Do alcoholic liver transplantation candidates merit lower medical priority than non-alcoholic candidates?

Alcoholic patients are frequently regarded as responsible for their alcoholism and alcohol-related diseases, such as liver damage. These patients run the risk of receiving lower medical priority for liver transplantation than patients who are considered as not responsible for their liver damage. However, hardly any scientific research findings support this supposed responsibility of the alcoholic patient for his addiction and the related diseases. Many alcoholic patients have comorbid psychiatric disorders such as antisocial personality disorder, schizophrenia and social phobia, and these cormorbid diseases are often linked specifically and also in a neurobiological way to alcohol abuse. Furthermore, concepts such as responsibility and health have multiple dimensions, which can be contrasted against each other. Useful and fair criteria are presented for the assessment of responsibility for our health.

Reduction potential of microbial, odour and ammonia emissions from a pig facility by biofilters

The intention of this study was the determination of the potential to reduce specific microbial bioaerosol (cultivable bacteria and fungi, total cell counts of microbes, airborne endotoxins and microbial volatile organic compounds, MVOC), odour and ammonia emissions from a pig facility by biofilters. Five identical biofilter units in half technical scale were filled with different filter materials (Biochips, coconut-peat, wood-bark, pellets + bark and compost) and connected in parallel to a piggery. The results showed obvious differences between the filter materials. Numbers of airborne cultivable bacteria were decreased by ca. 70 to 95% and the total counts of bacterial cells from ca. 25 to (>) 90%. The total amount of fungal cells was reduced by at least 60%, although the percentage of cultivable moulds in the air after passing the filters was sometimes higher than before. Airborne endotoxins and MVOC were effectively reduced by all filter materials to at least 90%. Regarding odour, the average reduction was between 40 and 83%, whereas only one of the filters proved to be capable of slightly reducing the ammonia emissions. No relationships between odour/ammonia and microbial bioaerosols with regard to the reduction efficiency of the different filter materials or the total load of the emitted air could be established. A tendency could be shown, that biofilters best capable to reduce odour emitted slightly more airborne bacteria, both cultivable and total cell counts.

How can we avoid some psychotic patients becoming violent offenders?

Every year a number of psychotic patients commit violent crimes and are recommended for forensic psychiatric treatment. Many of these patients already show risk symptoms before their fatal offense. Despite these risk signs the physicians and psychiatrists, who have the task of intervening in crisis situations of psychotic patients, are frequently waiting too long before compulsory admission of potentially dangerous psychotic patients to a general psychiatric hospital. A physician or psychiatrist, who admits a "harmless" patient against his or her will may risk prosecution. Therefore, many involved professionals are very careful with regard to a forced admission of problematic psychotic patients to a general psychiatric hospital. It is timely, that some risk signs, which are evidently linked to a significantly, increased risk of violent behavior in psychotic patients, become recognized officially by law as a good reason for compulsory admission to a general psychiatric hospital.

["Microbial air pollutants--methods for detection of endotoxins, mycotoxins and MVOC"]

In the context of microbial emissions from composting facilities the methods for the detection and identification of the groups of substances released, i.e. endotoxins, mycotoxins and Microbial Volatile Compounds (MVOC) are discussed. With the aid of an overview of the different methods employed for the investigation of the single groups of compounds the current state of the art in this field is presented. In conclusion the enormous research needs, especially with regard to the mycotoxins and MVOC, are pointed out.

[Microbial emissions in collection of residential garbage]

Two exemplary investigations with different questions were carried out in Munich and Stuttgart by sampling bio-aerosols due to and during the collection and emptying of different types of waste bins. The emissions were regarded qualitatively and quantitatively, in order to answer the question, whether and to which amount differences of bio-aerosol emissions occurred due to the kind of wastes collected. The lowest emissions of airborne microorganisms were found during the collection of the paper waste fraction. In comparison, the amounts of them during the collection of unseparated household wastes as well as source separated bio-wastes and the remaining residual waste fraction were higher. Between the three latter, no significant differences could be found, only a tendency of higher values for the thermotolerant mould A. fumigatus during the collection of bio- and residual wastes was observed. Maybe this was caused by special features of the different sampling locations, but it could also be due to the longer collection intervals (bio- and residual wastes were partially collected every two weeks, unseparated wastes every week).

