[Berthold Kihn (1895-1964) and the NS "Euthanasia": Profile of a Perpetrator]. / Berthold Kihn (1895­1964): Profil eines NS-"Euthanasie"-Täters.

INTRODUCTION: In historical sciences, there is no consensus on how to understand the transition from eugenic sterilization to "euthanasia". The aim of this article was to investigate this question based on the historical-critical method, using the example of the perpetrator profile of Berthold Kihn. His pseudoscientific way to "euthanasia", however, did not have an eugenic foundation. METHODS: Literature- and archival studies were carried out. For the first time, attention was paid to relevant Franconian and familial archival sources. Moreover, documents of the Jena University Archive were compared to those of the concentration camps of Buchenwald and Oranienburg. RESULTS: After professional as well as private dilemma, the neuroinfectiologist Kihn set a focus on the "eradication of the inferiors". Apart from Kihn's role in central "euthanasia" and "childrens' euthanasia", which has been clearly demonstrated, we found actual hints of his additional involvement in decentral "euthanasia". This is shown using the example of the prominent patient Felix von Papen. DISCUSSION: Kihn was no racial hygienist, he did not make his mark as an eugenicist. His professional and private dilemma may - among other things - have motivated him, to join a politically promoted movement. CONCLUSION: Further comparative research in the profiling of NS perpetrators may contribute to a better differentiation of the transition from eugenics to "euthanasia".

Overcoming Challenges Associated with Developing Industrial Prognostics and Health Management Solutions.

The development of prognostics and health management solutions in the manufacturing industry has lagged behind academic advances due to a number of practical challenges. This work proposes a framework for the initial development of industrial PHM solutions that is based on the system development life cycle commonly used for software-based applications. Methodologies for completing the planning and design stages, which are critical for industrial solutions, are presented. Two challenges that are inherent to health modeling in manufacturing environments, data quality and modeling systems that experience trend-based degradation, are then identified and methods to overcome them are proposed. Additionally included is a case study documenting the development of an industrial PHM solution for a hyper compressor at a manufacturing facility operated by The Dow Chemical Company. This case study demonstrates the value of the proposed development process and provides guidelines for utilizing it in other applications.

[A New Approach to the Life and Oeuvre of Karl Leonhard: His Role as a Psychiatrist under National Socialism and the Influence of "Erlangen School" on his Scientific Position]. / Ein neuer werkbiographischer Ansatz zu Karl Leonhard: Seine Rolle als Psychiater im Nationalsozialismus und seine wissenschaftliche Prägung durch die "Erlanger Schule".

AIM: The aim of this study was to present a new approach to the life and oeuvre of Karl Leonhard, focussing on his role as a psychiatrist during the period of national socialism and on his scientific affiliation to the "Erlangen school". METHOD: For the first time, documents from Franconian archives have been evaluated. RESULTS: At the University Hospital of Psychiatry in Erlangen, Leonhard described psychopathological states in a very detailed manner as a main component of his phenomenological approach. Although Leonhard was classified as a "follower" during his denazification, temporarily he was "incriminated" due to a denunciation. CONCLUSION: Leonhard as an opportunist supported the NS racial hygiene without any actual eugenic orientation. Further studies are needed to clarify Leonhard's proclaimed active opposition to NS "euthanasia".

[On the History of a Special Connection Between Academic and Non-Academic Psychiatric Institutions: Erlangen (1903-1974)]. / Zur Geschichte einer speziellen Verbindung von Universitäts- und Anstaltspsychiatrie (1903­1974).

