Management of patients during hunger strike and refeeding phase

OBJECTIVE Hunger strikers resuming nutritional intake may develop a life-threatening refeeding syndrome (RFS). Consequently, hunger strikers represent a core challenge for the medical staff. The objective of the study was to test the effectiveness and safety of evidence-based recommendations for prevention and management of RFS during the refeeding phase. METHODS This was a retrospective, observational data analysis of 37 consecutive, unselected cases of prisoners on a hunger strike during a 5-y period. The sample consisted of 37 cases representing 33 individual patients. RESULTS In seven cases (18.9%), the hunger strike was continued during the hospital stay, in 16 episodes (43.2%) cessation of the hunger strike occurred immediately after admission to the security ward, and in 14 episodes (37.9%) during hospital stay. In the refeed cases (n = 30), nutritional replenishment occurred orally, and in 25 (83.3%) micronutrients substitutions were made based on the recommendations. The gradual refeeding with fluid restriction occurred over 10 d. Uncomplicated dyselectrolytemia was documented in 12 cases (40%) within the refeeding phase. One case (3.3%) presented bilateral ankle edemas as a clinical manifestation of moderate RFS. Intensive medical treatment was not necessary and none of the patients died. Seven episodes of continued hunger strike were observed during the entire hospital stay without medical complications. CONCLUSIONS Our data suggested that seriousness and rate of medical complications during the refeeding phase can be kept at a minimum in a hunger strike population. This study supported use of recommendations to optimize risk management and to improve treatment quality and patient safety in this vulnerable population.

Biographien und Netzwerke im Kaffeehandel zwischen Deutschland und Zentralamerika, 1920-1959

Kaffee ist nicht nur ein beliebtes Getränk, sondern vernetzte auch unterschiedliche Welten: Der Kaffeehandel band Hamburg und Bremen in transnationale Netzwerke ein, die sich zwischen Europa und Lateinamerika erstreckten. Zentralamerika war für den globalen Kaffeehandel wichtig, weil die Region als erste die „nasse“ Form der Aufbereitung einführte. Die hohe Qualität dieser „gewaschenen“ Kaffees machte sie auf dem Weltmarkt begehrt. Deutsche Einwanderer prägten die Handelsverbindungen zwischen den zentralamerikanischen Kaffee-Anbauregionen und den norddeutschen Hafenstädten: Sie gründeten Exportfirmen, erwarben Kaffeeplantagen und beteiligten sich an der Vorfinanzierung der Ernten. Christiane Berth analysiert Biografien und Netzwerke deutscher Kaffee-Akteure in Guatemala, Costa Rica und Chiapas. Dabei zeigt sie, wie deren Handelsnetzwerke durch wirtschaftliche Krisen und neue außenpolitische Konstellationen brüchig wurden, im Nationalsozialismus unter Druck gerieten und während des Zweiten Weltkrieges zerbrachen. Trotzdem blieben auch in der Nachkriegszeit Handelsbeziehungen zwischen Nationalstaaten, Netzwerke in der Kaffeebranche und Biografien der Kaffee-Akteure eng miteinander verknüpft.

Fault development and interaction in distributed strike-slip shear zones: an experimental approach

Analogue model experiments using both brittle and viscous materials were performed to investigate the development and interaction of strike-slip faults in zones of distributed shear deformation. At low strain, bulk dextral shear deformation of an initial rectangular model is dominantly accommodated by left-stepping, en echelon strike-slip faults (Riedel shears, R) that form in response to the regional (bulk) stress field. Push-up zones form in the area of interaction between adjacent left-stepping Riedel shears. In cross sections, faults bounding push-up zones have an arcuate shape or merge at depth. Adjacent left-stepping R shears merge by sideways propagation or link by short synthetic shears that strike subparallel to the bulk shear direction. Coalescence of en echelon R shears results in major, through-going faults zones (master faults). Several parallel master faults develop due to the distributed nature of deformation. Spacing between master faults is related to the thickness of the brittle layers overlying the basal viscous layer. Master faults control to a large extent the subsequent fault pattern. With increasing strain, relatively short antithetic and synthetic faults develop mostly between old, but still active master faults. The orientation and evolution of the new faults indicate local modifications of the stress field. In experiments lacking lateral borders, closely spaced parallel antithetic faults (cross faults) define blocks that undergo clockwise rotation about a vertical axis with continuing deformation. Fault development and fault interaction at different stages of shear strain in our models show similarities with natural examples that have undergone distributed shear.