[Detection of airborne cultivatable microorganisms from compost sites--emissions and imissions]

The statement presented here gives an overview and assessment of the procedures and concepts currently used for the collection and determination of airborne, culturable microorganisms at sources of emission within composting plants and in their near vicinity. The paper focuses on "classical" methods, which involve cultivation as an intermediate step for the determination of viable, airborne microorganisms. The theoretical and practical requirements on such methods are discussed. Results and experiences from recent investigations are described.

[Recent methods for the detection of airborne microorganisms and source identification]

The detection of airborne microorganisms including selected cell constituents (e.g. allergens or endotoxins) depends on suitable methods and instruments for their collection. Furthermore, microbiological methods are necessary for their quantification and qualification. In the past these methods were largely based on the classical cultivation dependent approach. Modern molecular methods, e.g. direct staining procedures, hybridization assays with nucleic acids including the PCR-technology or immunological assays are promising new tools for a more sophisticated detection of bioaerosols. They allow a better detection rate, a more precise identification of certain members of the aerosol including cell constituents. With respect to speed and lower costs they are an important alternative to established detection methods.

What shall we do with untreatable forensic psychiatric patients?

The destiny of untreatable forensic psychiatric patients in many western countries is uncertain, because governments, staff members of forensic psychiatric hospitals, lawyers and other involved groups do not know what to do with this category of patients. The debate concerning this matter, and related cost saving measures, very frequently ignores two important questions. Who is responsible for the untreatability of these patients? What are the criteria for untreatability? These core questions, which are related to each other, must be answered before the debate can go further. An exact definition of untreatability is needed for a) a fair screening of the patients, and b) getting more insight in the precise nature of, and interactions of the factors which play a role in the phenomenon of untreatability. To say that some patients are not (totally) responsible for their untreatability is not justifiable, as they may eventually become the victims of cost saving measures.

The integration of psychosocial care in a general hospital: development of an interdisciplinary consultation program

The problems of multiple competing psychosocial services led to the development of an interdisciplinary consultation program in a university-affiliated Veterans Administration Hospital. The need for integration of services is frequently recognized but difficult to achieve. Representatives from Psychiatry, Psychology, Social Work, and Nursing worked out and carried through a coordinated plan to provide psychosocial consultation to the general hospital. Description of the initial experience focuses on the process of change within a traditional system. A case example which reflects the role and interaction of the disciplines is included. We found that the psychosocial system improved communication, established a pattern of interdisciplinary teaching and stressed preventive work.

Analysis of the haemagglutinin gene of current wild-type canine distemper virus isolates from Germany

The haemagglutinin (H) gene sequences from three wild-type canine distemper viruses (CDV) isolated during 1994-1995 were sequenced to determine whether contemporary strains had undergone significant genetic changes relative to the currently used vaccine strains. The new isolates were closely related to each other (> 99%) and displayed about 90-91% sequence homology to the Onderstepoort and Convac vaccine strains. There were one to four additional potential glycosylation sites compared to the vaccine strains which were also present in a German dog CDV isolate dating from 1990. However, only a very slight reduction in neutralizing titre against the new isolates was found when compared with the Onderstepoort and Rockborn vaccine strains. Cysteine and proline residues were well conserved indicating a conserved three dimensional structure for the protein. By phylogenetic analysis the recent isolates showed a narrow clustering close to the previous canine isolates indicating a linear pattern of evolutionary changes. A comparison with published CDV H gene sequences suggested the presence of different lineages of CDV on a global scale and possible cocirculation of more than one genotype of CDV.