OBJECTIVE: To examine the more than 70-year history of a special connection between academic and non-academic psychiatric institutions. METHOD: Relevant archival material as well as primary and secondary literature were critically examined. RESULTS: As early as 1818, Johann Michael Leupoldt (1794-1874), an assistant professor in Erlangen, held a seminar on "madness". But the University Psychiatric Clinic was not established until 1903 as part of the association to the mental asylum on a contract agreement between the Friedrich-Alexander-University Erlangen and the County Senate of Middle-Franconia. Clinic patients were registered as "institutional residents", and the Clinic had no income of its own. Especially relevant is the fact that the Head of Department and Director of the Clinic was formally considered as a "senior doctor of the asylum". The efforts to gain more autonomy were not successful until the mid- 1970s because of the socio-political situation. DISCUSSION: The complicated dependent employment relationship of the Head of Department on the Director of the asylum undoubtedly contributed to their "mésalliance tradition" over several decades. A public scandal arose in 1978 with a supervisory complaint to the government of Middle-Franconia with accusations of failure to protect patient documentation and medications during the relocation of the departments of the mental asylum to the newly constructed Regional Hospital on the "Europakanal". The lack of documents concerning the separation between the university and the district may be due to these processes. OUTLOOK: Cooperation between the University Clinic and the Regional Hospital exists in an altered form today. The Psychiatric Clinic can thus include patients from the Regional Hospital in scientific studies. The present study can contribute to discussions on demand-controlled integrated psychiatric care in combined academic and non-academic psychiatric institutions and points out how interinstitutional psychiatric care can succeed.

Parakinesia: A Delphi consensus report.

Abnormal movements are intrinsic to some forms of endogenous psychoses. Spontaneous dyskinesias are observed in drug-naïve first-episode patients and at-risk subjects. However, recent descriptions of spontaneous dyskinesias may actually represent the rediscovery of a more complex phenomenon, 'parakinesia' which was described and documented in extensive cinematographic recordings and long-term observations by German and French neuropsychiatrists decades before the introduction of antipsychotics. With the emergence of drug induced movement disorders, the description of parakinesia has been refined to emphasize the features enabling differential diagnosis with tardive dyskinesia. Unfortunately, parakinesia was largely neglected by mainstream psychiatry to the point of being almost absent from the English-language literature. With the renewed interest in motor phenomena intrinsic to SSD, it was timely not only to raise awareness of parakinesia, but also to propose a scientifically usable definition for this phenomenon. Therefore, we conducted a Delphi consensus exercise with clinicians familiar with the concept of parakinesia. The original concept was separated into hyperkinetic parakinesia (HPk) as dyskinetic-like expressive movements and parakinetic psychomotricity (PPM), i.e., patient's departing from the patient's normal motion style. HPk prevails on the upper part of the face and body, resembling expressive and reactive gestures that not only occur inappropriately but also appear distorted. Abnormal movements vary in intensity depending on the level of psychomotor arousal and are thus abated by antipsychotics. HPk frequently co-occurs with PPM, in which gestures and mimics lose their naturalness and become awkward, disharmonious, stiff, mannered, and bizarre. Patients are never spontaneously aware of HPk or PPM, and the movements are never experienced as self-dystonic or self-alien. HPk and PPM are highly specific to endogenous psychoses, in which they are acquired and progressive, giving them prognostic value. Their differential diagnoses and correspondences with current international concepts are discussed.

Gustav Nikolaus Specht (1860­1940): psychiatric practice, research and teaching during a change of psychiatric paradigm before and after Kraepelin.

Gustav Specht (1860-1940) developed academic psychiatry in Erlangen. After studying medicine in Würzburg, Munich and Berlin, he became assistant medical director in the mental asylum of Erlangen. In 1897 he was appointed extraordinary, and in 1903 ordinary, Professor of Psychiatry. A good clinician and teacher, Specht worked during a time of paradigm change in psychiatry. He was an expert in chronic mania, and introduced the concept of the 'grumbler's delusion'. Paranoia he believed to be the core problem of psychopathology and considered the depressive syndrome as an 'exogenous-type' of reaction. For him, trauma was important in the genesis of mental illness, and his 'hystero-melancholy' anticipated the concept of borderline personality disorder.

Alzheimer's disease: history, ethics and medical humanities in the context of assisted suicide.

