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Mit der am 01.08.2016 in Kraft getretenen Novellierung des Rechts der Unterbringung gemas § 63 StGB wurde der Abstand der zwingenden externen Begutachtung von jeweils 5 Jahren auf 3 und nach 6 Jahren auf 2 Jahre verkurzt, beginnend mit dem 01.08.2018. Ziel des Gesetzgebers war es, die Dauer der Unterbringungen zu verkurzen. Es fehlt nicht nur an Nachweisen dafur, dass enger getaktete externe Begutachtungen zu einer Verkurzung der Aufenthaltsdauer fuhren konnten, es gibt tatsachlich Hinweise fur das Gegenteil. Zugleich werden die ohnehin bestehenden Probleme der starren Begutachtungsfristen verscharft. Der Beitrag skizziert die konkreten Auswirkungen aus der Sicht der arztlichen Leitung einer Masregelvollzugsklinik.

As a result of a Federal Constitutional Court decision on coercive treatment, in its state Law the federal state of Hesse has newly regulated the possibility of coercive treatment (Section 7 Paragraph 2 of the Hesse Law on the Enforcement of Court-ordered Hospital Treatment) and expressly incorporated the observance of a patient’s advance directive as defined by Sections 1901a and 1901b of the German Civil Code (Bürgerliches Gesetzbuch [BGB]). Having been sentenced to hospital order treatment under section 63 of the German Criminal Code (Strafgesetzbuch [StGB]), in the Vitos Haina Forensic Psychiatric Hospital thirteen patients with schizophrenia stated in a patient’s advance directive that they wished to be treated with certain antipsychotic medication in case of a recurring psychotic episode. In particular, the patient’s advance directive stated that this treatment should be compulsory if necessary. Based on a case vignette this article delineates both the motivation of the patients for such a patient’s advance directive as well as the legal limitations and the enforceability of such a patient’s advance directive. There is no prevailing view in the jurisdiction or literature on the utilization of a patient’s advance directive to guarantee an explicitly desired treatment in case of incapacity for consent. This article wishes to highlight the perspectives of those directly affected and to encourage discussion. Being of special interest for forensic psychiatry, these considerations may also be of importance for treatment considerations in general psychiatry.

The electrospray mass/charge distribution for a protein is an instantaneous measurement of surface areas during the transition from liquid to gas phase. Protonation is dependent upon surface area and surface area is related to protein folding under all conditions. M/z distributions for proteins and protein analogues all with different degrees of entropy were compared. Rigid dipeptide self-assemblies of any size possess a single m/z, whereas protein always displays multiple m/z distributions. Native proteins have narrow, defined m/z distributions, while denatured proteins and synthetic homopolypetides possess the widest possible m/z distributions. These observations are consistent with dynamic changes in surface area resulting from molecular motion.

This chapter proposes that using knowledge about the implementation of change in organizations can facilitate the implementation of evidence-based practices in forensic mental health services. It explains a case study, during a 20-year period, to implement the use of different versions of HCR-20 in Vitos Haina Forensic Psychiatric Hospital, Haina, Germany. Forensic mental health services aim to reduce symptoms of mental disorders and antisocial, aggressive, and violent behaviors, and increase psychosocial functioning. In mental health services generally, and in forensic mental health, there is a wide gap between available evidence on effective assessment, treatment, and management strategies and clinical services. Performance implementation produces actual benefits to consumers, organizations, and systems, and requires careful and thoughtful efforts. Evidence-based practice refers to assessment tools that have been proven to be valid and treatment and management strategies that have proven efficacy and effectiveness. Efficacy is achieved when a study shows that a new treatment leads to a better outcome than treatment as usual.

We present a method for the systematic identification of picogram quantities of new lipids in total extracts of tissues and fluids. It relies on the modularity of lipid structures and applies all-ions fragmentation LC-MS/MS and Arcadiate software to recognize individual modules originating from the same lipid precursor of known or assumed structure. In this way it alleviates the need to recognize and fragment very low abundant precursors of novel molecules in complex lipid extracts. In a single analysis of rat kidney extract the method identified 58 known and discovered 74 novel endogenous endocannabinoids and endocannabinoid-related molecules, including a novel class of N-acylaspartates that inhibit Hedgehog signaling while having no impact on endocannabinoid receptors. Italian Ministry of Education, University and Research Deutsche Forschungsgemeinschaft (DFG)