Spot synthesis of overlapping peptides on paper membrane supports enables the identification of linear monoclonal antibody binding determinants on morbillivirus phosphoproteins

In order to map antigenic domains on the P-protein of morbillivirus, a series of overlapping peptides, representing the P-protein sequences of phocid distemper virus strain 2558/Han88 and canine distemper virus strain Onderstepoort, were synthesized on a paper support by the spot-technique. The reactivity of six monoclonal antibodies with the peptides was tested in an enzyme immunoassay and compared to their reactivity in Western blots and in an ELISA using detergent extracts from virus-infected cells. Three linear determinants could be localized on the P-protein. Two antibody-binding sites were delineated within the C-terminal (between amino acids 307-322 and 382-400, respectively), and a third one was located on the N-terminal part (amino acids 13-31) of the protein. Fine mapping of this binding site revealed that this was a part of an antigenic domain. In Western blots, the monoclonal antibodies reacting with this domain also reacted with a second protein which was possibly the V-protein.

[Stomach ulcer healing with enprostil, an orally effective prostaglandin E2 analog: direct comparative study with ranitidine]

In a randomized, endoscopically controlled double-blind trial the effectiveness of a twice daily dose of the prostaglandin E2-analogue enprostil was compared with ranitidine given to 93 ambulatory patients with benign gastric ulcers. Under 35 micrograms b.i.d. enprostil the ulcer healing rates after 2, 4, 6 and 8 weeks averaged 22% (10/46), 58% (26/45), 80% (35/44) and 86% (37/43). The corresponding values for ranitidine 150 mg b.i.d. were 22% (10/46), 66% (29/44), 84% (38/45) and 89% (41/46). The differences were not statistically significant. Both drugs had a similar influence on the ulcer symptoms and were well tolerated. The findings suggest that enprostil can be given in a twice daily dosage in the treatment of benign gastric ulcers.

20 versus 30 mg omeprazole once daily: effect on healing rates in 115 duodenal ulcer patients

In a double-blind, dose comparison multicenter trial 115 patients with duodenal ulcer were treated with either 20 or 30 mg oral omeprazole once daily for 4 weeks. There was no difference in the healing rates for the two groups after 2 and 4 weeks. After 2 weeks with 20 and 30 mg healing frequencies were 79.0 and 72.7%, after 4 weeks 96.5 and 92.7%. No difference was observed between the groups in the number of pain episodes during day and night. No side effects to the drug occurred. A daily dose of 20 mg omeprazole may be effective in ulcer therapy.

Critical bands in cat spatial vision

1. The ability of cats to detect sinusoidal grating patterns superimposed on one-dimensional visual noise was assessed using behavioural methods. 2. The magnitude of elevation in contrast threshold due to noise increased monotonically within limits with increasing noise contrast. 3. Visual noise was filtered using various techniques (band-reject, low-pass, high-pass and band-pass noise); filtered noise resulted in threshold elevation only when it contained frequencies similar to the test frequency. 4. In all cases the masking functions indicated that the band widths of the channels mediating detection ranged from +/- 0.50 to +/- 0.75 octaves across three spatial frequencies and that the channel sensitive to low spatial frequencies was asymmetrical in its tuning. 5. The spatial properties of these psychophysical detecting channels closely resemble the spatial frequency selectivity exhibited by some cat cortical neurones, both in the general narrowness of tuning and the asymmetry in tuning at lower, but not higher, spatial frequencies.

Reaction time as a measure of binocular interaction in human vision

In a series of psychophysical experiments monocular and binocular reaction times (RTs) were measured in response to the presentation of sinusoidal grating patterns. Over a wide range of contrast values, binocular RT was consistently faster than monocular RT, even at high-contrast levels where RT had reached asymptotic levels. For observers with good stereopsis this binocular summation effect was greater than that expected on the basis of probability summation alone, whereas observers with deficient stereopsis performed at the level of probability summation. For normal observers broadband random noise presented to one eye produced an elevation in RT to gratings presented to the other eye; no such dichoptic masking effect was found in a stereoblind observer. These results validate the use of RT as an efficient, reliable measure of binocular interaction in human vision.