Vorschläge für Erziehung, Schule und Haus, sowie zur Association der arbeitenden Klassen : ein Beitrag zur Lösung der Lebensfrage der Civilisation

sämmtlichen deutschen Staaten zur geneigten Prüfung ganz ergebenst dargereicht von M. Leidesdorf

Percutaneous closure of the patent foramen ovale, easy does it.

Closure of the patent foramen ovale does not benefit from echocardiographic guidance in the majority of cases. Guiding these procedures with fluoroscopy only reduces procedure time, radiation exposure, and amount of contrast medium. There is a clear trend to abandon echocardiographic guidance for this procedure over time and with growing experience.

Incremental Value of the CRUSADE, ACUITY, and HAS-BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

BACKGROUND Multiple scores have been proposed to stratify bleeding risk, but their value to guide dual antiplatelet therapy duration has never been appraised. We compared the performance of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) scores in 1946 patients recruited in the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) and assessed hemorrhagic and ischemic events in the 24- and 6-month dual antiplatelet therapy groups. METHODS AND RESULTS Bleeding score performance was assessed with a Cox regression model and C statistics. Discriminative and reclassification power was assessed with net reclassification improvement and integrated discrimination improvement. The C statistic was similar between the CRUSADE score (area under the curve 0.71) and ACUITY (area under the curve 0.68), and higher than HAS-BLED (area under the curve 0.63). CRUSADE, but not ACUITY, improved reclassification (net reclassification index 0.39, P=0.005) and discrimination (integrated discrimination improvement index 0.0083, P=0.021) of major bleeding compared with HAS-BLED. Major bleeding and transfusions were higher in the 24- versus 6-month dual antiplatelet therapy groups in patients with a CRUSADE score >40 (hazard ratio for bleeding 2.69, P=0.035; hazard ratio for transfusions 4.65, P=0.009) but not in those with CRUSADE score ≤40 (hazard ratio for bleeding 1.50, P=0.25; hazard ratio for transfusions 1.37, P=0.44), with positive interaction (Pint=0.05 and Pint=0.01, respectively). The number of patients with high CRUSADE scores needed to treat for harm for major bleeding and transfusion were 17 and 15, respectively, with 24-month rather than 6-month dual antiplatelet therapy; corresponding figures in the overall population were 67 and 71, respectively. CONCLUSIONS Our analysis suggests that the CRUSADE score predicts major bleeding similarly to ACUITY and better than HAS BLED in an all-comer population with percutaneous coronary intervention and potentially identifies patients at higher risk of hemorrhagic complications when treated with a long-term dual antiplatelet therapy regimen. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00611286.

Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty: Results of an angiographic randomized pilot study.

OBJETIVES The main objective of the present randomized pilot study was to explore the effects of upstream prasugrel or ticagrelor or clopidogrel for patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND Administration of clopidogrel "as soon as possible" has been advocated for STEMI. Pretreatment with prasugrel and ticagrelor may improve reperfusion. Currently, the angiographic effects of upstream administration of these agents are poorly understood. METHODS A total of 132 patients with STEMI within the first 12 hr of chest pain referred to primary angioplasty were randomized to upstream clopidogrel (600 mg), prasugrel (60 mg), or ticagrelor (180 mg) while still in the emergency room. All patients underwent protocol-mandated thrombus aspiration. RESULTS Macroscopic thrombus material was retrieved in 79.5% of the clopidogrel group, 65.9% of the prasugrel group, and 54.3% of the ticagrelor group (P = 0.041). At baseline angiography, large thrombus burden was 97.7% vs. 87.8% vs. 80.4% in the clopidogrel, prasugrel, and ticagrelor groups, respectively (P = 0.036). Also, at baseline, 97.7% presented with an occluded target vessel in the clopidogrel group, 87.8% in the prasugrel group and 78.3% in the ticagrelor group (P = 0.019). At the end of the procedure, the percentages of patients with combined TIMI grade III flow and myocardial blush grade III were 52.3% for clopidogrel, 80.5% for prasugrel, and 67.4% for ticagrelor (P = 0.022). CONCLUSIONS In patients with STEMI undergoing primary PCI within 12 hr, upstream clopidogrel, prasugrel or ticagrelor have varying angiographic findings, with a trend toward better results for the latter two agents. © 2015 Wiley Periodicals, Inc.

"Wider aller Willen disen Altar auß der Kirkhen gethon". Pluralisierung und Konkurrenz auf dem Markt der Wunder in der Landschaft Disentis (17. und 18. Jahrhundert)

Die katholische Kultlandschaft Disentis erfuhr im Zeitraum von ca. 1650–1750 eine tiefgreifende Umgestaltung. Während das Benediktinerkloster mit den Reliquien der Klosterheiligen lange Zeit das religiöse Zentrum bildete, entstanden im Verlaufe des 17. Jahrhunderts in den umliegenden Kirchen und Kapellen zahlreiche weitere Heiligenkulte, von denen sich die Gläubigen Wunder und Gnaden erhoffen konnten. Der Artikel argumentiert, dass diese Pluralisierung katholischer Kultformen auf die innerkatholische Konkurrenz um die Gunst der Gläubigen zurückzuführen war. Sowohl die einheimischen Benediktiner als auch die aus Italien kommenden Kapuziner versuchten, die Laien mit wunderversprechenden Kultpraktiken an ihre ordensspezifische Frömmigkeit zu binden und so den eigenen Einfluss auf Kosten des jeweils anderen Ordens zu stärken. Für die Laien war diese Situation ein Glücksfall: Von Kapuzinern, Benediktinern und Jesuiten umgarnt, konnten sie aus den konkurrenzierenden Heils- und Heilungsangeboten diejenigen auswählen, die ihnen zur Befriedigung ganz alltäglicher Bedürfnisse am nützlichsten erschienen. Der Einfluss der Laien auf die Ausgestaltung kirchlicher Kultformen ist daher höher zu veranschlagen, als dies die klassische Kirchengeschichte und die Konfessionalisierungsforschung getan hatten.

Ein Besuch bei einem Wunderrabbi

Hugo Ganz

Assimilation oder Regeneration?

Hugo Ganz

Ms. Ff. Mus. 768 - Feria II. Pentec.

Telemann. [Text: Gottfried Simonis]

Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^

Implementing and evaluating a Web -based close call reporting system at an urban hospital

Medical errors and close calls are pervasive in health care. It is hypothesized that the causes of close calls are the same as for medical errors; therefore learning about close calls can help prevent errors and increase patient safety. Yet despite efforts to encourage close call reporting, close calls as well as medical errors are under-reported in health care. The purpose of this dissertation was to implement and evaluate a web-based anonymous close call reporting system in three units at an urban hospital. ^ The study participants were physicians, nurses and medical technicians (N = 187) who care for patients in the Medical Intermediate Care Unit, the Surgical Intermediate Care Unit, and the Coronary Catheterization Laboratory in the hospital. We provided educational information to the participants on how to use the system and e-mailed and delivered paper reminders to report to the participants throughout the 19-month project. We surveyed the participants at the beginning and at the end of the study to assess their attitudes and beliefs regarding incident reporting. We found that the majority of the health care providers in our study are supportive of incident reporting in general but in practice very few had actually reported an error or a close call, semi-structured interview 20 weeks after we made the close call reporting system available. The purpose of the interviews was to further assess the participants' attitudes regarding incident reporting and the reporting system. Our findings suggest that the health care providers are supportive of medical error reporting in general, but are not convinced of the benefit of reporting close calls. Barriers to close call reporting cited include lack of time, heavy workloads, preferring to take care of close calls "on the spot", and not seeing the benefits of close call reporting. Consequently only two = close calls were reported via the system by two separate caregivers during the project. ^ The findings suggest that future efforts to increase close call reporting must address barriers to reporting, especially the belief among care givers that it is not worth taking time from their already busy schedules to report close calls. ^

A global seasonal surface ocean climatology of phytoplankton types based on CHEMTAX analysis of HPLC pigments

Much advancement has been made in recent years in field data assimilation, remote sensing and ecosystem modeling, yet our global view of phytoplankton biogeography beyond chlorophyll biomass is still a cursory taxonomic picture with vast areas of the open ocean requiring field validations. High performance liquid chromatography (HPLC) pigment data combined with inverse methods offer an advantage over many other phytoplankton quantification measures by way of providing an immediate perspective of the whole phytoplankton community in a sample as a function of chlorophyll biomass. Historically, such chemotaxonomic analysis has been conducted mainly at local spatial and temporal scales in the ocean. Here, we apply a widely tested inverse approach, CHEMTAX, to a global climatology of pigment observations from HPLC. This study marks the first systematic and objective global application of CHEMTAX, yielding a seasonal climatology comprised of ~1500 1°x1° global grid points of the major phytoplankton pigment types in the ocean characterizing cyanobacteria, haptophytes, chlorophytes, cryptophytes, dinoflagellates, and diatoms, with results validated against prior regional studies where possible. Key findings from this new global view of specific phytoplankton abundances from pigments are a) the large global proportion of marine haptophytes (comprising 32 ± 5% of total chlorophyll), whose biogeochemical functional roles are relatively unknown, and b) the contrasting spatial scales of complexity in global community structure that can be explained in part by regional oceanographic conditions. These publicly accessible results will guide future parameterizations of marine ecosystem models exploring the link between phytoplankton community structure and marine biogeochemical cycles.

