A risk of suicide in the course of a psychiatric disorder will often be answered with an admission for inpatient psychiatric treatment, resulting in a high potential of suicidal behavior on the ward. ...Despite extensive safety precautions and therapeutic interventions, suicides still occur within psychiatric hospitals. Such incidents, known as inpatient suicides, are rare but significant, necessitating further examination. We present the case of a 91-year-old suicidal male patient, who committed suicide on an open ward on a Sunday morning by blocking his nostrils with cotton and tissue and breathing into a pillow, leading to death by asphyxia. The case report aims to draw attention to the possibility of this extraordinary method of suicide, demonstrating that a suicide can be accomplished in a psychiatric hospital even without the use of prohibited dangerous objects.
Zusammenfassung
In Deutschland geschehen jedes zweite Körperverletzungsdelikt und etwa jedes vierte Sexualdelikt unter Alkohol- oder Drogeneinfluss. Unbehandelte Substanzkonsumstörungen sind ein ...Risikofaktor für weitere Straftaten. § 64 StGB regelt die Unterbringung in einer Entziehungsanstalt für Straftäter in Folge eines Hangs zur Einnahme berauschender Substanzen im Übermaß. Die bisherige Regelung steht in der Kritik, weil zu viele Patienten zugewiesen würden, das Angebot oftmals die falschen Personen bekämen, die Behandlung häufig nicht erfolgreich beendet wird und das Angebot zu viele Ressourcen verbrauche. Eine Reform der Unterbringung in einer Entziehungsanstalt (§ 64 StGB) muss aus psychiatrischer Sicht den medizinethischen Prinzipien, insbesondere dem Respekt vor der Autonomie des Patienten, dem Prinzip der Verteilungsgerechtigkeit und der ärztlichen Berufsordnung gerecht werden. Die Unterbringung nach § 64 StGB muss auf die Behandlung von Menschen mit klinisch relevanten Substanzkonsumstörungen beschränkt werden. Entscheidend für die Erfolgsaussicht einer psychiatrischen Suchtbehandlung sind die Behandlungsbereitschaft und Selbstbestimmung bei Aufnahme in die Klinik. Um die Therapie von behandlungsfremden Einflüssen des Strafvollstreckungsrechts zu entlasten, sollte bei Antritt der Behandlung bereits so viel Strafe verbüßt sein, dass die Unterbringung nur noch dem Behandlungs- und Resozialisierungszweck und dem Ziel dient, das Risiko weiterer substanzmittelbedingter Straftaten zu senken. Der Begriff „Entziehungsanstalt“ sollte ersetzt werden durch die angemessenere Bezeichnung „Forensische Klinik für Abhängigkeitserkrankungen“.
We have searched for Theta+(1540) and Xi(--)(1862) pentaquark candidates in proton-induced reactions on C, Ti, and W targets at midrapidity and square root of s = 41.6 GeV. In 2 x 10(8) inelastic ...events we find no evidence for narrow (sigma approximately 5 MeV) signals in the Theta+ --> pK0(S) and Xi(--) --> Xi- pi- channels; our 95% C.L. upper limits (UL) for the inclusive production cross section times branching fraction B dsigma/dy/(y approximately 0) are (4-16) mub/N for a Theta+ mass between 1521 and 1555 MeV, and 2.5 mub/N for the Xi(--). The UL of the yield ratio of Theta+/Lambda(1520) < (3-12)% is significantly lower than model predictions. Our UL of B Xi(--)/Xi(1530)0 < 4% is at variance with the results that have provided the first evidence for the Xi(--).
In the DEPFET pixel concept, the absorbed radiation directly modulates the channel current of a p-JFET transistor being integrated into a fully depleted high ohmic silicon substrate in every pixel ...cell, offering very low noise operation at room temperature. Hence, DEPFET pixels open new possibilities in biomedical applications, but also have a potential in particle physics and astrophysics. Second prototype
50
μm×50
μm
single pixels as well as large (64×64) DEPFET matrices have been successfully produced and operated confirming the low noise behavior (12
e). Device studies as well as a full DEPFET pixel Bioscope system to be used in real-time digital autoradiography with excellent spatial and energy resolution for X-rays are presented.
In Germany every second offence occasioning bodily harm and every fourth sexual offence occur under the influence of alcohol or drugs. Untreated substance use disorders are a risk factor for further ...offences. The §64 of the German Penal Code (StGB) regulates the commitment of offenders to a Forensic addiction treatment unit as a result of an addiction to excessive consummation of intoxicating substances. The previous regulation has come under criticism because too many patients are committed, the sentence is often given to the wrong persons, the treatment is often terminated without success and the sentence consumes to many resources. From a psychiatric perspective the reform of commitment to a Forensic addiction treatment unit (§64 StGB) must fulfil the principles of medical ethics, in particular the respect for the autonomy of the patient, the principle of distributional justice and the code of medical professional ethics. The commitment according to §64 must be restricted to the treatment of people with a clinically relevant substance use disorder. From a psychiatric perspective, decisive for the prospect of success are the willingness to be treated and self-determination for admission to the clinic. In order to release the treatment from the extrinsic influences of the enforcement law, on admission to treatment a sufficient amount of the sentence should have already been served that the commitment only serves the purpose of the treatment and resocialization, so that the risk of further substance-related offences is reduced. The legal term "Entziehungsanstalt" should be replaced by "Forensic Clinic for Dependancy Diseases".
