Analyse von psychologisch-diagnostischen Fallbeispielen in Hinblick auf deren zugrundeliegenden Entscheidungsstrategien

Die vorliegende Arbeit beschäftigt sich mit der Untersuchung von Entscheidungen von Psychologen im Rahmen des psychologisch-diagnostischen Prozesses. Die zumeist implizit erfolgten Entscheidungen sollen explizit gemacht und hinsichtlich Besonderheiten und Gemeinsamkeiten analysiert und miteinander verglichen werden. Die Untersuchung des Entscheidungsverhaltens erfolgte anhand von 33 Fällen aus dem Buch „Psychologische Diagnostik in Fallbeispielen“ von Kubinger und Ortner (2010). Dazu wurde für jeden Fall ein Flussdiagramm der Entscheidungsprozesse erstellt, das in einem weiteren Schritt qualitativ-explorativ, in Hinblick auf jene Entscheidungen, die zur Beantwortung der Fragestellungen bzw. zur Vergabe von Maßnahmenempfehlungen führen, analysiert wurde. Schließlich erfolgten zur Prüfung von Gemeinsamkeiten, Vergleiche von Fällen mit ähnlicher Thematik. Mit dieser Vorgehensweise konnte der diagnostische Prozess anschaulich dargestellt -und der Einfluss unterschiedlicher Erhebungsmethoden auf die Beantwortung der Fragestellungen in einzelnen Fällen, sowie über mehrere thematisch ähnliche Fälle hinweg, nachgewiesen werden. Vor der Darstellung der Fallanalyse, wird im theoretischen Teil der Arbeit der psychologischdiagnostische Prozess, vor allem in Hinblick auf mögliche Entscheidungen, beschrieben, bevor auf bestehende Arbeiten zur Analyse des Entscheidungsverhaltens von Psychologen eingegangen wird. Diese Arbeit kann als ein Beitrag dazu verstanden werden, den psychologisch-diagnostischen Prozess nachvollziehbarer und damit einer Prüfung zugänglich zu machen.This thesis is addressed to the investigation of psychologists´ decisions within the assessment process. The decisions, which are mostly implicit, should be made explicit and should be analysed and compared in terms of characteristics and similarities. The investigation of the decision-making was based on 33 psychological assessment cases taken from the book „Psychologische Diagnostik in Fallbeispielen“ by Kubinger and Ortner (2010). For every case a flow chart of the decision making process was made. In a second step this flow chart was analysed in a qualitative-explorative way in terms of those decisions, that led to the answering of the research questions and to treatment recommendations. Finally, cases with similar research questions were compared in terms of common features. By means of this procedure, the assessment process could be illustrated vividly and the impact of different methods of data collection (e.g. tests, explorations) on the answering of the research questions in single cases and across cases with similar topics, could be shown. Previous to the description of the analysis, the psychological assessment process is described, especially in terms of potential decisions. Furthermore existing works on the analysis of decision making are described. This thesis can be understood as a contribution to make the psychological assessment process understandable and thereby accessible to an evaluation

No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy: a Randomized Controlled Trial

BACKGROUND The use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury. METHODS One hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90. RESULTS The median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, -0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end-stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups. CONCLUSIONS With respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery

Comparison of 6 % hydroxyethyl starch and 5 % albumin for volume replacement therapy in patients undergoing cystectomy (CHART): study protocol for a randomized controlled trial

Background The use of artificial colloids is currently controversial, especially in Central Europe Several studies demonstrated a worse outcome in intensive care unit patients with the use of hydroxyethyl starch. This recently even led to a drug warning about use of hydroxyethyl starch products in patients admitted to the intensive care unit. The data on hydroxyethyl starch in non–critically ill patients are insufficient to support perioperative use. Methods/Design We are conducting a single-center, open-label, randomized, comparative trial with two parallel patient groups to compare human albumin 5 % (test drug) with hydroxyethyl starch 6 % 130/0.4 (comparator). The primary endpoint is cystatin C ratio, calculated as the ratio of the cystatin value at day 90 after surgery relative to the preoperative value. Secondary objectives are inter alia the evaluation of the influence of human albumin and hydroxyethyl starch on further laboratory chemical and clinical parameters, glycocalyx shedding, intensive care unit and hospital stay and acute kidney injury as defined by RIFLE criteria (risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage kidney disease) criteria. Discussion There is a general lack of evidence on the relative safety and effects of hydroxyethyl starch compared with human albumin for volume replacement in a perioperative setting. Previously conducted studies of surgical patients in which researchers have compared different hydroxyethyl starch products included too few patients to properly evaluate clinical important outcomes such as renal function. In the present study in a high-risk patient population undergoing a major surgical intervention, we will determine if perioperative fluid replacement with human albumin 5 % will have a long-term advantage over a third-generation hydroxyethyl starch 130/0.4 on the progression of renal dysfunction until 90 days after surgery

A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms:An International Multicenter Cohort Study

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off >= 0.2 mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size >= 3.0 cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all p <0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). Conclusions: CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival

Sequence-specific binding of single-stranded RNA: is there a code for recognition?

