Role and responsibility of oncologists in assisted suicide. Practice and views among members of the German Society of Haematology and Medical Oncology

Background

Physician-assisted suicide (PAS) is a controversial practice and regulatory frameworks differ regarding assigned physicians' roles. This study explores clinical experience and views of German oncologists concerning ethically and legally relevant aspects of PAS after change of the law.

Materials and methods

An online survey was conducted among members of the German Society of Haematology and Medical Oncology (DGHO) in March 2021. Descriptive analysis, bivariate and multivariable logistic regression of quantitative data on determinants related to (un)willingness to assist with suicide as well qualitative analysis of free-text comments were carried out.

Results

Seven hundred and forty-five of 3588 DGHO members responded (20.8%). Of these, 29.9% reported requests for a lethal drug and 3.0% (n = 22) reported to have assisted with suicide. Almost half of them (47.0%, n = 350) objected to providing PAS, whereas 45.9% indicated a willingness at least under certain conditions. Of those respondents who did not object to PAS, 25.4% would also consider assistance if those willing to die had a psychiatric disease and 10.2% if requestors had no disease at all. A majority viewed a role for physicians regarding different tasks associated with assisted suicide. Respondents with <10 years of professional experience, working in hospital with religious affiliation and with subspecialisation in palliative care were significantly less frequently willing to assist suicide.

Conclusions

Respondents are divided in their personal attitudes towards PAS but a majority supports involvement of physicians regarding different tasks related to assisted suicide. Data about the practice and envisaged professional role may inform development of an acceptable ethico-legal framework for a controversial practice.

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In Germany, as in other countries, assisted suicide has become lawful more recently.

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To be able to develop guidance on the highly controversial subject, empirical data on practice and related aspects are needed.

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30% of responding oncologists report requests for lethal drugs by their patients and 3% have assisted with suicide.

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Compared with 2015, significantly more oncologists report requests for lethal drugs and willingness to assist with suicide.

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Palliative care qualification and less professional experience were negatively associated with willingness to assist suicide.

Induction of trained immunity by influenza vaccination - impact on COVID-19

Non-specific protective effects of certain vaccines have been reported, and long-term boosting of innate immunity, termed trained immunity, has been proposed as one of the mechanisms mediating these effects. Several epidemiological studies suggested cross-protection between influenza vaccination and COVID-19. In a large academic Dutch hospital, we found that SARS-CoV-2 infection was less common among employees who had received a previous influenza vaccination: relative risk reductions of 37% and 49% were observed following influenza vaccination during the first and second COVID-19 waves, respectively. The quadrivalent inactivated influenza vaccine induced a trained immunity program that boosted innate immune responses against various viral stimuli and fine-tuned the anti-SARS-CoV-2 response, which may result in better protection against COVID-19. Influenza vaccination led to transcriptional reprogramming of monocytes and reduced systemic inflammation. These epidemiological and immunological data argue for potential benefits of influenza vaccination against COVID-19, and future randomized trials are warranted to test this possibility.

The Microbiome in Childhood Acute Lymphoblastic Leukemia

For almost 30 years, the term "holobiont" has referred to an ecological unit where a host (e.g., human) and all species living in or around it are considered together. The concept highlights the complex interactions between the host and the other species, which, if disturbed may lead to disease and premature aging. Specifically, the impact of microbiome alterations on the etiology of acute lymphoblastic leukemia (ALL) in children is not fully understood, but has been the focus of much research in recent years. In ALL patients, significant reductions in microbiome diversity are already observable at disease onset. It remains unclear whether such alterations at diagnosis are etiologically linked with leukemogenesis or simply due to immunological alteration preceding ALL onset. Regardless, all chemotherapeutic treatment regimens severely affect the microbiome, accompanied by severe side effects, including mucositis, systemic inflammation, and infection. In particular, dominance of Enterococcaceae is predictive of infections during chemotherapy. Long-term dysbiosis, like depletion of Faecalibacterium, has been observed in ALL survivors. Modulation of the microbiome (e.g., by fecal microbiota transplant, probiotics, or prebiotics) is currently being researched for potential protective effects. Herein, we review the latest microbiome studies in pediatric ALL patients.

Erratum: Azimuthal Anisotropy of K_{S}^{0} and Λ+Λ[over ¯] Production at Midrapidity from Au+Au Collisions at sqrt[s]_{NN}=130 GeV [Phys. Rev. Lett. 89, 132301 (2002)]

This corrects the article DOI: 10.1103/PhysRevLett.89.132301.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

Lifestyle behaviour and prevalence of cardiovascular risk factors - a pilot study comparing Kiribati and European seafarers

Background

According to internal observations within a German shipping company, obvious risk-behaviour persists among the crew members coming from the Pacific Island State of Kiribati and representing a large part of the crew aboard merchant vessels of this company. These observations were related to excessive eating habits. This study aims to assess the cardiovascular risk among seafarers and to compare lifestyle factors between Kiribati and European crew members.