INTRODUCTION: Dementia diseases, especially Alzheimer's disease (AD), are of considerable importance in terms of social policy and health economics. Moreover, against the background of the current Karlsruhe judgement on the legalisation of assisted suicide, there are also questions to be asked about medical humanities in AD. METHODOLOGY: Relevant literature on complementary forms of therapy and prognosis was included and discussed. RESULTS: Creative sociotherapeutic approaches (art, music, dance) and validating psychotherapeutic approaches show promise for suitability and efficiency in the treatment of dementia, but in some cases still need to be scientifically tested. Biomarker-based early diagnosis of dementia diseases is increasingly becoming a subject of debate against the background of the Karlsruhe ruling. DISCUSSION: Needs-oriented and resource-enhancing approaches can make a significant contribution to improving the quality of life of people with dementia. The discussion on the issue of "assisted suicide" should include questions of the dignity and value of a life with dementia. OUTLOOK: The integrative dementia therapy model can be complemented by a religion- and spirituality-based approach. Appropriate forms of psychotherapy should be scientifically evaluated.

[Gustav Nikolaus Specht (1860-1940) : His impact on Kraepelin's nosology and approaches to his position in National Socialism]. / Gustav Nikolaus Specht (1860­1940) : Sein Einfluss auf die Nosologie Kraepelins und Annäherungen an seine Position im Nationalsozialismus.

INTRODUCTION: Gustav Specht (1860-1940) represents the beginning of the university psychiatry in Erlangen. 80 years after his death, this article focuses on Specht's role in the psychopathologic nosological discussion initiated by Kraepelin. Despite the sparse data situation, the authors approach for the first time Specht's position within psychiatry under National Socialism. METHODS: The relevant primary and secondary literature as well as archival sources were evaluated. RESULTS: In 1897 Specht was appointed supernumerary professor and in 1903 the first full professor for psychiatry in Erlangen. Specht elaborated the role of the manic element in paranoia. Specht added the depressive reaction to Bonhoeffers "exogenic reaction type" in 1913; Specht himself was in the view of some colleagues suspected of having a cyclothyme temperament and twice suffered from exogenous depressive reaction. DISCUSSION: Specht's research studies on the pathological affect in chronic paranoia influenced the contemporary psychopathological discussion in a sustainable manner. Specht's change of attitude towards eugenic measures can be interpreted as an adaptation to the National Socialist regime. CONCLUSION: The work of Gustav Specht can stimulate the cultivation of an interdisciplinary psychopathological discourse.

Karl Leonhard (1904-88) and his academic influence through the 'Erlangen School'.

The Erlangen University Psychiatric and Mental Clinic was an annexe to the Erlangen Mental Asylum, so when Leonhard worked there he became acquainted with acute and chronic stages of schizophrenia. This can be viewed as a decisive impulse for his later differentiated classification of types of schizophrenia. The suspicion that Leonhard suffered from attention deficit hyperactivity disorder cannot be supported. His reticence concerning social-psychiatric aspects is analysed in the context of his early professional contact with the 'Erlangen system' of open care and its Nazi perversion. Leonhard's role in National Socialism is still uncertain. His unsuccessful attempts to retain the Erlangen Chair of Psychiatry and Mental Illness in 1951 can be viewed as his first difficulty in the tensions between West Germany and East Germany.

A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: -13.38 (±14.98); 95%-CI: (-17.68; -9.07); noTC: -11.09 (±14.15); 95%-CI: (-15.11; -7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: -1.58; 95%-CI: (-7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants' resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

[The Erlangen Academic Psychiatry in Nationalsocialism.] / Die Erlanger Universitätspsychiatrie im Nationalsozialismus.

INTRODUCTION: The 200th anniversary of the University Psychiatry Erlangen motivates a critical-historical analysis of the role of Friedrich Meggendorfer (1880-1953) as a psychiatrist under National Socialism. METHOD: A current evaluation of previously unconsidered sources made it possible to classify Friedrich Meggendorfer's role as a Nazi university psychiatrist in a differentiated way. RESULTS: Meggendorfer's expertise in hereditary psychiatry and forensic eugenics could be the decisive reason for his appointment as full professor of psychiatry to Erlangen in 1934. On 19.11.1945 Meggendorfer was supended by the military government. Although Meggendorfer was classified by the court on 20.09.1946 as a "follower", he succeeded no reintegration into the faculty of the Friedrich-Alexander-University. DISCUSSION: Meggendorfer - among others through his explanations on the law for the prevention of hereditary diseases - allowed himself to be at least partially robbed of the freedom for independent intellectual creation as the core of academic self-understanding. CONCLUSION: The increased inclusion of ethical reflections in the psychiatric/ psychosomatic specialist training can protect the "soul doctor" from being instrumentalized.

