Von der Diagnose zur Entscheidung. Eine Analyse von Entscheidungsprozessen für das Austragen der Schwangerschaft nach der pränatalen Diagnose Down-Syndrom

Werdende Elternschaft heute ist ohne das technologisch gestützte Monitoring natürlicher Wachstumsprozesse kaum noch denkbar. Von Tests und Ultraschall erhoffen sich die zukünftigen Eltern Sicherheit für ein gesundes Kind. Wird jedoch eine als schwerwiegend empfundene Diagnose wie das Down-Syndrom gestellt, finden sie sich mit der schwierigen Aufgabe konfrontiert, über Fortsetzung oder Abbruch der Schwangerschaft entscheiden zu müssen. Aus der Subjektperspektive von zehn Frauen, die einer solchen Entscheidungssituation ausgesetzt waren, analysiert die vorliegende Studie die durch die Diagnose ausgelösten psychodynamischen Prozesse und gesellschaftlichen Zugzwänge. Auf der Basis von Fallrekonstruktionen und fallübergreifenden Analysen werden konkrete Problemlagen der Betroffenen sichtbar und Kettenreaktionen im medizinischen, familiären und sozialen Umfeld aufgezeigt. Deutlich wird, wie die stetig perfektionierte Erfassung betroffener Feten dem - zunehmend privatisierten und kommerzialisierten – Medizinbetrieb eine Definitionsmacht darüber eröffnet, was lebenswert und normal ist. Die Handlungsmaxime lautet: Behinderung gilt es zu vermeiden, Normalität hat Vorrang vor Besonderheit. Mit der Analyse von Entscheidungsverläufen gegen den Selektionskonsens erschließt die Studie neue Sichtweisen auf diesen einseitig geführten Diskurs. Biographische Hintergründe der Frauen und ihre personalen und sozialen Ressourcen werden identifiziert und als Anhaltspunkte für eine professionelle Begleitung verstanden. Abgeleitet aus den Erfahrungen und Deutungsperspektiven der Betroffenen wird ein Modell der Beratung nach einer pränatalen Diagnose entworfen. Damit ist das Buch nicht nur für Professionelle aus Sonderpädagogik und Medizin, sondern auch aus Beratung und Therapie von Interesse. (DIPF/Orig.)

Thermomechanical sensitivity of microcantilever in the mid-infrared spectral region

This paper reports the thermomechanical sensitivity of bimaterial cantilevers over a mid-infrared (IR) spectral range (5-10 µm) that is critical both for chemical analysis via vibrational spectroscopy and for direct thermal detection in the 300-700 K range. Mechanical bending sensitivity and noise were measured and modeled for six commercially available microcantilevers, which consist of either an aluminum film on a silicon cantilever or a gold film on a silicon nitride cantilever. The spectral sensitivity of each cantilever was determined by recording cantilever deflection when illuminated with IR light from a monochromator. Rigorous modeling and systematic characterization of the optical system allowed for a quantitative estimate of IR energy incident upon the cantilever. Separately, spectral absorptance of the cantilever was measured using Fourier transform infrared (FT-IR) microscopy, which was compared with analytical models of radiation onto the cantilever and heat flow within the cantilever. The predictions of microcantilever thermomechanical bending sensitivity and noise agree well with measurements, resulting in a ranking of these cantilevers for their potential use in IR measurements.

Tourette's syndrome and associated disorders: a systematic review

To compile data on Tourette's syndrome (TS), tics and associated disorders. METHODS: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. RESULTS: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. CONCLUSIONS: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance.

Critical magnetic elds in superconducting systems with semi-metallic bands

In this work, we study the Zeeman splitting effects in the parallel magnetic field versus temperature phase diagram of two-dimensional superconductors with one graphene-like band and the orbital effects of perpendicular magnetic fields in isotropic two-dimensional semi-metallic superconductors. We show that when parallel magnetic fields are applied to graphene and as the intraband interaction decreases to a critical value, the width of the metastability region present in the phase diagram decreases, vanishing completely at that critical value. In the case of two-band superconductors with one graphene-like band, a new critical interaction, associated primarily with the graphene-like band, is required in order for a second metastability region to be present in the phase diagram. For intermediate values of this interaction, a low-temperature first-order transition line bifurcates at an intermediate temperature into a first-order transition between superconducting phases and a second-order transition line between the normal and the superconducting states. In our study on the upper critical fields in generic semi-metallic superconductors, we find that the pair propagator decays faster than that of a superconductor with a metallic band. As result, the zero field band gap equation does not have solution for weak intraband interactions, meaning that there is a critical intraband interaction value in order for a superconducting phase to be present in semi-metallic superconductors. Finally, we show that the out-of-plane critical magnetic field versus temperature phase diagram displays a positive curvature, contrasting with the parabolic-like behaviour typical of metallic superconductors.

