Ethisch begründet entscheiden in der Intensivmedizin.

The process recommendations of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for ethically based decision-making in intensive care medicine are intended to create the framework for a structured procedure for seriously ill patients in intensive care. The processes require appropriate structures, e.g., for effective communication within the treatment team, with patients and relatives, legal representatives, as well as the availability of palliative medical expertise, ethical advisory committees and integrated psychosocial and spiritual care services. If the necessary competences and structures are not available in a facility, they can be consulted externally or by telemedicine if necessary. The present recommendations are based on an expert consensus and are not the result of a systematic review or a meta-analysis.

Prevalence and risk factors for patient-reported joint pain among patients with HIV/hepatitis C coinfection, hepatitis C monoinfection, and HIV monoinfection.

BACKGROUND: To determine the prevalence of patient-reported joint pain among patients with human immunodeficiency virus (HIV)/chronic hepatitis C virus (HCV) coinfection, chronic HCV monoinfection, and HIV monoinfection followed in hepatology and infectious disease outpatient practices. METHODS: Standardized interviews were performed among 79 HIV/HCV-coinfected, 93 HCV-monoinfected, and 30 HIV-monoinfected patients in a cross-sectional study within hepatology and infectious disease clinics at three centers. The Multi-Dimensional Health Assessment Questionnaire was used to ascertain joint pain and associated symptoms. Information on potential risk factors for joint pain was obtained during the interview and by chart review. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of joint pain associated with risk factors of interest among chronic HCV-infected and HIV-infected patients. RESULTS: Joint pain was more commonly reported in HCV-monoinfected than HIV/HCV-coinfected (71% versus 56%; p = 0.038) and HIV-monoinfected (71% versus 50%; p = 0.035) patients. A previous diagnosis of arthritis and current smoking were risk factors for joint pain among HCV-infected patients (arthritis: aOR, 4.25; 95% CI, 1.84-9.81; smoking: aOR, 5.02; 95% CI, 2.15-11.74) and HIV-infected (arthritis: aOR, 5.36; 95% CI, 2.01-14.25; smoking: aOR, 6.07; 95% CI, 2.30-16.00) patients. CONCLUSION: Patient-reported joint pain was prevalent among all three groups, but more common among chronic HCV-monoinfected than either HIV/HCV-coinfected or HIV-monoinfected patients. A prior diagnosis of arthritis and current smoking were risk factors for patient-reported joint pain among both HCV-infected and HIV-infected patients.

The Role of Prior Knowledge and Intelligence in Gaining from a Training on Proportional Reasoning.

We explored the mediating role of prior knowledge on the relation between intelligence and learning proportional reasoning. What students gain from formal instruction may depend on their intelligence, as well as on prior encounters with proportional concepts. We investigated whether a basic curriculum unit on the concept of density promoted students' learning in a training on proportional reasoning. A 2 × 2 design with the factors basic curriculum unit (with, without) and intervention context to introduce proportional reasoning (speed, density) was applied in two consecutive, randomized classroom studies (N1 = 251, N2 = 566 fourth- and fifth-graders; 49%/56% female). We controlled for intelligence and mathematical achievement. We expected the combination of having received the basic curriculum unit on floating and sinking and proportional reasoning introduced via density (a familiar problem-solving context for this group) to be especially favorable. Whereas this hypothesis was not supported, we showed that mathematical achievement mediated the relation between intelligence and proportional reasoning and enabled learners to better exploit the learning opportunities.

The test of basic Mechanics Conceptual Understanding (bMCU): using Rasch analysis to develop and evaluate an efficient multiple choice test on Newton's mechanics.