[The "popular saint" Therese of Konnersreuth and her stigmata : An historical example for the interaction of psyche and religiosity]. / Die "Volksheilige" Therese Neumann von Konnersreuth und ihre Stigmata : Ein historisches Beispiel zur Wechselwirkung von Psyche und Religiosität.

BACKGROUND: In present times, we see ourselves confronted by the challenge of engaging increasingly diverse views of the world, god and healing in a constructive dialogue. Consequently, it is important to research into the contrary effects of religiosity on the human psyche. METHODS: Original- and literary medical historian research RESULTS: Gottfried Ewald (1888-1963), a psychiatric expert at the Friedrich-Alexander University of Erlangen, was appointed 90 years ago with the task of examining Therese Neumann (1898-1962), colloquially known as Resl of Konnersreuth. In 1927, Ewald retrospectively confirmed the diagnosis of "most severe hysteria with blindness and partial paralysis". Within the context of regular pastoral care, Resl's "hysterical blindness" disappeared on 24.06.1923. This remission might be ascribed to a positive effect of religiosity on mental health. Besides the beneficial effects of religiosity on healing, pathogenic phenomena of religion can also be seen in the case of Resl. During Lent in 1926, Resl experienced ecstatic states as well as blood-stained tears. On Good Friday in 1926, bleeding of the scalp occurred; since Holy Saturday 1927, she experienced stigmata on her hands and the soles of her feet. Ewald assessed the latter as probably being genuine, although he spoke in favor of a clinical observation in hospital to obtain scientifically substantiated findings. DISCUSSION: The story of Resl of Konnersreuth shows the contrary influences of religiosity on mental health in one and the same individual. CONCLUSION: Detailed psychiatric historical and ethical research on the interaction of the psyche and religiosity can provide information about mechanisms that channel the psychic power of religiosity to promote remission. It is further important to take a religious and spiritual history of the patients.

Person and ethics of a psychiatrist during National Socialism: Friedrich Meggendorfer (1880-1953).

Evaluation of sources not previously considered makes it possible to describe Friedrich Meggendorfer's role as a National Socialist university psychiatrist. Relevant archive material and literature were both assessed. The gene-hygiene affinity promulgated by Meggendorfer was based on his own scientific interests, early academic influences, and also positive reinforcement from his career choices. His application of scientific knowledge in the legitimization of National Socialist jurisdiction reflects a dark facet in Meggendorfer's life. One can also criticize his ethics in failing to use his eugenics expertise to stop 'euthanasia'. Future studies into the history of the ethical aspects of Nazi psychiatry should benefit from the setting up of criteria for the collection of biographical data. This would render comparisons and contrasts fairer and more stable.

[Carl Wernicke (1848-1905) and the "Wernicke-Kleist-Leonhard school". Connections to "Erlangen School" of psychiatry]. / Carl Wernicke (1848­1905) und die "Wernicke-Kleist-Leonhard Schule". Beziehungen zur "Erlanger Schule" der Psychiatrie.

BACKGROUND: To celebrate Carl Wernicke's 170th anniversary, the paper aims at analysing possible connections of Wernicke and his "Wernicke-Kleist-Leonhard (WKL) school" to the "Erlangen school" of psychiatry. METHODS: Relevant primary and secondary literature as well as archival material were examined to test the hypothesis. RESULTS: Wernicke's efforts to realise his nosological system in clinical practice were continued by his pupil Karl Kleist (1879-1960). After Wernicke's tragic early death Kleist worked under Gustav Specht's "Erlangen school of psychiatry". Karl Leonhard (1904-1988), who worked under Specht as well as under Kleist, continued Wernicke's and Kleist's research and ended up with a very differentiated classification of endogenous psychoses. DISCUSSION: Specht's "Erlangen school" of psychiatry can be regarded as a link in the development of the "Wernicke-Kleist-Leonhard school". Wernicke's description of "anxiety psychosis" motivated Specht to study the emotion of anxiety in "manic-depressive disorder". Specht's study again stimulated Leonhard's concept of "anxiety-happiness psychosis". Generally, Specht's intensive focus on bipolarity has influenced Leonhard's concept of cycloid psychoses. Specht's description of "pathologic affect" had an impact on Leonhard's concept of "affect-laden paraphrenia". CONCLUSION: Modern methods of neuro-imaging open a new perspective to Wernicke's localisation theory. The natural-scientific-philosophical "double orientation" of the WKL school motivates an increased integration of philosophical elements (ethics, religiosity, spirituality) in the field of psychiatry, psychosomatic medicine and psychotherapy.