The cytoskeleton is a key regulator of cell morphogenesis. Crescentin, a bacterial intermediate filament-like protein, is required for the curved shape of Caulobacter crescentus and localizes to the inner cell curvature. Here, we show that crescentin forms a single filamentous structure that collapses into a helix when detached from the cell membrane, suggesting that it is normally maintained in a stretched configuration. Crescentin causes an elongation rate gradient around the circumference of the sidewall, creating a longitudinal cell length differential and hence curvature. Such curvature can be produced by physical force alone when cells are grown in circular microchambers. Production of crescentin in Escherichia coli is sufficient to generate cell curvature. Our data argue for a model in which physical strain borne by the crescentin structure anisotropically alters the kinetics of cell wall insertion to produce curved growth. Our study suggests that bacteria may use the cytoskeleton for mechanical control of growth to alter morphology.

Zusammenfassung: Es wurden 96 ausländische und 171 inländische Studierende einer deutschen Universität schriftlich befragt, welche Art sozialer Unterstützung sie sich in drei prototypischen kritischen Studiensituationen wünschten und von welchen Personen/Rollenträgern diese Unterstützung ausgehen solle. In- und ausländische Studierende bevorzugten problemorientierte gegenüber emotionsorientierter Unterstützung. Die ausländischen Studierenden zeigten eine stärkere Präferenz für problemorientierte soziale Unterstützung als inländische. Problemorientierte Unterstützung wurde umso mehr gewünscht, je schwieriger die kritische Situation den Befragten erschien.

Helical cell shape of the gastric pathogen Helicobacter pylori has been suggested to promote virulence through viscosity-dependent enhancement of swimming velocity. However, H. pylori csd1 mutants, which are curved but lack helical twist, show normal velocity in viscous polymer solutions and the reason for their deficiency in stomach colonization has remained unclear. Characterization of new rod shaped mutants identified Csd4, a DL-carboxypeptidase of peptidoglycan (PG) tripeptide monomers and Csd5, a putative scaffolding protein. Morphological and biochemical studies indicated Csd4 tripeptide cleavage and Csd1 crosslinking relaxation modify the PG sacculus through independent networks that coordinately generate helical shape. csd4 mutants show attenuation of stomach colonization, but no change in proinflammatory cytokine induction, despite four-fold higher levels of Nod1-agonist tripeptides in the PG sacculus. Motility analysis of similarly shaped mutants bearing distinct alterations in PG modifications revealed deficits associated with shape, but only in gel-like media and not viscous solutions. As gastric mucus displays viscoelastic gel-like properties, our results suggest enhanced penetration of the mucus barrier underlies the fitness advantage conferred by H. pylori's characteristic shape., Author Summary The only habitat of Helicobacter pylori is the human stomach, where it can promote stomach ulcers and cancer. Cells lining the stomach are protected from luminal acid by a thick layer of gastric mucus composed of polymerized gastric mucins. Gastric mucin undergoes a physical transition between a viscoelastic solution at neutral pH to a viscoelastic gel-like state at low pH. Helical rod shape in bacteria has been suggested to enhance swimming velocity in viscous solutions by a cork-screw mechanism, but H. pylori mutants lacking helical twist show normal swimming velocity in viscous polymer solutions used in prior studies comparing motility across bacterial species. These same mutants, however, show diminished colonization suggesting helical shape promotes stomach infection by another mechanism. Here we identified Csd4, a protease of cell wall tripeptides, which induces curvature in the cell body independently from the changes in cell wall crosslinking previously shown to promote helical twist. Cells lacking Csd4 form straight rods that also show colonization defects but normal velocity in several viscous polymer solutions. Upon examination of motility in gel-like media, however, we discovered that elimination or exaggeration of cell curvature perturbs motility. Thus H. pylori's helical shape may aid penetration of gel-like stomach mucus.

In handwritten copy there are often systematic errors such as horizontal and vertical overextension and increased uprightness in slant. This study was designed to find out whether the horizontal overextension depends on characteristics of the model, on the mode of copy production, or on the characteristics of the copier's normal handwriting. 100 subjects copied different models with and without interruptions of movement. Contrary to expectations there was less overextension with a continuous mode of production and with more extended models; familiarity with the model had no effect on the extension error. Further analysis showed that the overextension was particularly small during longer horizontal passages. The correlations with the subjects' normal handwriting were only minimal. In the discussion possible bases for the overextension and the consequences for expertise in forensic handwriting analysis were considered.