Carbonate content in lower Cretaceous sediments of ODP Hole 123-765C

Sediments recovered during Ocean Drilling Program (ODP) Leg 123 from the Argo Abyssal Plain (AAP) consist largely of turbidites derived from the adjacent Australian continental margin. The oldest abundant turbidites are Valanginian-Aptian in age and have a mixed (smarl) composition; they contain subequal amounts of calcareous and siliceous biogenic components, as well as clay and lesser quartz. Most are thin-bedded, fine sand- to mud-sized, and best described by Stow and Piper's model (1984) for fine-grained biogenic turbidites. Thicker (to 3 m), coarser-grained (medium-to-coarse sand-sized) turbidites fit Bouma's model (1962) for sandy turbidites; these generally are base-cut-out (BCDE, BDE) sequences, with B-division parallel lamination as the dominant structure. Parallel laminae most commonly concentrate quartz and/or calcispheres vs. lithic clasts or clay, but distinctive millimeter- to centimeter-thick, radiolarian-rich laminae occur in both fine- and coarse-grained Valanginian-Hauterivian turbidites. AAP turbidites were derived from relatively deep parts of the continental margin (outer shelf, slope, or rise) that lay below the photic zone, but above the calcite compensation depth (CCD). Biogenic components are largely pelagic (calcispheres, foraminifers, radiolarians, nannofossils); lesser benthic foraminifers are characteristic of deep-water (abyssal to bathyal) environments. Abundant nonbiogenic components are mostly clay and clay clasts; smectite is the dominant clay species, and indicates a volcanogenic provenance, most likely the Triassic-Jurassic volcanic suite exposed along the northern Exmouth Plateau. Lower Cretaceous smarl turbidites were generated during eustatic lowstands and may have reached the abyssal plain via Swan Canyon, a submarine canyon thought to have formed during the Late Jurassic. In contrast to younger AAP turbidites, however, Lower Cretaceous turbidites are relatively fine-grained and do not contain notably older reworked fossils. Early in its history, the northwest Australian margin provided mainly contemporaneous slope sediment to the AAP; marginal basins adjacent to the continent trapped most terrigenous detritus, and pronounced canyon incisement did not occur until Late Cretaceous and, especially, Cenozoic time.

Las clases de Educación Física en las Escuelas de Jornada Extendida en el Distrito de Avellaneda

El presente trabajo recoge los primeros avances de una investigación de la Universidad Nacional de Avellaneda en el marco del Programa de Apoyo a la Investigación y Formación de Docentes Investigadores, del año 2012, que tiene por objetivo describir y analizar la enseñanza de la Ed. Física en las escuelas primarias públicas con jornada extendida de Avellaneda (Acta firmada el 26/08/2011 entre el Director General de Escuelas de la Provincia de Bs As y el actual Intendente de Avellaneda), haciendo foco en los modelos de práctica de la enseñanza que realizan los profesores de Educación Física como así también en la descripción de qué se enseña en estas clases. Tal como lo indica la Resolución No 3638/05, del 29/7/2005, la implementación de la jornada extendida implica 'extender la jornada escolar en diez horas semanales adicionales en Ed. Tecnológica, Ed. Física y Ed. Artística'; en este sentido se contempla que la motivación hacia este estudio no surge de una consideración negativa de la práctica escolar con estas características; por el contrario, se observa allí un espacio de amplitud de la propuesta educativa donde se abre un abanico de posibles intervenciones y prácticas docentes. Esta propuesta se encuadra en un diseño descriptivo cuya estrategia metodológica es de corte cualitativo. Las fuentes de recolección de información serán: documentos, entrevistas semi estructurada, entrevistas abiertas y observaciones de actividades llevadas adelante en cuatro de las ochos escuelas con jornada extendida del Distrito de Avellaneda, las cuales fueron seleccionadas a partir de la posibilidad de entrada al campo, como así también por la disponibilidad de recursos necesarios para el desarrollo de las clases de Ed. Física