Religiosity, Guilt, Altruism and Forgiveness in Alcohol Dependence: Results of a Cross-sectional and Prospective Cohort Study.

AIMS: To compare religious denomination, religiosity, guilt, altruism and forgiveness between alcohol-dependent patients and healthy control subjects and to prospectively investigate their relationship to the disorder's 24-month course following in-patient withdrawal treatment. METHOD: This study in Franconia (a mainly Christian protestant region of southern Germany) applied six questionnaires to evaluate religiosity, guilt, altruism and forgiveness in 166 alcohol-dependent in-patients during withdrawal and compared findings with that of 240 healthy controls. RESULTS: Compared to controls religious denomination was more frequently reported by the patients (OR = 1.72, P = 0.014) and patients showed higher guilt (P < 0.001). The subjective attainability of altruism was lower in patients than in controls (P = 0.015). Higher scores on scale of inter-religious private practice predicted earlier (Rho = -0.184, P = 0.021) and more frequent alcohol-related readmissions during the follow-up (Rho = 0.207, P = 0.009). Higher religious affiliation was related to earlier (Rho = -0.214, P = 0.008) and more frequent alcohol-related readmissions (Rho = 0189, P = 0.020). Lower values of subjective attainability of altruism predicted a worse outcome (earlier [Rho = 0.231, P = 0.003] and more frequent readmissions [Rho = -0.223, P = 0.004]). The sex-specific analyses show that some of the associations are stronger in women and others are stronger in men; however, these gender differences are small and possibly biased by multiple hypothesis testing. CONCLUSIONS: We identified religious denomination, private religious practice, religious affiliation, guilt and reduced attainability of altruism as risk factors for alcohol dependence and a worse follow-up outcome. Our findings may help to establish future preventive and therapeutic strategies.

[500 Years of Reformation: The History of Martin Luther's Pathography and its Ethical Implications]. / 500 Jahre Reformation: Zur Historie der Pathographie Martin Luthers und ethischen Implikationen.

Introduction In the context of the 500th anniversary of the Reformation, it is time to take a survey of the history of Martin Luther's (1483-1546) pathography and to deduce possible conclusions from it for psychiatric practice. Results In a 1035-page work written in German between 1937 and 1941, the Dane Paul Reiter retrospectively diagnosed Luther as manic-depressive. In 1956, Grossmann was unable to prove persistent synchronicity of depressive mood and reduced motivation in Luther in the key years 1527 and 1528, which led him to conclude that Luther had a cyclothymic personality with a pyknic constitution. Discussion One very central source of Luther's life's work may have arisen from the tension between emotional constraints and crises of faith, on the one hand, and resilience and trust in God, on the other. Conclusion Luther can be used as an example of the importance of religiousness as a curative resource for the psyche.

Cloninger Type 2 Score and Lesch Typology Predict Hospital Readmission of Female and Male Alcohol-Dependent Inpatients During a 24-Month Follow-Up.