Ten healthy sedentary subjects [age, 27.5 (SD 3.5) years; height, 180 (SD 5) cm; mass, 69.3 (SD 6.3) kg] performed two periods of maximal incremental graded cycle ergometer exercise in a supine position. Randomly ordered and using an open spirometric system, one exercise was carried out during normoxia [maximal oxygen consumption (\(\dot V\)O2max)=38.6 (SD 3.5) ml·min−1·kg−1; maximal blood lactate concentration, 9.86 (SD 1.85) mmol·l−1; test duration, 22.6 (SD 2.7) min], the other during hypoxia [\(\dot V\)O2max=33.2 (SD 3.2) ml·min−1· kg−1; maximal blood lactate concentration, 10.38 (SD 2.02) mmol·l−1; test duration, 19.7 (SD 2.8) min]. At rest, immediately (0 p) and 60 min (60 p) after exercise, counts of leucocyte subpopulations (flow cytometry), cortisol and catecholamine concentrations were determined. At 0 p in contrast to normoxia, during hypoxia there was no significant increase of granulocytes. There were no significant differences between normoxia and hypoxia in the increases from rest to 0 p in counts of monocytes, total lymphocytes and lymphocyte subpopulations [clusters of differentiation (CD), CD3+, CD4+CD45RO−, CD4+CD45RO+, CD8+CD45RO−, CD8+CD45RO+, CD3+HLA-DR+, CD3−CD16/CD56+, CD3+CD16/CD56+, CD 19+] as well as adrenaline, noradrenaline and cortisol concentrations. The counts of CD3 −CD16/CD56+-and CD8 +CD45RO+-cells increased most. At 60 p, CD3−CD16/CD56+ and CD3+CD16/CD56+-cell counts were below pre-exercise levels and under hypoxia slightly but significantly lower than under normoxia. We concluded that the exercise-induced mobilization and redistribution of most leucocyte and lymphocyte subpopulations were unimpaired under acute hypoxia at sea level. Reduced increases of granulocyte counts during the study and reduced cell numbers of natural killer cells and cytotoxic, not major histocompatibility complex-restricted T-cells, only indicated marginal effects on the immune system.

Publisher Summary This chapter provides an overview on the diversity and variability of the peptidoglycan structures found in various bacteria. It summarizes the biophysical properties of peptidoglycan and discusses its architecture. Peptidoglycan is responsible for the osmotic stability by encasing the cytoplasmic membrane of most bacteria. It is a unique, net-like polymer made of glycan strands that are cross-linked by unusual peptides. Although there are some common structural features of peptidoglycan, there is large variability in the structure of bacterial peptidoglycan due to differences in the amino acid sequence, types of cross-links, and the presence or absence of secondary modifications in both the glycan strands and peptides. The glycans are synthesized as oligo- ( N -acetylglucosamine- N -acetylmuramic acid) strands of variable length and become modified shortly after their synthesis in many species. The peptides contain L- and D-amino acids and have a species-specific amino acid composition, sequence, and type of cross-linkage. Maturation of peptidoglycan involves cleavage of amide bonds in the peptides resulting in a nonhomogeneous structure of the polymer. Introduction of secondary modifications and maturation are the reasons for the complex composition of mature peptidoglycan often manifesting in a species-specific fine structure.

The penicillin-binding protein (PBP) 1A is a major murein (peptidoglycan) synthase in Escherichia coli. The murein synthesis activity of PBP1A was studied in vitro with radioactive lipid II substrate. PBP1A produced murein glycan strands by transglycosylation and formed peptide cross-links by transpeptidation. Time course experiments revealed that PBP1A, unlike PBP1B, required the presence of polymerized glycan strands carrying monomeric peptides for cross-linking activity. PBP1A was capable of attaching nascent murein synthesized from radioactive lipid II to nonlabeled murein sacculi. The attachment of the new material occurred by transpeptidation reactions in which monomeric triand tetrapeptides in the sacculi were the acceptors.

Untersuchungen zu geschlechtsstereotypen Konzepten psychischer Gesundheit haben in Amerika eine inzwischen zwanzigjahrige Tradition, wahrend dieses Forschungsthema in Deutschland nur in der grauen Literatur1 vertreten ist.

