Die konstitutionellen Zehn Gebote: den Männern aus dem Volke gewidmet: Frage. Wie lauten die konstitutionellen zehn Gebote? ...

Welsch (Projektbearbeiter): 1. Gebot: Du sollst neben dem konstitutionellen König auch andere Stimmen hören, so vor allem die Volks-Stimme (Zeitung) sowie die Stimmen der verantwortlichen Minister. 2. Gebot: Du sollst - als Mitglied eines freien Volkes - Deine Freiheit mit Hilfe von Petitionen (solche aus Papier und solche, die man Barrikaden nennt) wahren. 3. Gebot: Du sollst die Festtage der Freiheit heiligen (18. März sowie der noch ausstehende Tag, an dem eine Verfassung eingeführt wird). 4. Gebot: Du sollst Freiheit und Recht ehren und das Wohl des Vaterlandes fördern. 5. Gebot: Du sollst nicht töten, außer im offenen Kampf und in Notwehr. 6. Gebot: Du sollst nicht das beschwören, was Du nicht halten kannst. 7. Gebot: Du sollst kein fremdes Eigentum an Dich bringen, sei es nun eine Stecknadel oder eine Kaiserkrone. 8. Gebot: Du sollst das Volk in den Ohren des Königs nicht verleumden. 9. Gebot: Du sollst nicht begehren Deines Nächsten Eigentum, mit der Ausnahme des Nationaleigentums (Paläste, Kasernen, Schilderhäuser etc.). 10. Gebot: Du sollst nicht dulden, daß Dein Nächster sich wie ein Knecht behandeln läßt

Detection of haemorrhagic shock: Are vital signs obsolete? A commentary by Dr M. Luginbühl

The ATLS program by the American college of surgeons is probably the most important globally active training organization dedicated to improve trauma management. Detection of acute haemorrhagic shock belongs to the key issues in clinical practice and thus also in medical teaching. (In this issue of the journal William Schulz and Ian McConachrie critically review the ATLS shock classification Table 1), which has been criticized after several attempts of validation have failed [1]. The main problem is that distinct ranges of heart rate are related to ranges of uncompensated blood loss and that the heart rate decrease observed in severe haemorrhagic shock is ignored [2]. Table 1. Estimated blood loos based on patient's initial presentation (ATLS Students Course Manual, 9th Edition, American College of Surgeons 2012). Class I Class II Class III Class IV Blood loss ml Up to 750 750–1500 1500–2000 >2000 Blood loss (% blood volume) Up to 15% 15–30% 30–40% >40% Pulse rate (BPM) <100 100–120 120–140 >140 Systolic blood pressure Normal Normal Decreased Decreased Pulse pressure Normal or ↑ Decreased Decreased Decreased Respiratory rate 14–20 20–30 30–40 >35 Urine output (ml/h) >30 20–30 5–15 negligible CNS/mental status Slightly anxious Mildly anxious Anxious, confused Confused, lethargic Initial fluid replacement Crystalloid Crystalloid Crystalloid and blood Crystalloid and blood Table options In a retrospective evaluation of the Trauma Audit and Research Network (TARN) database blood loss was estimated according to the injuries in nearly 165,000 adult trauma patients and each patient was allocated to one of the four ATLS shock classes [3]. Although heart rate increased and systolic blood pressure decreased from class I to class IV, respiratory rate and GCS were similar. The median heart rate in class IV patients was substantially lower than the value of 140 min−1 postulated by ATLS. Moreover deterioration of the different parameters does not necessarily go parallel as suggested in the ATLS shock classification [4] and [5]. In all these studies injury severity score (ISS) and mortality increased with in increasing shock class [3] and with increasing heart rate and decreasing blood pressure [4] and [5]. This supports the general concept that the higher heart rate and the lower blood pressure, the sicker is the patient. A prospective study attempted to validate a shock classification derived from the ATLS shock classes [6]. The authors used a combination of heart rate, blood pressure, clinically estimated blood loss and response to fluid resuscitation to classify trauma patients (Table 2) [6]. In their initial assessment of 715 predominantly blunt trauma patients 78% were classified as normal (Class 0), 14% as Class I, 6% as Class II and only 1% as Class III and Class IV respectively. This corresponds to the results from the previous retrospective studies [4] and [5]. The main endpoint used in the prospective study was therefore presence or absence of significant haemorrhage, defined as chest tube drainage >500 ml, evidence of >500 ml of blood loss in peritoneum, retroperitoneum or pelvic cavity on CT scan or requirement of any blood transfusion >2000 ml of crystalloid. Because of the low prevalence of class II or higher grades statistical evaluation was limited to a comparison between Class 0 and Class I–IV combined. As in the retrospective studies, Lawton did not find a statistical difference of heart rate and blood pressure among the five groups either, although there was a tendency to a higher heart rate in Class II patients. Apparently classification during primary survey did not rely on vital signs but considered the rather soft criterion of “clinical estimation of blood loss” and requirement of fluid substitution. This suggests that allocation of an individual patient to a shock classification was probably more an intuitive decision than an objective calculation the shock classification. Nevertheless it was a significant predictor of ISS [6]. Table 2. Shock grade categories in prospective validation study (Lawton, 2014) [6]. Normal No haemorrhage Class I Mild Class II Moderate Class III Severe Class IV Moribund Vitals Normal Normal HR > 100 with SBP >90 mmHg SBP < 90 mmHg SBP < 90 mmHg or imminent arrest Response to fluid bolus (1000 ml) NA Yes, no further fluid required Yes, no further fluid required Requires repeated fluid boluses Declining SBP despite fluid boluses Estimated blood loss (ml) None Up to 750 750–1500 1500–2000 >2000 Table options What does this mean for clinical practice and medical teaching? All these studies illustrate the difficulty to validate a useful and accepted physiologic general concept of the response of the organism to fluid loss: Decrease of cardiac output, increase of heart rate, decrease of pulse pressure occurring first and hypotension and bradycardia occurring only later. Increasing heart rate, increasing diastolic blood pressure or decreasing systolic blood pressure should make any clinician consider hypovolaemia first, because it is treatable and deterioration of the patient is preventable. This is true for the patient on the ward, the sedated patient in the intensive care unit or the anesthetized patients in the OR. We will therefore continue to teach this typical pattern but will continue to mention the exceptions and pitfalls on a second stage. The shock classification of ATLS is primarily used to illustrate the typical pattern of acute haemorrhagic shock (tachycardia and hypotension) as opposed to the Cushing reflex (bradycardia and hypertension) in severe head injury and intracranial hypertension or to the neurogenic shock in acute tetraplegia or high paraplegia (relative bradycardia and hypotension). Schulz and McConachrie nicely summarize the various confounders and exceptions from the general pattern and explain why in clinical reality patients often do not present with the “typical” pictures of our textbooks [1]. ATLS refers to the pitfalls in the signs of acute haemorrhage as well: Advanced age, athletes, pregnancy, medications and pace makers and explicitly state that individual subjects may not follow the general pattern. Obviously the ATLS shock classification which is the basis for a number of questions in the written test of the ATLS students course and which has been used for decades probably needs modification and cannot be literally applied in clinical practice. The European Trauma Course, another important Trauma training program uses the same parameters to estimate blood loss together with clinical exam and laboratory findings (e.g. base deficit and lactate) but does not use a shock classification related to absolute values. In conclusion the typical physiologic response to haemorrhage as illustrated by the ATLS shock classes remains an important issue in clinical practice and in teaching. The estimation of the severity haemorrhage in the initial assessment trauma patients is (and was never) solely based on vital signs only but includes the pattern of injuries, the requirement of fluid substitution and potential confounders. Vital signs are not obsolete especially in the course of treatment but must be interpreted in view of the clinical context. Conflict of interest None declared. Member of Swiss national ATLS core faculty.

Performance of gene-expression profiling test score variability to predict future clinical events in heart transplant recipients.

BACKGROUND A single non-invasive gene expression profiling (GEP) test (AlloMap®) is often used to discriminate if a heart transplant recipient is at a low risk of acute cellular rejection at time of testing. In a randomized trial, use of the test (a GEP score from 0-40) has been shown to be non-inferior to a routine endomyocardial biopsy for surveillance after heart transplantation in selected low-risk patients with respect to clinical outcomes. Recently, it was suggested that the within-patient variability of consecutive GEP scores may be used to independently predict future clinical events; however, future studies were recommended. Here we performed an analysis of an independent patient population to determine the prognostic utility of within-patient variability of GEP scores in predicting future clinical events. METHODS We defined the GEP score variability as the standard deviation of four GEP scores collected ≥315 days post-transplantation. Of the 737 patients from the Cardiac Allograft Rejection Gene Expression Observational (CARGO) II trial, 36 were assigned to the composite event group (death, re-transplantation or graft failure ≥315 days post-transplantation and within 3 years of the final GEP test) and 55 were assigned to the control group (non-event patients). In this case-controlled study, the performance of GEP score variability to predict future events was evaluated by the area under the receiver operator characteristics curve (AUC ROC). The negative predictive values (NPV) and positive predictive values (PPV) including 95 % confidence intervals (CI) of GEP score variability were calculated. RESULTS The estimated prevalence of events was 17 %. Events occurred at a median of 391 (inter-quartile range 376) days after the final GEP test. The GEP variability AUC ROC for the prediction of a composite event was 0.72 (95 % CI 0.6-0.8). The NPV for GEP score variability of 0.6 was 97 % (95 % CI 91.4-100.0); the PPV for GEP score variability of 1.5 was 35.4 % (95 % CI 13.5-75.8). CONCLUSION In heart transplant recipients, a GEP score variability may be used to predict the probability that a composite event will occur within 3 years after the last GEP score. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT00761787.

Clinical usefulness of gene-expression profile to rule out acute rejection after heart transplantation: CARGO II.

AIMS A non-invasive gene-expression profiling (GEP) test for rejection surveillance of heart transplant recipients originated in the USA. A European-based study, Cardiac Allograft Rejection Gene Expression Observational II Study (CARGO II), was conducted to further clinically validate the GEP test performance. METHODS AND RESULTS Blood samples for GEP testing (AlloMap(®), CareDx, Brisbane, CA, USA) were collected during post-transplant surveillance. The reference standard for rejection status was based on histopathology grading of tissue from endomyocardial biopsy. The area under the receiver operating characteristic curve (AUC-ROC), negative (NPVs), and positive predictive values (PPVs) for the GEP scores (range 0-39) were computed. Considering the GEP score of 34 as a cut-off (>6 months post-transplantation), 95.5% (381/399) of GEP tests were true negatives, 4.5% (18/399) were false negatives, 10.2% (6/59) were true positives, and 89.8% (53/59) were false positives. Based on 938 paired biopsies, the GEP test score AUC-ROC for distinguishing ≥3A rejection was 0.70 and 0.69 for ≥2-6 and >6 months post-transplantation, respectively. Depending on the chosen threshold score, the NPV and PPV range from 98.1 to 100% and 2.0 to 4.7%, respectively. CONCLUSION For ≥2-6 and >6 months post-transplantation, CARGO II GEP score performance (AUC-ROC = 0.70 and 0.69) is similar to the CARGO study results (AUC-ROC = 0.71 and 0.67). The low prevalence of ACR contributes to the high NPV and limited PPV of GEP testing. The choice of threshold score for practical use of GEP testing should consider overall clinical assessment of the patient's baseline risk for rejection.

Ganz Berlin muß nach Wien, Jegen die Croaten ziehn! Dann is Windischjrätz verloren! Karbe hat es uns jeschworen: Eene Rede, jered't von Herr Karben, am 31. October, uf de Kummödientreppe, un wortjetrei abjekuppirt: Freinde! Brüder! Mitbürger! Berliner! Souveränet Volk! ...

Welsch (Projektbearbeiter): Satire auf den Werdegang der sehr weitgehenden und radikalen Forderungen der Berliner Volksredner, der immer nach demselben Muster abläuft: die Forderungen werden auf einer Volksversammlung vom Redner formuliert und von der Versammlung gutgeheißen. Darauf wird eine Deputation gebildet, die die fraglichen Forderungen der Nationalversammlung als Petition übergibt. Nach dem Empfang der Deputation durch die Nationalversammlung macht sich der Abgeordnete D'Ester die Petition zu eigen und übergibt sie dem Präsidenten, der sie in die Kommissionen verweist. Die Kommissionen wiederum beraten darüber und erstatten am nächsten Tag Bericht. "Un so war et, un so is et, un so wird et bleiben." Geschildert vor dem Hintergrund der Niederschlagung der Wiener Revolution am Beispiel einer - fiktiven - Rede von Adolph Friedrich Karbe

