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.

Der Strike der Schnorrer

Theodor Zlocisti

Der Wiener Tramway-Strike : (ein Epilog)

x. y.

Der Strike der Tallesweber

Robert Hahndel

Georg Solti, Ganzfigurbildnis, Paris, 1959

Signatur des Originals: S 36/F09918

Georg Solti, Ganzfigurbildnis, Paris, 1959

Signatur des Originals: S 36/F09919

Strike-slip faults mediate the rise of crustal-derived fluids and mud volcanism in the deep sea

We report on newly discovered mud volcanoes located at about 4500 m water depth 90 km west of the deformation front of the accretionary wedge of the Gulf of Cadiz, and thus outside of their typical geotectonic environment. Seismic data suggest that fluid flow is mediated by a >400-km-long strike-slip fault marking the transcurrent plate boundary between Africa and Eurasia. Geochemical data (Cl, B, Sr, 87Sr/86Sr, Delta18O, DeltaD) reveal that fluids originate in oceanic crust older than 140 Ma. On their rise to the surface, these fluids receive strong geochemical signals from recrystallization of Upper Jurassic carbonates and clay-mineral dehydration in younger terrigeneous units. At present, reports of mud volcanoes in similar deep-sea settings are rare, but given that the large area of transform-type plate boundaries has been barely investigated, such pathways of fluid discharge may provide an important, yet unappreciated link between the deeply buried oceanic crust and the deep ocean.