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.

     

Targeting Mitochondria in Diabetes

Type 2 diabetes (T2D), one of the most prevalent noncommunicable diseases, is often preceded by insulin resistance (IR), which underlies the inability of tissues to respond to insulin and leads to disturbed metabolic homeostasis. Mitochondria, as a central player in the cellular energy metabolism, are involved in the mechanisms of IR and T2D. Mitochondrial function is affected by insulin resistance in different tissues, among which skeletal muscle and liver have the highest impact on whole-body glucose homeostasis. This review focuses on human studies that assess mitochondrial function in liver, muscle and blood cells in the context of T2D. Furthermore, different interventions targeting mitochondria in IR and T2D are listed, with a selection of studies using respirometry as a measure of mitochondrial function, for better data comparison. Altogether, mitochondrial respiratory capacity appears to be a metabolic indicator since it decreases as the disease progresses but increases after lifestyle (exercise) and pharmacological interventions, together with the improvement in metabolic health. Finally, novel therapeutics developed to target mitochondria have potential for a more integrative therapeutic approach, treating both causative and secondary defects of diabetes.     

Nano- and microstructuring of graphene using UV-NIL

In this work we demonstrate for the first time the micro-?and nanostructuring of graphene by means of UV-nanoimprint lithography. Exfoliated graphene on SiO(2) substrates, as well as graphene deposited by chemical vapor deposition (CVD) on polycrystalline nickel and copper, and transferred CVD graphene on dielectric substrates, were used to demonstrate that our technique is suitable for large-area patterning (2?×?2?cm(2)) of graphene on various types of substrates. The demonstrated fabrication procedure of micrometer as well as nanometer-sized graphene structures with feature sizes down to 20?nm by a wafer-scale process opens up an avenue for the low-cost and high-throughput manufacturing of graphene-based optical and electronic applications. The processed graphene films show electron mobilities of up to 4.6?×?10(3)?cm(2)?V (-1)?s(-1), which confirms them to exhibit state-of-the-art electronic quality with respect to the current literature.     

Fuzzy inference mechanism for recognition of contact states in intelligent robotic assembly

This paper presents a methodology for generating a fuzzy inference mechanism (FIM) for recognizing contact states within robotic part mating using active compliant motion. In the part mating process, significant uncertainties are inherently present. As a result it is pertinent that contact states recognition systems operating in such environment be able to make decisions on the contact state currently present in the process, based on data full of uncertainties and imprecision. In such conditions, implementation of fuzzy logic and interval inference brings significant robustness to the system. As a starting point for FIM generation, we use a quasi-static model of the mating force between objects. By applying Discrete Wavelet Transform to the signal generated using this model, we extract qualitative and representative features for classification into contact states. Thus, the obtained patterns are optimally classified using support vector machines (SVM). We exploit the equivalence of SVM and Takagi–Sugeno fuzzy rules based systems for generation of FIM for classification into contact states. In this way, crisp granulation of the feature space obtained using SVM is replaced by optimal fuzzy granulation and robustness of the recognition system is significantly increased. The information machine for contact states recognition that is designed using the given methodology simultaneously uses the advantages of creation of machine based on the process model and the advantages of application of FIM. Unlike the common methods, our approach for creating a knowledge base for the inference machine is neither heuristic, intuitive nor empirical. The proposed methodology was elaborated and experimentally tested using an example of a cylindrical peg in hole as a typical benchmark test.     

Harmonic spatial coherence imaging: an ultrasonic imaging method based on backscatter coherence

We introduce a harmonic version of the short-lag spatial coherence (SLSC) imaging technique, called harmonic spatial coherence imaging (HSCI). The method is based on the coherence of the second-harmonic backscatter. Because the same signals that are used to construct harmonic B-mode images are also used to construct HSCI images, the benefits obtained with harmonic imaging are also obtained with HSCI. Harmonic imaging has been the primary tool for suppressing clutter in diagnostic ultrasound imaging, however secondharmonic echoes are not necessarily immune to the effects of clutter. HSCI and SLSC imaging are less sensitive to clutter because clutter has low spatial coherence. HSCI shows favorable imaging characteristics such as improved contrast-to-noise ratio (CNR), improved speckle SNR, and better delineation of borders and other structures compared with fundamental and harmonic B-mode imaging. CNRs of up to 1.9 were obtained from in vivo imaging of human cardiac tissue with HSCI, compared with 0.6, 0.9, and 1.5 in fundamental B-mode, harmonic B-mode, and SLSC imaging, respectively. In vivo experiments in human liver tissue demonstrated SNRs of up to 3.4 for HSCI compared with 1.9 for harmonic B-mode. Nonlinear simulations of a heart chamber model were consistent with the in vivo experiments.     

Novel Lytic Enzyme of Prophage Origin from Clostridium botulinum E3 Strain Alaska E43 with Bactericidal Activity against Clostridial Cells

Clostridium botulinum is a Gram-positive, anaerobic, spore-forming bacterium capable of producing botulinum toxin and responsible for botulism of humans and animals. Phage-encoded enzymes called endolysins, which can lyse bacteria when exposed externally, have potential as agents to combat bacteria of the genus Clostridium. Bioinformatics analysis revealed in the genomes of several Clostridium species genes encoding putative N-acetylmuramoyl-l-alanine amidases with anti-clostridial potential. One such enzyme, designated as LysB (224-aa), from the prophage of C. botulinum E3 strain Alaska E43 was chosen for further analysis. The recombinant 27,726 Da protein was expressed and purified from E. coli Tuner(DE3) with a yield of 37.5 mg per 1 L of cell culture. Size-exclusion chromatography and analytical ultracentrifugation experiments showed that the protein is dimeric in solution. Bioinformatics analysis and results of site-directed mutagenesis studies imply that five residues, namely H25, Y54, H126, S132, and C134, form the catalytic center of the enzyme. Twelve other residues, namely M13, H43, N47, G48, W49, A50, L73, A75, H76, Q78, N81, and Y182, were predicted to be involved in anchoring the protein to the lipoteichoic acid, a significant component of the Gram-positive bacterial cell wall. The LysB enzyme demonstrated lytic activity against bacteria belonging to the genera Clostridium, Bacillus, Staphylococcus, and Deinococcus, but did not lyse Gram-negative bacteria. Optimal lytic activity of LysB occurred between pH 4.0 and 7.5 in the absence of NaCl. This work presents the first characterization of an endolysin derived from a C. botulinum Group II prophage, which can potentially be used to control this important pathogen.