BACKGROUND: Valid assessment of the understanding of Newton's mechanics is highly relevant to both physics classrooms and research. Several tests have been developed. What remains missing, however, is an efficient and fair test of conceptual understanding that is adapted to the content taught to secondary school students and that can be validly applied as a pre- and posttest to reflect change. In this paper, we describe the development and evaluation of the test of basic Mechanics Conceptual Understanding (bMCU), which was designed to meet these requirements. RESULTS: In the context of test development, qualitative and quantitative methods, including Rasch analyses, were applied to more than 300 Swiss secondary school students. The final test's conformity to the Rasch model was confirmed with a sample of N = 141 students. We further ascertained the bMCU test's applicability as a change measure. Additionally, the criterion validity of the bMCU test was investigated in a sample of secondary school students (N = 66) and a sample of mechanical engineering students (N = 21). In both samples, the bMCU test was a useful predictor of actual student performance. CONCLUSIONS: The bMCU test proved to enable fair, efficient, and simultaneously rigorous measurement of secondary school students' conceptual understanding of Newton's mechanics. This new instrument might fruitfully be used in both physics classrooms and educational research.

What Should Be the Cut Point for Classification Criteria of Studies in Gout? A Conjoint Analysis.

OBJECTIVE: To determine the acceptable level of positive predictive value (PPV) and negative predictive value (NPV) for classification criteria for gout, given the type of study. METHODS: We conducted an international web-based survey with 91 general practitioners and rheumatologists experienced in gout. Conjoint analysis was used as the framework for designing and analyzing pairs of 2 profiles, each describing a study type, a PPV, and an NPV. There were 5 study types presented: a phase III randomized controlled trial (RCT) of a nonsteroidal antiinflammatory drug versus prednisone for acute gout flares, a phase III RCT of a biologic agent for acute gout flares, a phase II RCT of a novel uricosuric drug of unknown efficacy and limited toxicity data, a case-control, genome-wide association study of gout, and a cohort study examining long-term outcomes of gout. PPV and NPV both had 5 levels ranging from 60-99%. RESULTS: The panelists in majority were male (65%) rheumatologists (93%) with an average of 19 years of practice, seeing 5 to 60 gout patients monthly. PPV was most highly weighted in decision making: the relative importance was 59% for PPV, 29% for NPV, and 13% for study type. The preferred PPV was 90% or 80%, with an accompanying NPV of 70% or 80%, dependent on study type. CONCLUSION: Preferred PPVs and NPVs range between 70% and 90% and differ by study type. A single cut point can be a reasonable approach for all study types if a PPV of 90% and NPV of 80% is approximated.

Action in perception? Empirical and philosophical arguments against the enactive approach to perception.

This paper focuses on the epistemic conditions of visual perception, ie it concentrates on the question of what kind of knowledge is required for us in order to be able to see colours and shapes as spatial properties of things. According to contemporary theories of sensory perception that follow the tradition of George Berkeley, like Alva Noe's so-called enactive approach to perception, this type of visual perception requires a certain kind of implicit practical knowledge, namely implicit sensorimotor knowledge of the way sensory stimulation varies as the perceiver moves. Two objections are presented against this central claim of the enactive approach. First, empirical evidence from psychological research on children's cognitive and motor development suggests that visual content is entirely independent of sensorimotor knowledge. Second, the enactive approach gets involved in the characteristic problems of classical sense--datum theories by introducing the extremely problematic claim that the recognition of appearances is the epistemic starting point for the perception of things and their properties.

Milwaukee shoulder: correlating possible etiologic variables.

The current study evaluated the relative correlation of apatite crystal-induced inflammation and rotator cuff deficiency in the development of cuff tear arthropathy. Thirty-seven patients with full thickness rotator cuff tears were evaluated by history, physical examination, and plain radiographs. Thirty patients had surgical intervention for their rotator cuff defects, and calipers were used intraoperatively to quantify the size of the tear in its largest diameter. The remaining seven patients were treated nonoperatively and the size of the tear was quantified using magnetic resonance imaging. Synovial fluid was obtained from all patients and analyzed for crystal content using an alizarin red stain. Synovial fluid also was analyzed for leukocyte count and differential, prostaglandin E, and matrix metalloproteinase. An unpaired Student's t test revealed that significantly higher levels of prostaglandin E were found in the synovial fluid of patients with apatite crystals, shown by alizarin red stain. Chi squared analysis showed that patients with elevated crystal levels were significantly more likely to have large rotator cuff tears or glenohumeral arthritis. Establishing such relations potentially can elucidate the etiology and treatment of this complex disorder.(2) (2)