Architectural-Physical Co-Design of 3D CPUs with Micro-Fluidic Cooling

The performance, energy efficiency and cost improvements due to traditional technology scaling have begun to slow down and present diminishing returns. Underlying reasons for this trend include fundamental physical limits of transistor scaling, the growing significance of quantum effects as transistors shrink, and a growing mismatch between transistors and interconnects regarding size, speed and power. Continued Moore's Law scaling will not come from technology scaling alone, and must involve improvements to design tools and development of new disruptive technologies such as 3D integration. 3D integration presents potential improvements to interconnect power and delay by translating the routing problem into a third dimension, and facilitates transistor density scaling independent of technology node. Furthermore, 3D IC technology opens up a new architectural design space of heterogeneously-integrated high-bandwidth CPUs. Vertical integration promises to provide the CPU architectures of the future by integrating high performance processors with on-chip high-bandwidth memory systems and highly connected network-on-chip structures. Such techniques can overcome the well-known CPU performance bottlenecks referred to as memory and communication wall. However the promising improvements to performance and energy efficiency offered by 3D CPUs does not come without cost, both in the financial investments to develop the technology, and the increased complexity of design. Two main limitations to 3D IC technology have been heat removal and TSV reliability. Transistor stacking creates increases in power density, current density and thermal resistance in air cooled packages. Furthermore the technology introduces vertical through silicon vias (TSVs) that create new points of failure in the chip and require development of new BEOL technologies. Although these issues can be controlled to some extent using thermal-reliability aware physical and architectural 3D design techniques, high performance embedded cooling schemes, such as micro-fluidic (MF) cooling, are fundamentally necessary to unlock the true potential of 3D ICs. A new paradigm is being put forth which integrates the computational, electrical, physical, thermal and reliability views of a system. The unification of these diverse aspects of integrated circuits is called Co-Design. Independent design and optimization of each aspect leads to sub-optimal designs due to a lack of understanding of cross-domain interactions and their impacts on the feasibility region of the architectural design space. Co-Design enables optimization across layers with a multi-domain view and thus unlocks new high-performance and energy efficient configurations. Although the co-design paradigm is becoming increasingly necessary in all fields of IC design, it is even more critical in 3D ICs where, as we show, the inter-layer coupling and higher degree of connectivity between components exacerbates the interdependence between architectural parameters, physical design parameters and the multitude of metrics of interest to the designer (i.e. power, performance, temperature and reliability). In this dissertation we present a framework for multi-domain co-simulation and co-optimization of 3D CPU architectures with both air and MF cooling solutions. Finally we propose an approach for design space exploration and modeling within the new Co-Design paradigm, and discuss the possible avenues for improvement of this work in the future.

A home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with metabolic syndrome

Introduction: The current study was designed to determine the effect of home-based treadmill training on epicardial and abdominal adipose tissue in postmenopausal women with metabolic syndrome (MS). A secondary objective was to identify significant correlations between imaging and conventional anthropometric parameters. Material and methods: Sixty postmenopausal women with MS volunteered for the current trial. Thirty were randomly assigned to perform a supervised home-based 16-week treadmill training program, 3 sessions/week, consisting of a warm-up, 30-40 min treadmill exercise (increasing 5-minutes each 4-weeks) at a work intensity of 60-75% of peak heart rate (increasing 5% each 4-weeks) and cooling-down. Epicardial fat thickness (EFT) was assessed by echocardiography. Abdominal fat mass in the lumbar regions L1-L4 and L4-L5 was determined by dual X-ray absorptiometry. Results: Epicardial fat thickness and abdominal fat percentages were significantly improved after the completion of the training program. Another striking feature of the current study was the moderate correlation that was found between EFT and waist circumference (WC). Conclusion: Home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with MS. A secondary finding was that a moderate correlation was found between EFT and WC. While current investigations are promising, future studies are still required to consolidate this approach in clinical application.

Europeanization beyond the EU: The case of Georgia.

320 p.

Modeling Flood Stage-Duration-Frequency: A Risk Assessment of Critical Infrastructure in the Tidal Potomac

The service of a critical infrastructure, such as a municipal wastewater treatment plant (MWWTP), is taken for granted until a flood or another low frequency, high consequence crisis brings its fragility to attention. The unique aspects of the MWWTP call for a method to quantify the flood stage-duration-frequency relationship. By developing a bivariate joint distribution model of flood stage and duration, this study adds a second dimension, time, into flood risk studies. A new parameter, inter-event time, is developed to further illustrate the effect of event separation on the frequency assessment. The method is tested on riverine, estuary and tidal sites in the Mid-Atlantic region. Equipment damage functions are characterized by linear and step damage models. The Expected Annual Damage (EAD) of the underground equipment is further estimated by the parametric joint distribution model, which is a function of both flood stage and duration, demonstrating the application of the bivariate model in risk assessment. Flood likelihood may alter due to climate change. A sensitivity analysis method is developed to assess future flood risk by estimating flood frequency under conditions of higher sea level and stream flow response to increased precipitation intensity. Scenarios based on steady and unsteady flow analysis are generated for current climate, future climate within this century, and future climate beyond this century, consistent with the WWTP planning horizons. The spatial extent of flood risk is visualized by inundation mapping and GIS-Assisted Risk Register (GARR). This research will help the stakeholders of the critical infrastructure be aware of the flood risk, vulnerability, and the inherent uncertainty.