A code predicting the RNA sequence that will be bound by a certain protein based on its amino acid sequence or its structure would provide a useful tool for the design of RNA binders with desired sequence-specificity. Such de novo designed RNA binders could be of extraordinary use in both medical and basic research applications. Furthermore, a code could help to predict the cellular functions of RNA-binding proteins that have not yet been extensively studied. A comparative analysis of Pumilio homology domains, zinc-containing RNA binders, hnRNP K homology domains and RNA recognition motifs is performed in this review. Based on this, a set of binding rules is proposed that hints towards a code for RNA recognition by these domains. Furthermore, we discuss the intermolecular interactions that are important for RNA binding and summarize their importance in providing affinity and specificity

Uropathogenic E. coli Induce Different Immune Response in Testicular and Peritoneal Macrophages: Implications for Testicular Immune Privilege

Infertility affects one in seven couples and ascending bacterial infections of the male genitourinary tract by Escherichia coli are an important cause of male factor infertility. Thus understanding mechanisms by which immunocompetent cells such as testicular macrophages (TM) respond to infection and how bacterial pathogens manipulate defense pathways is of importance. Whole genome expression profiling of TM and peritoneal macrophages (PM) infected with uropathogenic E. coli (UPEC) revealed major differences in regulated genes. However, a multitude of genes implicated in calcium signaling pathways was a common feature which indicated a role of calcium-dependent nuclear factor of activated T cells (NFAT) signaling. UPEC-dependent NFAT activation was confirmed in both cultured TM and in TM in an in vivo UPEC infectious rat orchitis model. Elevated expression of NFATC2-regulated anti-inflammatory cytokines was found in TM (IL-4, IL-13) and PM (IL-3, IL-4, IL-13). NFATC2 is activated by rapid influx of calcium, an activity delineated to the pore forming toxin alpha-hemolysin by bacterial mutant analysis. Alpha-hemolysin suppressed IL-6 and TNF-α cytokine release from PM and caused differential activation of MAP kinase and AP-1 signaling pathways in TM and PM leading to reciprocal expression of key pro-inflammatory cytokines in PM (IL-1α, IL-1β, IL-6 downregulated) and TM (IL-1β, IL-6 upregulated). In addition, unlike PM, LPS-treated TM were refractory to NFκB activation shown by the absence of degradation of IκBα and lack of pro-inflammatory cytokine secretion (IL-6, TNF-α). Taken together, these results suggest a mechanism to the conundrum by which TM initiate immune responses to bacteria, while maintaining testicular immune privilege with its ability to tolerate neo-autoantigens expressed on developing spermatogenic cells

Center and Periphery. Theological Perspectives on Church and Society

Krisenzeit – Zeit der Kirche – Zeit der Theologie? Die Problemlagen der Gegenwart stellen die wissenschaftliche Theologie vor so große Herausforderungen wie selten zuvor. Nicht allein stehen in den kommenden Jahren strukturelle Weichenstellungen an, welche die Kirche kaum unberührt lassen werden. Schon jetzt verlangt die prekäre Situation vieler Menschen und ganzer Völker nach einer tragfähigen Reflexion und Verkündigung des Glaubens. Christliche Theologie darf die notwendigen Antworten hier nicht schuldig bleiben. In der vorliegenden Festschrift haben sich Kollegen, Freunde und Schüler von Otmar Meuffels den vielfältigen Fragestellungen zugewandt, welche die Arbeit an der zeitgenössischen Heilsbedeutung des christlichen Glaubens aufwirft. Sie schreiben damit seinen prägenden Ansatz fort, der stets die aktuelle Relevanz der Rede von Gott im Blick hat. In diesem Sinn zeigen die in diesem Band versammelten Beiträge auf ganz unterschiedlichen Feldern die Anschlussfähigkeit der Theologie in den heute virulenten gesellschaftlichen Debatten.Time of Crisis – Times of Church – Time of Theology? Academic theology has rarely faced bigger challenges than those of the present. The coming years will see structural course changes which will leave the church hardly untouched. Even today, the precarious situation of people and people’s demands for viable reflection and proclamation of Faith. Christian theology must not fail to give necessary answers in this regard. In this publication, colleagues, friends, and students of Otmar Meuffels faced these diverse questions, which are posed by working with the contemporary soteriological significance of Christian faith. With this, they continue his defining approach which always focuses on the current relevance of the speech of God. Therefore, all contributions collected in this publication show the ability to connect theology with current and relevant societal controversies in completely different fields