Methods

In the present maritime field study 81 sailors (48 Kiribati, 33 European, average age at 38.9 and 36.8 years respectively) were examined from April until August 2014 aboard four container ships crossing the Atlantic Ocean (participation rate of 90.9%).

Results

Based on the number of established risk factors, 35.4% of the Kiribati and 16.7% of the European crew members were regarded as a high risk group for cardiovascular diseases. The HDL-values of Kiribati were found to be considerably lower (34.9 mg/dl) than the references values given by the WHO and in comparison to the European crew members (44.8 mg/dl) (p = 0.002). 91.7% of Kiribati and 51.5% of European participants were found to be overweight according to WHO-criteria - with a mean Body Mass Index (BMI) of 30.3 kg/m² and 25.6 kg/m² (p <  0.001). Regarding lifestyle factors Kiribati often claimed to eat significantly larger amounts of food aboard while most European sailors stated to eat less or about the same during their shipboard stay (p = 0.017). Daily sleeping hours were slight on both sides; however with a mean of 5.2 h a day Kiribati crew members had significant fewer sleep (p = 0.038). The examined Kiribati sailors had a mean increase in weight of 6 kg over a 12 months period of observation.

Conclusions

In total the compiled data points towards a higher risk of cardiovascular diseases particularly due to alimentary habits within the Kiribati crew members. The distinct weight-gain measured among the Kiribati in spite of higher energy consumption levels at sea is alarming. Thus, the results of this study confirm the necessity of health-improving interventions aboard cargo vessels.

Targeting HSP90 dimerization via the C terminus is effective in imatinib-resistant CML and lacks the heat shock response

Heat shock protein 90 (HSP90) stabilizes many client proteins, including the BCR-ABL1 oncoprotein. BCR-ABL1 is the hallmark of chronic myeloid leukemia (CML) in which treatment-free remission (TFR) is limited, with clinical and economic consequences. Thus, there is an urgent need for novel therapeutics that synergize with current treatment approaches. Several inhibitors targeting the N-terminal domain of HSP90 are under investigation, but side effects such as induction of the heat shock response (HSR) and toxicity have so far precluded their US Food and Drug Administration approval. We have developed a novel inhibitor (aminoxyrone [AX]) of HSP90 function by targeting HSP90 dimerization via the C-terminal domain. This was achieved by structure-based molecular design, chemical synthesis, and functional preclinical in vitro and in vivo validation using CML cell lines and patient-derived CML cells. AX is a promising potential candidate that induces apoptosis in the leukemic stem cell fraction (CD34+CD38-) as well as the leukemic bulk (CD34+CD38+) of primary CML and in tyrosine kinase inhibitor (TKI)-resistant cells. Furthermore, BCR-ABL1 oncoprotein and related pro-oncogenic cellular responses are downregulated, and targeting the HSP90 C terminus by AX does not induce the HSR in vitro and in vivo. We also probed the potential of AX in other therapy-refractory leukemias. Therefore, AX is the first peptidomimetic C-terminal HSP90 inhibitor with the potential to increase TFR in TKI-sensitive and refractory CML patients and also offers a novel therapeutic option for patients with other types of therapy-refractory leukemia because of its low toxicity profile and lack of HSR.

Enhancing the photoluminescence of surface anchored metal-organic frameworks: mixed linkers and efficient acceptors

We present two approaches to enhance the photoluminescence quantum yield (PLQY) of surface-anchored metal-organic frameworks (SURMOFs). In the first approach we fabricate SURMOFs from a mix of an emissive linker with an optically-inert linker of equivalent length, diluting the emissive linker while maintaining the SURMOF structure. This approach enhances the internal PLQY. However, the increase in internal PLQY is achieved at the expense of a drastic reduction in optical absorption, thus the external PLQY remains low. To overcome this limitation, a second approach is explored wherein energy-accepting guest chromophores are infiltrated into the framework of the active linker. At the correct acceptor concentration, an internal PLQY of 52% - three times higher than the previous approach - is achieved. Additionally, the absorption remains strong leading to an external PLQY of 8%, an order of magnitude better than the previous approach. Using this strategy, we demonstrate that SURMOFs can achieve PLQYs similar to their precursor chromophores in solution. This is of relevance to SURMOFs as emitter layers in general, and we examine the optimized emitter layer as part of a photon upconversion (UC) SURMOF heterostructure. Surprisingly, the same PLQY is not observed after triplet-triplet annihilation in the UC heterostructure as after its normal photoexcitation (although the UC layers exhibit low thresholds consistent with those reported in our previous work). We discuss the potential bottlenecks in energy transport that could lead to this unexpected reduction in PLQY after excitation via triplet-triplet annihilation, and how future design of SURMOF UC multilayers could overcome these limitations.