Producers' Perceptions and Consumers' Behaviour Toward Certified Beans from Integrated Production (IP) in the Brazilian Central Region

Integrated production (IP) is part of the Brazilian government program to promote sustainable agricultural production. IP ensure minimum food quality standards for domestic market, and export. Furthermore, IP is considered a good option to reduce negative environmental impacts of intensive crops in tropical Savannas, including common beans, as a Brazilian staple food. Although its advantages, and the government’s effort to promote IP, few growers are adopting IP. Maybe, the perception about IP usefulness and/or its ease of use is not too clear. Moreover, the production sector is driven by market signs, and there is few information on the consumer's preferences toward IP certified products in Brazil. In this study, we sought to identify some critical factors that can influence the IP adoption in beans' production. Moreover, we sought to verify the consumers’ perceptions and intention of purchasing IP certified beans (hypothetical product). This report comprises four chapters: (1) an introduction illustrating the context in which the research was based; (2) the results on the study of IP adoption based on the Technology Acceptance Model (TAM); (3) the choice experiment results applied to identify consumers preferences and willingness-to-pay (WTP) for IP label; (4) the results on the Theory of Planned Behaviour (TPB) applied to identify consumers’ perception toward IP certified beans. This research contributes with rich information for the beans’ supply chain, providing several insights to growers, retail and other agents, including policy makers. Beans’ production sector seems to be positively intentioned to adopt IP, but further studies should be conducted to test other adoption indicators using TAM model. Surveyed consumers are willing to pay a premium price for IP labelled beans. They showed a positive attitude toward purchasing IP labelled beans. It is an important information to motivate production sector to offer certified beans to the market.

No relationship between most polymorphisms of steroidogenic acute regulatory (StAR) gene with polycystic ovarian syndrome

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine women’s disorders in reproductive age. Hyperandrogenism has a critical role in the etiology of PCOS and it can cause fault in Steroidogenesis process. During steroidogenesis, steroidogenic acute regulatory protein (StAR) seems to increase the delivery of cholesterol through mitochondrial membrane. Therefore, polymorphisms of StAR might effect on this protein and play a role in the etiology of PCOS. Objective: The aim of this study was to investigate the association between StAR SNPs with PCOS. Thus, seven polymorphisms in this gene: rs104894086, rs104894089, rs104894090, rs137852689, rs10489487, rs104894085 were detected. Materials and Methods: In this case control study, 45 PCOS women, 40 male factor/unexplained infertile women, and 40 fertile women as two control groups were participated from 2008-2012. Polymorphisms were detected using restriction fragment length polymorphism (PCR-RFLP) method. Results: Heterozygote genotyping for rs137852689 SNP (amino acid 218 C > T) was only seen in seven PCOS patients, one in normal ovulatory women, and five in male factor/unexplained infertile women (15.5%, 2.5%, 12.5%, respectively) (p= 0.12). While, it has shown no association between other SNPS with PCOs. Conclusion: The RFLP results for seven chosen SNPs, which located in exon 5 and 7 showed normal status in three groups, it means no heterozygous or homozygous forms of selected SNPs were observed. So, it seems evaluation of the active amino acid sites should be investigated and also the study population should be increased.

Understanding ten-eleven translocation-2 in hematological and nervous systems

I proposed the study of two distinct aspects of Ten-Eleven Translocation 2 (TET2) protein for understanding specific functions in different body systems. ^ In Part I, I characterized the molecular mechanisms of Tet2 in the hematological system. As the second member of Ten-Eleven Translocation protein family, TET2 is frequently mutated in leukemic patients. Previous studies have shown that the TET2 mutations frequently occur in 20% myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN), 10% T-cell lymphoma leukemia and 2% B-cell lymphoma leukemia. Genetic mouse models also display distinct phenotypes of various types of hematological malignancies. I performed 5-hydroxymethylcytosine (5hmC) chromatin immunoprecipitation sequencing (ChIP-Seq) and RNA sequencing (RNA-Seq) of hematopoietic stem/progenitor cells to determine whether the deletion of Tet2 can affect the abundance of 5hmC at myeloid, T-cell and B-cell specific gene transcription start sites, which ultimately result in various hematological malignancies. Subsequent Exome sequencing (Exome-Seq) showed that disease-specific genes are mutated in different types of tumors, which suggests that TET2 may protect the genome from being mutated. The direct interaction between TET2 and Mutator S Homolog 6 (MSH6) protein suggests TET2 is involved in DNA mismatch repair. Finally, in vivo mismatch repair studies show that the loss of Tet2 causes a mutator phenotype. Taken together, my data indicate that TET2 binds to MSH6 to protect genome integrity. ^ In Part II, I intended to better understand the role of Tet2 in the nervous system. 5-hydroxymethylcytosine regulates epigenetic modification during neurodevelopment and aging. Thus, Tet2 may play a critical role in regulating adult neurogenesis. To examine the physiological significance of Tet2 in the nervous system, I first showed that the deletion of Tet2 reduces the 5hmC levels in neural stem cells. Mice lacking Tet2 show abnormal hippocampal neurogenesis along with 5hmC alternations at different gene promoters and corresponding gene expression downregulation. Through the luciferase reporter assay, two neural factors Neurogenic differentiation 1 (NeuroD1) and Glial fibrillary acidic protein (Gfap) were down-regulated in Tet2 knockout cells. My results suggest that Tet2 regulates neural stem/progenitor cell proliferation and differentiation in adult brain.^

Critical behavior in the site-diluted three-dimensional three-state Potts model

We have studied numerically the effect of quenched site dilution on a weak first-order phase transition in three dimensions. We have simulated the site diluted three-states Potts model studying in detail the secondorder region of its phase diagram. We have found that the n exponent is compatible with the one of the three-dimensional diluted Ising model, whereas the h exponent is definitely different.

Acute respiratory distress syndrome: does histology matter?

Kao et al. have reported in Critical Care the histological findings of 101 patients with acute respiratory distress syndrome (ARDS) undergoing open lung biopsy. Diffuse alveolar damage (DAD), the histological hallmark of ARDS, was present in only 56.4 % of cases. The presence of DAD was associated with higher mortality. Evidence from this and other studies indicates that the clinical criteria for the diagnosis of ARDS identify DAD in only about half of the cases. On the contrary, there is evidence that the clinical course and outcome of ARDS differs in patients with DAD and in patients without DAD. The discovery of biomarkers for the physiological (increased alveolocapillary permeability) or histological (DAD) hallmarks of ARDS is thus of paramount importance.

Climate change adaptation solutions for the green sectors of selected zones in the MENA region

In this paper, we propose climate adaptation solutions for the green sectors in three different zones of MENA: Egypt’s Delta (irrigated), Karak, in the highlands of Jordan (rainfed), and Lebanon’s Orontes basin (mixed: rainfed-irrigated). We analysed land use and crop intensification, and calculated the economic productivity of water – a critical scarce resource in MENA. By integrating the results with evidence from literature on the potential impacts of climate change and socio-economic factors, we could identify vulnerability levels of the three regions and propose adaptation measures relying of the concept of the “food-water-energy nexus.” While the vulnerability levels are found to be high in the Delta (Egypt) and Karak (Jordan), mainly due to water scarcity and poor adaptive capacity, the vulnerability level is moderate in the Orontes zone (Lebanon) due to a diversified agricultural sector and good market development, coupled with moderate water scarcity. Proposed adaptation solutions range from measures to improve technical efficiency, to measures that encourage economically efficient allocation by use of market forces. For both cases, the development of market opportunities is emphasized to make the proposed measures attractive to farmers.

Metabolic syndrome and associated factors in a population-based sample of schoolchildren in Colombia: The FUPRECOL Study

In contrast to the definition of metabolic syndrome (MetS) in adults, there is no standard definition of MetS in pediatric populations. We aimed to assess the differences in the prevalence of MetS in children and adolescents aged 9–17 years in the city of Bogota (Colombia) using four different operational definitions for these age groups and to examine the associated variables. A total of 673 children and 1,247 adolescents attending public schools in Bogota (54.4% girls; age range 9–17.9 years) were included. The prevalence of MetS was determined by the definitions provided by the International Diabetes Federation (IDF) and three published studies by Cook et al., de Ferranti et al., and Ford et al. The prevalence of MetS was 0.3%, 6.3%, 7.8%, and 11.0% according to the IDF, Cook et al., Ford et al., and de Ferranti et al. definitions, respectively. The most prevalent components were low high-density lipoprotein cholesterol and high triglyceride levels, whereas the least prevalent components were abdominal obesity and hyperglycemia. Overall, the prevalence of MetS was higher in obese than in non-obese schoolchildren. In conclusion, MetS diagnoses in schoolchildren strongly depend on the definition chosen. These findings may be relevant to health promotion efforts for Colombian youth to develop prospective studies and to define which cut-offs are the best indicators of future morbidity.