by MRI in 12 of 23 patients (52%) after LAAC. The number of periprocedural LAA angiographies was significantly higher in patients with ABL than in those without ABL (1.67 ± 0.65 vs 1.18 ± 0.41; P = .048) and was associated with a higher number of ABL (ρ = 0.615; P = .033). Compared to pre-LAAC assessment, post-LAAC MoCA and NIHSS scores revealed similar results. After LAAC, MoCA test (mean 24.1 ± 4.6 vs 23.2 ± 4.6; P = .09) and NIHSS score (mean 1.0 ± 1.7 vs 1.2 ± 1.8; P = .1) were similar between patients with and those without ABL, respectively. CONCLUSION MRI-detected ABLs are commonly observed after percutaneous LAAC. The number of LAA angiographies is significantly associated with the number of ABLs; however, the clinical implications of ABL have yet to be determined

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation