Patientenverfügungen und Advance Care Planning bei Demenz und anderen kognitiven Beeinträchtigungen

Definition of the problem

Advance directives for later states of grave cognitive impairment that are typical for late stages of dementia meet with more far-reaching reservations than advance directives for other states of reduced competence. One of the reasons seems to lie in the ethical and psychological conflicts arising from advance directives demanding nontreatment of additional diseases or the abstention from artificial nutrition in situations in which patients show no signs of suffering from their condition.

Arguments

In this article, it is argued that a “mixed” ethical strategy be used for these cases.

Conclusion

Advance directives in the legally defined sense, especially if drawn up in a process of advance care planning, should be followed in order to avoid that advance directives as an instrument of patient autonomy are rendered futile to a degree incompatible with confidence that wishes for terminating medical treatment will be followed. In contrast, the authority of “care directives” without recognized legal status should be restricted to cases in which there is concordance between the patient’s will as expressed in the directive and the patient’s “natural” will in the relevant situation.

     

Mit zweierlei Maß: Die mangelnde Verbindlichkeit von Patientenverfügungen bei untergebrachten Personen mit psychischen Störungen in der Schweiz

Definition of the problem

Full age patients with mental disorders and preserved decision-making capacity are increasingly interested in drafting advance directives. Whereas in Switzerland (as well as in Germany) advance directives are binding in principle, an advance directive is not binding and has only to be considered in case of involuntary admission due to a mental disorder. Thereby, the virtual aim of an advance directive – the anticipated self-determination – is questioned.

Arguments

From an ethical perspective, patients with mental disorders have the same rights as patients with somatic diseases. Therefore, the question arises if there are good reasons for this unequal treatment. In the present contribution, four possible reasons are analyzed: (1) persons with mental disorders are “different”; (2) protection from self-harm; (3) often not present end-of-life context; (4) reduced bindingness as the more appropriate standard in general.

Conclusion

The authors come to the conclusion that patients with mental disorders are often capable of composing a valid advance directive, and just as any other human being, they have a principal and binding right for self-determination, even though they are particularly vulnerable in crisis situations.

     

Patientenverfügung und Behandlungsvereinbarung als Instrumente der Vorausplanung in der forensischen Psychiatrie

Definition of the problem

In Germany as well as in many other countries, mentally ill criminals who are not guilty by reasons of insanity can be sentenced to psychiatric treatment in forensic clinics. In 2011, the German Constitutional Court substantially strengthened these patients’ right to self-determination in case of treatment refusal.

Arguments

In this context, we discuss the significance of instruments of advance healthcare planning. First, we describe the context of psychiatric treatment in forensic clinics and the changes the new German legal regulations brought about. A case study helps to illustrate the consequences of treatment refusal for both patient and healthcare personnel.

Conclusion

Eventually, we discuss if and how advance directives and joint crisis plans can be useful in forensic clinics and how additional measures can help to facilitate patient self-determination.

     

Effects of annealing processes on Cu<Subscript><Emphasis Type="Italic">x</Emphasis></Subscript>Si<Subscript>1-<Emphasis Type="Italic">x</Emphasis></Subscript> thin films

The Cu _x Si_1-x thin films have been grown by pulsed laser deposition (PLD) with in situ annealing on Si (001) and Si (111), respectively. The transformation of phase was detected by X-ray diffraction (XRD). The results showed that the as-deposited films were composed of Cu on both Si (001) and Si (111). The annealed thin films consisted of Cu + η”-Cu₃Si on Si (001) while Cu + η’-Cu₃Si on Si (111), respectively, at annealed temperature (T _a) = 300-600 °C. With the further increasing of T _a, at T _a= 700 °C, there was only one main phase, η”-Cu₃Si on Si (001) while η’-Cu₃Si on Si (111), respectively. The annealed thin films transformed from continuous dense structure to scattered-grain morphology with increasing T _a detected by field emission scanning electron microscope (FESEM). It was also showed that the grain size would enlarge with increasing annealing time (t _a).     

Influence of coal fly ash particle size on structure and adsorption properties of forming adsorbents for Cr<Superscript>6+</Superscript>

Forming adsorbents FFA-R, FFA-A and FFA-B were prepared from different particle size coal fly ashes FA-R, FA-A and FA-B, their average particle sizes (d ₅₀) were 15.75, 3.61 and 1.73 μm respectively. The structure and adsorption properties for Cr⁶⁺ of forming adsorbents from aqueous solution were studied. The results show that forming adsorbent prepared from the coal fly ash with smaller particle size exhibits higher specific surface area, higher pore volume and better adsorption properties for Cr⁶⁺.The adsorption kinetics of Cr⁶⁺ on FFA-R, FFA-A and FFA-B fitts the second order kinetic model and the second adsorption rate constants are 7.523, 3.197 and 2.187 mg·g^-1· min^-1/2, respectively. The adsorption of Cr⁶⁺ on FFA-R, FFA-A and FFA-B can be described in terms of Langmuir isotherms better, and the adsorption processes are spontaneous and exothermic.     

First-Principles Study of the High-Temperature Behaviors of the Willemite-Ⅱ and Post-Phenacite Phases of Silicon Nitride

The structural and elastic properties of the recently-discovered wⅡ- and δ-Si_3N_4 are investigated through the plane-wave pseudo-potential method within ultrasoft pseudopotentials.The elastic constants show that wⅡ- and δ-Si_3N_4 are mechanically stable in the pressure ranges of 0-50 GPa and 40-50 GPa,respectively.The α→wⅡ phase transition can be observed at 18.6 GPa and 300 K.The β→δ phase transformation occurs at pressures of 29.6,32.1,35.9,39.6,41.8,and 44.1 GPa when the temperatures are100,200,300,400,500,and 600 K,respectively.The results show that the interactions among the N-2s,Si-3s,3p bands(lower valence band) and the Si-3p,N-2p bands(upper valence band) play an important role in the stabilities of the wⅡ and S phases.Moreover,several thermodynamic parameters(thermal expansion,free energy,bulk modulus and heat capacity) of δ-Si_3N_4 are also obtained.Some interesting features are found in these properties.δ-Si_3N_4 is predicted to be a negative thermal expansion material.The adiabatic bulk modulus decreases with applied pressure,but a majority of materials show the opposite trend.Further experimental investigations with higher precisions may be required to determine the fundamental properties of wⅡ- andδ-Si_3N_4.     

