[Palliative geriatrics. What are the differences between oncologic and non-oncologic palliative geriatric inpatients?]. / Palliative Geriatrie. Wie unterscheiden sich onkologische von nichtonkologischen geriatrischen Palliativpatienten im Krankenhaus?

AIM OF THE STUDY: Analysis of differences between oncologic and non-oncologic patients in the first German hospital-based special care unit for palliative geriatrics. METHODS: Systematic analysis of patients' records according to a standardized protocol. RESULTS: A total of 217 patients from a hospital-based special care unit for palliative geriatrics (56.7% women, 43.4% men) were included over a retrospective period of 1.5 years. Patients were categorized as non-oncologic (53.4%, n=116) or oncologic (46.5%, n=101). Non-oncologic patients were older than oncologic patients (84.0 vs. 76.8 years, p=0.02), and showed a higher degree of functional dependence (p<0.001) and mortality (87.1% vs. 53.3%, p<0.001). The two most common non-oncologic categories of primary diagnoses were pulmonary and neurologic diseases: 19% each. Certain secondary diagnoses had a higher incidence with non-oncologic than oncologic patients, such as pulmonary disease (39% vs. 24%, p=0.02) and dementia (38% vs. 8%, p<0.001). The Charlson comorbidity index was found to be higher for oncologic patients than for non-oncologic patients (6.6 vs. 4.1, p=0.001). Non-oncologic patients also experienced more dysphagia (57% vs. 17%, p<0.001), NPO (43% vs. 12%, p<0.001), and tube or parenteral feeding (31% vs. 9%, p=0.001). Oncologic patients experienced more often symptoms of pain, constipation, agitation, diarrhea, vomiting, and nausea. CONCLUSION: There are clinically relevant differences between oncologic and non-oncologic palliative geriatric inpatients regarding the constellation of symptoms, care, mortality, and the prevalence of concerns about hydration and feeding. These differences ought to be taken into account for further education, as well as further improvement of the healthcare system, to enable an appropriate standard of palliative care for geriatric patients.

Ancient mitogenomes of Phoenicians from Sardinia and Lebanon: A story of settlement, integration, and female mobility.

The Phoenicians emerged in the Northern Levant around 1800 BCE and by the 9th century BCE had spread their culture across the Mediterranean Basin, establishing trading posts, and settlements in various European Mediterranean and North African locations. Despite their widespread influence, what is known of the Phoenicians comes from what was written about them by the Greeks and Egyptians. In this study, we investigate the extent of Phoenician integration with the Sardinian communities they settled. We present 14 new ancient mitogenome sequences from pre-Phoenician (~1800 BCE) and Phoenician (~700-400 BCE) samples from Lebanon (n = 4) and Sardinia (n = 10) and compare these with 87 new complete mitogenomes from modern Lebanese and 21 recently published pre-Phoenician ancient mitogenomes from Sardinia to investigate the population dynamics of the Phoenician (Punic) site of Monte Sirai, in southern Sardinia. Our results indicate evidence of continuity of some lineages from pre-Phoenician populations suggesting integration of indigenous Sardinians in the Monte Sirai Phoenician community. We also find evidence of the arrival of new, unique mitochondrial lineages, indicating the movement of women from sites in the Near East or North Africa to Sardinia, but also possibly from non-Mediterranean populations and the likely movement of women from Europe to Phoenician sites in Lebanon. Combined, this evidence suggests female mobility and genetic diversity in Phoenician communities, reflecting the inclusive and multicultural nature of Phoenician society.

Parametric X rays observed under bragg condition: boost of intensity by a factor of Two

Parametric x rays (PXR) produced by bombarding silicon and diamond crystals with electrons of 30 to 87 MeV were detected at 180 degrees relative to the direction of the electron beam. It was found that the dependence of the intensity on the orientation of the crystal agrees with the predictions of the kinematical theory of PXR. The absolute intensity is twice as large as predicted. These findings can be explained considering dynamical effects that govern the x-ray crystal interaction. Additionally, x rays caused by self-diffracted transition radiation have been observed.

[Incidence of infant tuberculosis in Germany during the first year after cessation of unselected BCG vaccination (author's transl)]. / Entwicklung der Säuglingstuberkulose in Deutschland im ersten Jahr nach Aussetzen der ungezielten BCG-Impfung.

At the end of May 1975, BCG vaccine was withdrawn from the market in the Federal Republic of Germany, because a newly introduced vaccine had given rise to untoward reactions. Neonatal vaccination practically ceased. The results of a survey by questionnaire, undertaken on behalf of the Vaccination Committee of the German Society for Social Paediatrics, are reported. From 1.9.1975 to 31.8.1976 the incidence of tuberculosis in the first year of life had already doubled compared with the reported annual rate in both 1973 and 1974. Almost all cases were due to infection by adults not thought to be infectious. It is recommended that indications for "selective vaccination" should be broadened and the results of longer exposure time of unvaccinated children be awaited before any stoppage of general vaccination is decided upon.

[The spread of tuberculosis among infants and small children in the G.F.R. (author's transl)]. / Zur Ausbreitung der Tuberkulose unter den Säuglingen und Kleinkindern in der Bundesrepublik Deutschland.