Measurements of the kinematic distributions of
J
/
ψ
mesons produced in
p
–C,
p
–Ti and
p
–W collisions at
in the Feynman-
x
region −0.34<
x
F
<0.14 and for transverse momentum up to
p
T
=5.4 GeV/c ...are presented. The
x
F
and
p
T
dependencies of the nuclear suppression parameter,
α
, are also given. The results are based on 2.4×10
5
J
/
ψ
mesons reconstructed in both the
e
+
e
−
and
μ
+
μ
−
decay channels. The data have been collected by the HERA-B experiment at the HERA proton ring of the DESY laboratory. The measurement explores the negative region of
x
F
for the first time. The average value of
α
in the measured
x
F
region is 0.981±0.015. The data suggest that the strong nuclear suppression of
J
/
ψ
production previously observed at high
x
F
turns into an enhancement at negative
x
F
.
This article is concerned with the measurement of activity limitations in neurologic patients and with the application of the item response theory (IRT), especially the Rasch analysis, in analyzing ...activity ratings. Activity limitations of 166 patients with different neurologic disorders (e.g., stroke, traumatic brain injury) were assessed with the Functional Independence Measure (FIM) during their stay in a rehabilitation hospital. Data analysis was performed with the Rasch model, which allows testing the psychometric qualities of the FIM. Results indicate that the FIM has good psychometric qualities. However, results also show that the 18 FIM items define two statistically and clinically different indicators. Thirteen items define disability in motor functions. Five items define disability in cognitive functions. Separate analyses of the two scales help to improve the psychometric quality of the FIM.
•Appendectomy (appy) increases hospital readmission risk directly related to adhesions.•Adhesions may cause small bowel obstruction (SBO) that require adhesiolysis.•Pro- and anti-inflammatory ...mediators in appy rA may regulate de novo adhesion.•SBO rA showed markers of increased oxidative stress and altered energy metabolism.•Appy rA may represent a suitable fluid to elucidate human adhesion dynamics.
Pathological abdominal adhesions can cause bowel obstructions. A history of appendectomy (appy) increases patient rehospitalization risk directly related to adhesions. To potentially identify strategies for adhesion treatment, we characterized reactive ascites (rA) collected during appy or adhesiolysis for small bowel obstruction (SBO).
This is a non-randomized, prospective observational study recruiting patients with non-perforated appendicitis or SBO from three Level 1 trauma centers in the United States. rA were analyzed via liquid chromatography-mass spectrometry (LC-MS) (n = 31), bead-based quantification cytokines and chemokines (n = 32) and soluble receptors (n = 30), and LC-MS metabolomics (n = 18).
LC-MS showed that samples contained albumin, apolipoprotein A1, and transthyretin and that metabolites increased in SBO vs appy rA were biomarkers of oxidative stress. Multi-plex analyses showed levels of 17 cytokines/chemokines and 6 soluble receptors were significantly different in appy vs SBO rA. Top increased proteins in appy compared to SBO rA by 20.14-, 11.53-, and 8.18-fold were granulocyte-colony stimulating factor, C-X-C motif chemokine ligand 10, and interleukin-10, respectively.
These data further define pro- and anti-inflammatory mediators and metabolites that may drive formation or perpetuate chronic abdominal adhesions. Future research is to further explore whether attenuation of these factors may decrease pathologic adhesion formation.
Background Complication rates reported after locking plate fixation of proximal humeral fractures still range up to 40%. Whether modifications of surgical techniques, use of primary shoulder ...arthroplasty, or a fracture-specific management resulted in decreased complication rates during recent years remains unclear. Therefore, the aim of this long-term observation study was to analyze the incidence of complications and revision surgery after locked plating. Methods Between February 2002 and December 2013, 788 patients (aged 67.4 ± 17.3 years) with displaced proximal humeral fractures were treated with locking plate, primary hemiarthroplasty (HA), or reverse shoulder arthroplasty (RSA). Standardized follow-up included radiographs at 1 day, 6 weeks, and 3, 6, and 12 months. Complications and unplanned revision surgery were prospectively recorded over the complete follow-up. Results Of 788 patients, 646 (82%) were treated with locking plate, 82 (10.4%) with HA, and 60 (7.6%) with RSA. Mean follow-up was 14.8 ± 3.8 months. The mean complication rate associated with locked plating was 12.8%, and revision surgery was necessary in 11.6%. Within the last 5 years, the loss of fixation rate markedly decreased from 14.3% to 4.8%; simultaneously, an increased use of RSA was observed. Conclusion The overall complication rate of locking plate osteosynthesis for proximal humeral fractures has been decreasing considerably within the last years. Among others, this might be due to an increased use of primary RSA for complex fracture types. In addition to a precise surgical technique, choosing the adequate treatment for each individual fracture to avoid complications and revision surgery is of utmost importance.
PDF