Das freie Preußen! : Geschichte des Berliner Freiheits-Kampfes vom 18. März 1848 und seiner Folgen

Boberach: Die Darstellung, die mit zahlreichen Zitaten belegt wird, reicht bis zur Oktroyierung der Preußischen Verfassung; im Mittelpunkt stehen die Entwicklung der demokratischen Vereine, für deren Scheitern Held verantwortlich gemacht wird, die gegen sie gerichteten Maßnahmen und die Verhandlungen der Nationalversammlung

Die Ereignisse im Jahre 1849 nebst einer Geschichte der Kriege in Ungarn, Italien, Schleswig-Holstein und Baden, so wie des deutschen Parlaments im Jahre 1848

von Adolph Streckfuß

Die Staats-Umwälzungen der Jahre 1847 und 1848

dargestellt von Adolph Carl (Adolph Streckfuß) [u. Hexamer]

Das Volks-Archiv : eine Sammlung geschichtlicher Erzählungen aus der neuesten Zeit, Biographien berühmter Freiheits-Kämpfer u.s.w.

von Adolph Streckfuß

Erika Mann im Schweizer Exil. Die "Pfeffermüllerin" und das intellektuelle Unternehmen

Die Intellektuellengeschichte hat den Fokus bislang weitgehend auf männliche Intellektuelle gelegt und die Kategorie "Geschlecht" nicht fruchtbar gemacht. Sie hat ausserdem das Exil als Ursache und Kontext von intellektuellem Eingreifen unzureichend in Rechnung gestellt. Sie hat es schliesslich versäumt, die materiellen Voraussetzungen und Interessen für intellektuelles Engagement zu problematisieren. Der Aufsatz geht diesen Fragen anhand von Erika Manns Exil in der Schweiz nach.

La réparation (« Wiedergutmachung ») comme raison d’être : les études sur l’exil (« Exilforschung ») dans l’aire germanophone

La réparation (« Wiedergutmachung ») comme raison d’être : les études sur l’exil (« Exilforschung ») dans l’aire germanophone La contribution se concentrera sur trois aspects des études sur l’exil (« Exilforschung ») germanophone, en donnant priorité à l’évolution en RFA. Les développements en Autriche et en Suisse pourront être abordés pendant la discussion, de même que, d’une manière moins exhaustive, ceux en RDA. 1. Genèse et professionnalisation du champ des études sur l’exil Elles naissent au lendemain de la Seconde Guerre Mondiale suite à l’initiative d’écrivains exilés, qui commencent à réunir des textes littéraires écrits en exil que l’on a appelés à l’époque « Emigrantenliteratur ». Mais ce n’est que dans les années 1960 que les études sur l’exil (« Exilforschung ») se constituent comme un champ d’étude en soi. La Gesellschaft für Exilforschung est créée en 1984 sur le modèle de la North American Society for Exile Studies. Sur fond du lourd héritage des violences perpétrées par le régime nazi et de l’Holocauste, les études allemandes sur l’exil se consacrent, en premier lieu, à la commémoration des victimes du nazisme dans un désir de réparation (« Wiedergutmachung »). Cette volonté de réparation constituera pendant deux décennies un obstacle à une ouverture vers des champs voisins, tels que les études migratoires (migration studies), les études juives (Judaistik) ou encore les études sur le refuge (refugee studies). Une telle ouverture, qui prévoit aussi une expansion temporelle du concept de l’exil (réservé jusqu’ici implicitement aux temps du Nazisme), est le but de plusieurs chaires et initiatives de recherche créées dernièrement. 2. Approches et acquis Il s’agira de caractériser les approches et les acquis des études sur l’exil dans l’aire germanophone. Nous montrerons notamment comment la mission initiale de saisir l’exil des années 1933-45 dans sa totalité a fait place à des questions plus complexes, entre autre autour des concepts d’assimilation et d’acculturation. 3. Perspectives Quelles sont les perspectives des études sur l’exil dans l’aire germanophone ? Nous suggèrerons que l’Exilforschung a, par le biais de son expérience interdisciplinaire et de son approche transnationale, le statut d’un laboratoire permettant d’appréhender questionnements et approches aptes à saisir des phénomènes exiliques au sens large.