From rare events to systematic data collection: the RESCUED registry for sudden cardiac death in the young in Germany.

BACKGROUND: Approximately one-third of sudden cardiac deaths in the young (SCDY) occur due to a structural cardiac disease. Forty to fifty percent of SCDY cases remain unexplained after autopsy (including microscopic and forensic-toxicological analyses), suggesting arrhythmia syndromes as a possible cause of death. Due to the possible inheritability of these diseases, blood relatives of the deceased may equally be carriers of the causative genetic variations and therefore may have an increased cardiac risk profile. A better understanding of the forensic, clinical, and genetic data might help identify a subset of the general population that is at increased risk of sudden cardiac death. STUDY DESIGN: The German registry RESCUED (REgistry for Sudden Cardiac and UnExpected Death) comprises information about SCDY fatalities and clinical and genetic data of both the deceased and their biological relatives. The datasets collected in the RESCUED registry will allow for the identification of leading causes of SCDY in Germany and offer unique possibilities of scientific analyses with the aim of detecting unrecognized trends, risk factors, and clinical warning signs of SCDY. In a pilot phase of 24 months, approximately 180 SCDY cases (< 50 years of age) and 500 family members and clinical patients will be included. CONCLUSION: RESCUED is the first registry in Germany collecting comprehensive data of SCDY cases and clinical data of the biological relatives reviewed by cardiac experts. RESCUED aims to improve individual risk assessment and public health approaches by directing resources towards early diagnosis and evidence-based, personalized therapy and prevention in affected families. Trial registration number (TRN): DRKS00033543.

[Miserable conditions in hospitals, institutional pathologies and clinical organizational ethics]. / Miseren des Krankenhauses, institutionelle Pathologien und klinische Organisationsethik.

DEFINITION OF THE PROBLEM: Staff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these "miserable conditions" as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them but cannot handle them effectively. ARGUMENTS: I propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions. CONCLUSION: The institutional pathology paradigm, oriented to concrete institutions and organizations, can help "clinical" organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility.

The effect of chin-to-chest contact on upper neck axial force in UN Regulation No. 129 frontal impact tests of child restraint systems.

OBJECTIVE: The objective of this study was to investigate the effect of chin-to-chest contact on upper neck axial force in United Nations (UN) Regulation No. 129 frontal impact tests of child restraint systems. METHODS: Frontal impact pilot experiments were carried out according to the test procedure in UN Regulation No. 129. Q-Series child dummies were seated in a small convenience sample of forward-facing child restraint systems. The timing and duration of chin-to-chest contact were determined using the procedure for calculating external head impact force in SAE J2052. RESULTS: Chin-to-chest contact was observed in all of our experiments and generated a tensile peak in the upper neck axial force of the Q-Series dummies. Prior to chin-to-chest contact, a purely inertial, noncontact peak was observed in the axial tension force. The tensile peak due to chin-to-chest contact was often greater than the inertial, noncontact peak force. CONCLUSIONS: Chin-to-chest contact can increase axial neck tension force beyond the level it would reach under purely inertial loading. Adopting upper neck axial force in regulation, without considering how the force is generated, might encourage child restraint designs that mitigate only chin-to-chest contact, rather than the true inertial neck loading.

Chirality-Dependent Electron Spin Filtering by Molecular Monolayers of Helicenes.

The interaction of low-energy photoelectrons with well-ordered monolayers of enantiopure helical heptahelicene molecules adsorbed on metal surfaces leads to a preferential transmission of one longitudinally polarized spin component, which is strongly coupled to the helical sense of the molecules. Heptahelicene, composed of only carbon and hydrogen atoms, exhibits only a single helical turn but shows excess in longitudinal spin polarization of about P Z = 6 to 8% after transmission of initially balanced left- and right-handed spin polarized electrons. Insight into the electronic structure, that is, the projected density of states, and the spin-dependent electron scattering in the helicene molecule is gained by using spin-resolved density functional theory calculations and a model Hamiltonian approach, respectively. Our results support the semiclassical picture of electronic transport along a helical pathway under the influence of spin-orbit coupling induced by the electrostatic molecular potential.

[Ethical and communicative significance of "personalised medicine"]. / Ethische und kommunikative Bedeutung der "personalisierten Medizin"

The first aim of the paper is to analyse in a culture-theoretical perspective those characteristic semantic markers that permit "personalized" medicine (PM) to figure as a prestigious seminal trend of future medicine. In fact, there is evidence that the ambiguity of the favourite semantic markers of PM engenders a conception of PM that is analogous to the tailoring of services to customers. There is an air of paradox: while patients are supposed to be the key beneficiaries of PM, their genuine preferences, at present, are seriously underarticulated. The second aim of the paper is to focus attention on some highlights within the multifarious ethical discourse that accompanies the development of PM. As a result, valuable methodological options are outlined that support a consistently ethical analysis of ethical value-conflicts pertaining to the rise of PM.

Spin-dependent electron transmission through bacteriorhodopsin embedded in purple membrane.

Spin-dependent photoelectron transmission and spin-dependent electrochemical studies were conducted on purple membrane containing bacteriorhodopsin (bR) deposited on gold, aluminum/aluminum-oxide, and nickel substrates. The result indicates spin selectivity in electron transmission through the membrane. Although the chiral bR occupies only about 10% of the volume of the membrane, the spin polarization found is on the order of 15%. The electrochemical studies indicate a strong dependence of the conduction on the protein's structure. Denaturation of the protein causes a sharp drop in the conduction through the membrane.

The novel H1N1/swine-origin influenza virus and its implications for autopsy practice.

As fatalities attributable to novel H1N1/S-OIV infections are currently rising, an increasing number of autopsies will have to be performed on these cases. In view of this challenge, adequate safety precautions and recommendations for autopsy procedures and the sampling and handling of specimens have to be established. Based on current literature, procedures for daily autopsy practice are proposed, particularly in regard to personal protection equipment, swab usage, and autopsy hygiene.

["Medicine of desire" between commercialization and patient-centeredness]. / "Wunscherfullende Medizin" zwischen Kommerz und Patientendienlichkeit.

DEFINITION OF THE PROBLEM: Ample evidence points to an emerging new self-understanding within medical practice, away from the established goals of medicine towards greater responsiveness to individual preferences. ARGUMENTS: The altered self-understanding of medical practice unfettered by indications grounded in concepts of disease can be conceptually characterized as desire-driven medicine, or "medicine of desire." This raises the question of morally justifiable limits for the normative governance of a medicine of desire. CONCLUSION: In liberal societies, only two forms of argumentation seem promising for setting limits to the provision and consumption of what a medicine of desire has to offer: Arguments that place expected benefit into the perspective of risks, and arguments that probe the coherence of desires and their fulfillment against the background of a person's conception of a good life for that person.