Suchergebnisse

Foreword -- Preface -- Part I Introduction -- How ethics can support clinicians caring for critically ill patients -- Patients and teams caring for them: parallels between critical care and emergency medicine -- Part II Goal of therapy, teams and patients -- Indication and prognostication -- Consent, advance directives, and decisions by proxies -- Cultural diversity -- Inter-professional shared decision-making -- Shared decision-making with patients and families -- Part III Extent of treatment -- Triage -- Usage of cutting edge technology: eCPR -- Usage of cutting edge technology: ECMO -- Limiting life-sustaining therapies -- Advancing palliative care in intensive care and emergency medicine -- Organ donation and transplantation -- Part IV Disproportionate care -- Disproportionate care, ethical climate and moral distress -- Part V The way ahead -- Chapter 15.To treat or not to treat: How to arrive at an appropriate decision under critical circumstances? -- Epilogue.

Der medizinisch-technische Fortschritt führt verbunden mit der demographischen Entwicklung dazu, dass immer mehr, und v.a. ältere und vorerkrankte Menschen intensivmedizinisch behandelt werden. Die Vorhersage des Behandlungsergebnisses bleibt dabei häufig schwierig. Im Verlauf einer intensivmedizinischen Behandlung geraten Ärzte und Pflegekräfte oft in ein Spannungsfeld zwischen dem, was technisch möglich ist, und dem, was dem Patientenwillen entspricht. Immer wieder wird man deshalb bei Intensivpatienten mit sehr ernster Prognose entscheiden müssen, den Therapieumfang zu begrenzen oder das Therapieziel vom kurativen Ansatz zur Symptomkontrolle und Begleitung zu verändern. Hier sind für das therapeutische Team Entscheidungshilfen und konkrete Handlungsanleitungen, basierend auf ethischen Überlegungen, dem Willen des Patienten und juristischen Regularien, hilfreich. Das vorliegende Werk beschäftigt sich u.a. mit folgenden Themen: ethische Prinzipien, juristische Grundlagen, Patientenautonomie, Entscheidungsfindung und operative Umsetzung bei Therapiebegrenzung und Therapiezieländerung, Einheit von Patient und Familie, kulturelle und religiöse Einflüsse sowie Konflikte und Burnout im Behandlungsteam. Für alle auf Intensivstationen tätigen Ärzte und Pflegekräfte, die sich mit schwierigen Entscheidungen auseinandersetzen

Research has consistently shown that most women under the control of the criminal justice system are mothers. The robustness of this finding has been accompanied by a failure to consider the characteristics and needs of women without children. In this study, we examine data on 1,334 formerly incarcerated women. Findings indicate that while mothers and non-mothers share some characteristics, they differ on several others, most notably demographic profile, mental health, and timing of contacts with the criminal justice system. These results suggest a need to recognize the diversity among women offender groups, particularly when developing policies and programs need.

AbstractThe majority of people in America's prisons are the parents of minor children. Incarcerated mothers, in particular, were likely to have been a part of their children's lives before their imprisonment, and most will soon be returning to the community and to their children. Research has shown that it is in the best interests of the mothers and the children to maintain a relationship across the prison bars. In this article, we use the example of New York State to show how institutional policies and structures can impede or encourage efforts to maintain ties between women and their children and why demonstrating support for family ties must extend well beyond having visiting hours.

The book edition of Constitutions of the World from the late 18th Century to the middle of the 19th Century is the most complete and academically thorough collection of its kind. It contains constitutional documents from all over the world, written from 1776 to the end of the year 1849. This collection includes about 1,000 constitutions, human rights declarations, and draughts of constitutions that never came into force, from this period. These early constitutional documents were collected and examined in archives and libraries all over the world, as part of a project by the Deutsche Forschung

The book edition of Constitutions of the World from the late 18th Century to the middle of the 19th Century is the most complete and academically thorough collection of its kind. It contains constitutional documents from all over the world, written from 1776 to the end of the year 1849. This collection includes about 1,000 constitutions, human rights declarations, and draughts of constitutions that never came into force, from this period. These early constitutional documents were collected and examined in archives and libraries all over the world, as part of a project by the Deutsche Forschung.

Three experiments investigated the effects of positive mood on perceptions of variability within and between groups. Participants formed impressions of two different and highly variable groups under a neutral or positive mood. When participants expected to learn about both groups, positive mood increased perceived intergroup similarity but did not affect perceived intragroup variability. In contrast, when participants expected to learn about only one group, judgments of intergroup and intragroup similarity were both affected by mood. Mood and the intergroup context influenced the nature and degree of information processing and resultant judgments of variability in social groups.

AbstractBackgroundIdentifying barriers that can be modified to promote physical activity is important for informing health interventions for adults with intellectual disabilities.ObjectivesExploring participation in physical activity considering age, sex, living conditions, and health conditions. Further, identifying barriers significantly associated with sedentary activity after adjustment for physical activity correlates.MethodsA cross‐sectional study including physical activity and barrier questions from the POMONA‐15 health indicators. Multivariate logistic regression analysis with sedentary activity level as dependent variable.ResultsAmong 213 participants with intellectual disabilities, 36% reported predominately sedentary activities, 53% light and 11% moderate/vigorous physical activity. Barriers related to sedentary activity after adjustment were transportation, health conditions, mobility impairment, and lack of activities at the day activity centre.ConclusionsThe findings highlight the need to enhance physical activity opportunities at day activity centres, tailor programmes for wheelchair users, and improve access to physical activity facilities for adults with intellectual disabilities.

The bioactivation of both endogenous and equine estrogens to electrophilic quinoid metabolites has been postulated as a contributing factor in carcinogenic initiation and/or promotion in hormone sensitive tissues. Bearing structural resemblance to estrogens, extensive studies have shown that many selective estrogen receptor modulators (SERMs) are subject to similar bioactivation pathways. Lasofoxifene (LAS), a third generation SERM which has completed Phase III clinical trials for the prevention and treatment of osteoporosis, is currently approved in the European Union for this indication. Previously, Prakash et al. (Drug Metab. Dispos. 2008, 36, 1218-26) reported that similar to estradiol, two catechol regioisomers of LAS are formed as primary oxidative metabolites, accounting for roughly half of total LAS metabolism. However, the potential for further oxidation of these catechols to electrophilic o-quinones has not been reported. In the present study, LAS was synthesized and its oxidative metabolism investigated in vitro under various conditions. Incubation of LAS with tyrosinase, human liver microsomes, or rat liver microsomes in the presence of GSH as a trapping reagent resulted in formation of two mono-GSH and two di-GSH catechol conjugates which were characterized by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Similar conjugates were also detected in incubations with P450 3A4, P450 2D6, and P450 1B1 supersomes. Interestingly, these conjugates were also detected as major metabolites when compared to competing detoxification pathways such as glucuronidation and methylation. The 7-hydroxylasofoxifene (7-OHLAS) catechol regioisomer was also synthesized and oxidized either chemically or enzymatically to an o-quinone that was shown to form depurinating adducts with DNA. Collectively, these data show that analogous to estrogens, LAS is oxidized to catechols and o-quinones which could potentially contribute to in vivo toxicity for this SERM.