A total of 14 healthy subjects [means (SD): 27.6 (3.8) years; body mass 77.8 (6.6) kg; height 183 (6) cm] performed endurance exercise to exhaustion at 100% of the individual anaerobic threshold (Th(an)) on a cycle ergometer (mean workload 207 (55) W; lactate concentrations 3.4 (1.2) mmol.l-1; duration 83.8 (22.2) min, including 5 min at 50% of individual Th(an)). Leucocyte subpopulations were measured by flow cytometry and catecholamines by radioimmunological methods. Blood samples were taken before and several times during exercise. Values were corrected for plasma volume changes and analysed using ANOVA for repeated measures. During the first 10 min of exercise, of all cell subpopulations the natural killer cells (CD3-CD16/CD56+) increased the most (229%). Also CD3+CD16/CD56+ (84%), CD8+CD45RO- (69%) cells, eosinophils (36%) and monocytes (62%) increased rapidly during that time. CD3+, CD3+HLA-DR+, CD4+CD45RO+, CD4+CD45RO-, CD8+CD45RO+ and CD19+ cells either did not increase or increased only slightly during exercise. Adrenaline and noradrenaline increased nearly linearly by 36% and 77% respectively at 10 min exercise. The increase of natural killer cells and heart rates between rest and 10 min of exercise correlated significantly (r = 0.576, P = 0.031). We conclude that natural killer cells, cytotoxic, non-MHC-restricted T-cells, monocytes and eosinophils are mobilized rapidly during the first minutes of endurance exercise. Both catecholamines and increased blood flow are likely to contribute this effect.

Im vorherigen Kapitel wurde die “Schrotschustechnik” bisheriger Untersuchungen kritisiert, d.h. die Verwendung einer Vielzahl scheinbar beliebiger, abhangiger Variablen, die mangelnde Hypothesenbildung vor der Durchfuhrung der Untersuchungen und die Uberprufung zu breit gefaster Fragestellungen.

Dieses Kapitel gibt einen Uberblick uber den derzeitigen Forschungsstand zu der Frage, ob das Geschlecht der zu beurteilenden Person und deren geschlechtsstereotype Charakteristika diagnostische Urteile3 im Sinne von Verzerrungen (“bias”) beeinflussen.

Die Hauptuntersuchung hat zwei Schwerpunkte: Zum einen wurde das Konzept psychischer Gesundheit (Hypothese 1) mit der in der ersten Voruntersuchung entwickelten Skala erfast und zum anderen wurde der Einflus des Geschlechts und der Geschlechtsrolle auf das diagnostische Urteil untersucht (Hypothese 2 bis 4). Dazu wurde das in der zweiten Voruntersuchung uberprufte Fall- und Skalenmaterial benutzt. Die Untersuchung wurde in Form einer postalischen Befragung therapeutisch arbeitender Psychologinnen durchgefuhrt.

Dieses Kapitel gibt einen Uberblick uber die zwanzigjahrige Forschung zu Geschlechtsstereotypen im Konzept psychischer Gesundheit. Die Darstellung der uberwiegend amerikanischen Studien erfolgt tabellarisch. Zwei Untersuchungen werden ausfuhrlich referiert, nicht nur, weil es sich hier um die “klassischen” handelt, sondern auch, um die Logik der Folgestudien zu demonstrieren und das Verstandnis der beiden Ubersichtstabellen zu erleichtern.

Wahrend im Deutschen nur die drei in der Uberschrift genannten Begriffe terminologisch voneinander abgegrenzt werden mussen, herrscht in der amerikanischen Literatur “babylonische” Sprachverwirrung. Die Vielzahl der Begriffe und ihre unprazise Verwendung (“... like Humpty Dumptys’ words, they mean whatever one chooses them to mean”; Lipman-Blumen, 1984, 1) fuhrte in der letzten Zeit zu einer Kontroverse, die im Sinne einer beginnenden definitorischen Klarheit zu begrusen ist (Stoppard und Kalin, 1978, 1983 contra Archer 1980, 1984). Die haufige Ubernahme amerikanischer Fachausdrucke und die starke Prasenz amerikanischer Untersuchungen in dieser Arbeit lassen es geboten erscheinen, die begriffliche Problematik darzustellen.

Ziel dieser Voruntersuchung war es, eine Skala zur Erfassung von Geschlechtsstereotypen zu erstellen. Die Notwendigkeit der Konstruktion einer solchen Skala ergab sich zum einen daraus, das keine geeignete deutsche Skala existierte und zum anderen aus der Kritik an den in den amerikanischen Untersuchungen benutzten Skalen (siehe Kapitel 2.2), die es verbot, eine dieser Skalen einfach zu ubernehmen.

Ziel der zweiten Voruntersuchung war es, die Brauchbarkeit des Fall- und Skalenmaterials zu prufen. Im Mittelpunkt stand vor allem die Prufung der Glaubwurdigkeit des fiktiven Fallmaterials und der Verstandlichkeit der Instruktionen.