Effect of wafer size on the film internal stress measurement by wafer curvature method

Wafer curvature method has been applied to determine the internal stress in the films using Stoney’s equation. During the film deposition, the wafer fixation on the sample holder will restrict the deformation of the rectangle-shaped wafer, which may result in the stress datum difference along length and width direction. In this paper, the effect of wafer size and the wafer fixation on the TiN film internal stress measured by wafer curvature method was discussed. The rectangle-shaped wafers with different length/width ratios (L/W=1:1, 2:1, 3:1 and 4:1) were fixed as a cantilever beam. After the TiN films deposition, the profiles of the film/wafer were measured using a stylus profilometer and then the internal stress was calculated using the Stoney equation in the film. The results showed that the fixed end of the wafers limited to some degree the curvature of the wafers along the width direction. For film internal stress measured by wafer curvature method, the wafer profile should be scanned along the length direction and the scan distance should be greater than or equal to half of wafer length. When the length/width ratio of the wafer reached 3:1, the wafer curvature and the calculated stress were basically the same at different positions along the length direction. For film internal stress measured by wafer curvature method, it was recommended that the length/width ratio of wafer should be considered to be greater than or equal to 3:1, and the deformed profile was scanned along the length direction.     

Characterization and methanol adsorption of walnut-shell activated carbon prepared by KOH activation

Walnut-shellactivated carbons(WSACs)were prepared by the KOH chemicalactivation.The effects of carbonization temperature,activation temperature,and ratio of KOH to chars on the pore development of WSACs were investigated.Fourier transform infrared spectroscopy(FTIR),X-ray powder diffraction(XRD),and scanning electron microscopy(SEM)were employed to characterize the microstructure and morphology of WSACs.Methanoladsorption performance onto the optimalWSAC and the coal-based AC were also investigated.The results show that the optimalpreparation conditions are a carbonization temperature of 700 ℃,an activation temperature of 700 ℃,and a mass ratio of 3.The BET surface area,the micropore volume,and the micropore volume percentage of the optimalWASC are 1636 m~2/g,0.641 cm~3/g and 81.97%,respectively.There are a lot of micropores and a certain amount of meso-and macropores.The characteristics of the amorphous state are identified.The results show that the optimalWSAC is favorable for methanoladsorption.The equilibrium adsorption capacity of the optimalWSAC is 248.02mg/g.It is shown that the equilibrium adsorption capacity of the optimalWSAC is almost equivalent to that of the common activated carbon.Therefore the optimalWSAC could be a potentialadsorbent for the solar energy adsorption refrigeration cycle.     

Rheological behaviors of fresh cement pastes with polycarboxylate superplasticizer

The rheologicalbehaviors of fresh cement paste with polycarboxylate superplasticizer were systematically investigated.Influentialfactors including superplasticizer to cement ratio(Sp/C),water to cement ratio(w/c),temperature,and time were discussed.Fresh cement pastes with Sp/Cs in the range of 0 to 2.0% and varied W/Cs from 0.25 to 0.5 were prepared and tested at 0,20 and 40 °C,respectively.Flowability and rheologicaltests on cement pastes were conducted to characterize the development of the rheologicalbehavior of fresh cement pastes over time.The exprimentalresults indicate that the initialflowability and flowability retention over shelf time increase with the growth in superplasticizer dosage due to the plasticizing effect and retardation effect of superplasticizer.Higher temperature usually leads to a sharper drop in initialflowability and flowability retention.However,for the cement paste with high Sp/C or w/c,the flowability is slightly affected by temperature.Yield stress and plastic viscosity show similar variation trends to the flowability under the abovementioned influentialfactors at low Sp/C.In the case of high Sp/C,yield stress and plastic viscosity start to decline over shelf time and the decreasing rate descends at elevated temperature.Moreover,two equations to roughly predict yield stress and plastic viscosity of the fresh cement pastes incorporating Sp/C,w/c,temperature and time are developed on the basis of the existing models,in which experimentalconstants can be extracted from a database created by the rheologicaltest results.     

Microstructure and erosion resistance of in-situ SiAlON reinforced BN-SiO<Subscript>2</Subscript> composite ceramics

BN-SiO₂-SiAlON composite ceramics were successfully prepared by the means of hot pressed sintering. Xe plasma flow generated by Hall Thruster was used for sputtering the surface of the samples in order to evaluate the plasma erosion resistance. XRD, TEM, SEM, and LSCM were used to characterize the phase composition and morphologies of as-made composite ceramics before and after Xe plasma erosion. The ceramics were composed of h-BN, fused silica, and SiAlON, which maintained structural stability during the process of Xe plasma sputtering. In conclusion, comparing with BN-SiO₂ composite ceramics, the plasma erosion rate of BN-SiO₂-SiAlON composite ceramics decreases significantly at first then rises with the increase of AlN addition. Erosion pits can be observed by using SEM on the surface after plasma sputtering, which demonstrates that the BN grains have dropped off the surface. In addition, mechanical denudation by high-speed Xe ions is recognized as the injury mechanism for the BN-matrix composite materials.