BACKGROUND: Relapse after detoxification treatment is a common problem in alcohol dependence. However, its prediction still lacks reliability. We here investigated whether the easily accessible clinical Cloninger and Lesch classifications predict alcohol-related hospital readmission following inpatient withdrawal treatment. METHODS: In this bicentric prospective clinical study, 67 female and 84 male alcohol-dependent inpatients were characterized according to the Cloninger items and the Lesch typology. The patients' records were followed for 24 months. Because of the well-established sex differences in alcohol dependence, we studied females and males separately. RESULTS: Overall, 54% of the female patients and 67% of the male patients sustained at least 1 alcohol-related hospital readmission during the follow-up. Readmission was related to a higher Cloninger type 2 score than nonreadmission (females, p = 0.007, males p = 0.044). In females, the Cloninger type 2 score correlated with the number of readmissions (ρ = 0.384, p = 0.001) and the days to first readmission (ρ = -0.333, p = 0.006). The effects were stronger in patients with age at onset of alcohol dependence over 25 years. We found gender dimorphisms concerning the Cloninger items. In female patients, the 4 Lesch subtypes differed in their risk (p = 0.010), the number (p = 0.040), and the days to first readmission (p = 0.031). Lesch type 1 was associated with an increased risk (OR = 4.83, p = 0.041) and Lesch type 2 with a reduced risk (OR = 0.07, p = 0.004). In addition, the number of previous inpatient alcohol withdrawals predicted the patients' outcomes (p < 0.05). CONCLUSIONS: The Cloninger type 2 score and the Lesch typology are promising tools for the prediction of alcohol-related readmissions. Our findings provide the basis to optimize relapse prevention in alcohol dependence.

Synthesis of M + 4 Stable Isotopomers of Ergometrine and Ergometrinine.

The priority ergot alkaloids ergometrine and ergometrinine are highly toxic mycotoxins naturally occurring in different types of grains (i.e. rye, wheat, rice), as well as grain-based foods and, therefore, have gained increasing importance for food safety over the last years. The application of HPLC-MS/MS for the analysis of ergot alkaloids in food presupposes the availability of isotopically labelled internal standards. Thus, a multistep synthesis was developed for ergometrine-(N-13CD3) and its epimer ergometrinine-(N-13CD3) with a mass shift of four units compared with the parent compounds. The synthesis is based on the preparation of stable isotope labelled lysergic acid that was coupled with (S)-alaninol. The chemical synthesis of both compounds has been achieved in six steps with an overall yield of 1 % (ergometrine-(N-13CD3)) and 0.6 % (ergometrinine-(N-13CD3)), respectively. Structural identification was performed by MS analysis as well as 1H and 13C NMR.

Gaming and Religion: The Impact of Spirituality and Denomination.

A previous investigation from Korea indicated that religion might modulate gaming behavior (Kim and Kim in J Korean Acad Nurs 40:378-388, 2010). Our present study aimed to investigate whether a belief in God, practicing religious behavior and religious denomination affected gaming behavior. Data were derived from a Western cohort of young men (Cohort Study on Substance Use Risk Factors, n = 5990). The results showed that a stronger belief in God was associated with lower gaming frequency and smaller game addiction scale scores. In addition, practicing religiosity was related to less frequent online and offline gaming. Finally, Christians gamed less frequently and had lower game addiction scale scores than subjects without religious denomination. In the future, these results could prove useful in developing preventive and therapeutic strategies for the Internet gaming disorder.

Supra-molecular ecobionanocomposites based on polylactide and cellulosic nanowhiskers: synthesis and properties.

Successful filler dispersion and establishment of good interfacial contact with the surrounding matrix are essential for optimized reinforcement in polymeric nanocomposites. In particular, in renewable-based composites this can be challenging, where hydrophilic attractions between nanofillers facilitate aggregation. Here an innovative approach to prepare cellulosic nanowhisker (CNW) reinforced polylactide (PLA) is presented. The lactide ring-opening polymerization is initiated from CNW surface hydroxyl groups after partial acetylation to control the grafting density. Grafting of PLA chains is verified by Fourier transform infrared spectroscopy. The resulting nanocomposites display exceptional properties; a heat distortion temperature of 120 °C is achieved at 10 wt % CNW loading and can be further enhanced to reach 150 °C at 15 wt % CNW. The formation of a percolating network is verified by comparison of modulus data with an established theoretical model. Additionally, nucleation by CNWs reduces the crystallization half-time to 15 s compared with 90 s for PLA. Melt-pressed films retain transparency indicating good filler dispersion.