Due to the interruption of routine BCG immunisation for the first time for 3 decades the current tuberculosis risk for unprotected infants and small children could be assessed locally and nation-wide. Nearly all of the 1,190,714 children born during 2 years between 1975 and 1977 were unprotected. Out of these 469 children had to be admitted up to the beginning of 1978 due to tuberculosis. The number of recognised cases of tuberculosis was thus considerably higher than the expected figures which in this country as a consequence of insufficient notification are used when decisions are necessary. Patients treated on an out-patient basis are not included in these figures and the children were all under 6, maximum age 34 months. In addition no less than 35 generalised and a further 180 more complicated cases of childhood tuberculosis were seen despite unlimited diagnostic possibilities.

[Severe pregnancy hemostasis disorders: diagnosis and therapeutic procedures]. / Schwere geburtshilfliche Hämostasedefekte: Diagnostik und therapeutisches Vorgehen.

We evaluated 21 pregnant patients with severe disorders of haemostasis by retrospective chart analyses, 15 patients were treated with intravenous heparin (10.000 to 20.000 I.U.) during and after surgery. Eighteen of 21 patients developed renal failure and 8 died. Postoperative bleeding complications making laparotomies mandatory occurred in 10 patients. These bleeding complications are seen in relation to the heparin treatment instituted immediately after surgery. We do not favor the administration of heparin during the immediate obstetrical postoperative period, the more as Antithrombin III-concentrate is now available. Surgical intervention in order to achieve haemostasis is of paramount therapeutic importance. Drainage of infections remains furthermore the most important task in those obstetrical emergency cases where infections play a predominant role. To maintain or to re-establish the normovolemic perfusion ameliorates the rheological conditions which should monitored with care.

[Job strain as a risk factor for occupational accidents among hospital nursing staff]. / Psychischer Stress als Risikofaktor für Arbeitsunfälle bei Pflegekräften im Krankenhaus.

In a cross-sectional questionnaire study the influence of psychological job strain and nine other factors on the occurrence of accidents at work were examined. Data were collected by a national survey of nursing personnel in Germany. The sample of this study consists of 874 nurses working in acute care hospitals. Job strain was operationalised according to Karasek's demand-control model and measured by a self-developed questionnaire. 32 % had experienced at least one accident during the 12 months preceding the survey (mostly accidental cuts or needle punctures). No association with accident risk was found for age, sex, professional status (supervising function) and hours of overtime work. The six factors significantly associated with accident risk in univariate analyses were entered into a logistic regression model: high job strain, working in a functional unit (e. g. laboratory), full-time work, less than 3 years of occupation in the present department, having children of less than 3 years of age and being a single parent. In the multivariate analyses high job strain turned out to be the most important risk factor for occupational accidents (odds ratio: 2.4, 95 % C.I.: 1.7-3.3). Significantly elevated risks were found for full-time work, less than 3 years of occupation in the present department and being a single parent (odds ratios between 1.5 and 1.8). Having at least one child of less than 3 years of age was a protective factor (odds ratio 0.5, 95-% C.I.: 0.4-0.8).

Morphology of Fallopian tubes removed from a patient after failure of clip sterilization.

A bilateral salpingectomy was performed at the time of vaginal hysterectomy in a pregnant patient sterilized 20 months earlier by application of Bleier clips to the fallopian tubes. Clip application to the left tube had been incomplete. Undisturbed tissue (left tube) and clipped tissue (right tube) were examined and compared by light and scanning electron microscopy. The segment of tube fully grasped by the clip had a completely detached lining epithelium with coarse and flattened mucosa, a loose stroma, and disorganized muscular bundles. The left tubal mucosa was normal, whereas the right tube was stenosed at the site of clip placement, with rigid walls and a 0.175 mm luminal diameter. With progressively greater stenosis toward the clip site, mucosal destruction increased. Polypoidal mucosal folds were seen, as well as fibrous adhesions between mucosal folds. These observations indicate that tissue damage is extensive enough after clip application to require excision of the damaged segment of tube and microsurgical re-anastomosis for reversal of sterilization.

PIP: A 37-year-old woman had a bilateral salpingectomy performed at the time of vaginal hysterectomy although she had been sterilized 20 months before via application of Bleier clips to the fallopian tubes. The woman presented pregnant. Using both a scanning electron and a light microscope, undisturbed tissue (left tube where clip application had been incomplete) and clipped tissue were examined. The right tube (clipped) showed completely detached lining epithelium with coarse and flattened mucosa, loose stroms, and disorganized muscular bundles in the segment where the clip had been attached. The left tubal mucosa, where the clip had failed to attach, was perfectly normal, whereas the right tube was stenosed at the site of clip placement. The tissue destruction seen after clip sterilization is so extensive that excision of damaged segment followed by microsurgical reanastomosis seems the only procedure to reverse sterilization of this type.

Generation of GW radiation pulses from a VUV free-electron laser operating in the femtosecond regime.

Experimental results are presented from vacuum-ultraviolet free-electron laser (FEL) operating in the self-amplified spontaneous emission (SASE) mode. The generation of ultrashort radiation pulses became possible due to specific tailoring of the bunch charge distribution. A complete characterization of the linear and nonlinear modes of the SASE FEL operation was performed. At saturation the FEL produces ultrashort pulses (30-100 fs FWHM) with a peak radiation power in the GW level and with full transverse coherence. The wavelength was tuned in the range of 95-105 nm.