Human TLR8 senses UR/URR motifs in bacterial and mitochondrial RNA

Toll‐like receptor (TLR) 13 and TLR2 are the major sensors of Gram‐positive bacteria in mice. TLR13 recognizes Sa19, a specific 23S ribosomal (r) RNA‐derived fragment and bacterial modification of Sa19 ablates binding to TLR13, and to antibiotics such as erythromycin. Similarly, RNase A‐treated Staphylococcus aureus activate human peripheral blood mononuclear cells (PBMCs) only via TLR2, implying single‐stranded (ss) RNA as major stimulant. Here, we identify human TLR8 as functional TLR13 equivalent that promiscuously senses ssRNA. Accordingly, Sa19 and mitochondrial (mt) 16S rRNA sequence‐derived oligoribonucleotides (ORNs) stimulate PBMCs in a MyD88‐dependent manner. These ORNs, as well as S. aureus‐, Escherichia coli‐, and mt‐RNA, also activate differentiated human monocytoid THP‐1 cells, provided they express TLR8. Moreover, Unc93b1^−/−‐ and Tlr8^−/−‐THP‐1 cells are refractory, while endogenous and ectopically expressed TLR8 confers responsiveness in a UR/URR RNA ligand consensus motif‐dependent manner. If TLR8 function is inhibited by suppression of lysosomal function, antibiotic treatment efficiently blocks bacteria‐driven inflammatory responses in infected human whole blood cultures. Sepsis therapy might thus benefit from interfering with TLR8 function.

Seafarer deaths at sea: a German mortality study

BACKGROUND

Seafarers face numerous hazards during their work at sea.

AIMS

To demonstrate the frequency and causes of mortality in German seafarers.

METHODS

The deaths of all German seafarers from 1998 to 2008 were counted and evaluated using the German central civil register in Berlin.

RESULTS

The study cohort comprised a total of 159588 seafarer-years. During the 11 year period, 68 male seafarers died on board. The average age was 48.5 years (SD 12.7 years) and comprised 35 deck officers, 16 engine officers and 17 general crew members (i.e. non-officers from the deck and engine room crew and galley staff). Cause of death was documented in 45 cases (66%): 26 were due to unnatural causes (occupational accidents, suicides) and 19 due to natural causes (particularly, ischaemic heart disease). The crude annual mortality rate for German seamen was 65 per 100000 seafarer-years. For cardiac causes, this rate was significantly higher among deck and engine officers (24 and 38) than among crew ranks (7 per 100000 seafarer-years) (P < 0.05). Deck and engine offi-cers also showed a higher mortality rate for accidents (28 and 22) than crew ranks (15) (P < 0.05). The age-stratified fatal accident rate of German seafarers aboard was 10 times higher than the mortality of the German general population on shore.

CONCLUSIONS

Seafaring constitutes an occupation with a high risk for serious accidents. Due to the unexpectedly high mortality rate among officers associated with work-related accidents, this occupational group should receive more effective education on safety behaviour on board.

Comparison of hospitalization among German coastal and deep sea fishermen

PURPOSE

This study aims to compare the hospitalization of German fishermen employed on German-flagged fishing vessels with that of the general German population in consideration of differences between coastal and deep sea fishery.

METHODS

By means of a database from the health insurance company for seafarers, diagnoses of German fishermen treated in German hospitals were determined from January 1997 to December 2007. Compared with the general German population, the fishermen's risk for specific diseases leading to hospitalization was calculated as standardized hospitalization ratio (SHR).

RESULTS

Compared with the German reference population, German fishermen showed a considerably high SHR for malignant neoplasms at all sites (SHR 1.46; 95% CI 1.37-1.56), for respiratory cancer, and for non-Hodgkin lymphoma (NHL). Furthermore, they had more often been hospitalized due to diabetes mellitus, diseases of the respiratory and digestive systems as well as due to injury and poisoning. The risk for respiratory cancer and NHL among coastal fishermen exceeded that of deep sea fishermen, whereas the latter displayed a considerably higher SHR for diabetes mellitus, diseases of the respiratory system and metabolic and nutritional disorders. In contrast, the SHR for hypertensive and ischemic heart diseases was decreased among deep sea fishermen. Less qualified deep sea fishermen displayed a considerably higher SHR for malignant neoplasms at all sites than more highly qualified ones.

CONCLUSIONS

Fishery is still an occupation which poses a high risk for malignant neoplasms and injuries. This is likely due to lifestyle and work-related factors. Further studies are needed to evaluate the different working and living conditions of coastal and deep sea fishermen.

Actinic keratosis among seafarers

The aim of this study was to assess the prevalence of UV-induced actinic keratosis and further skin lesions. A newly developed questionnaire about lifetime UV radiation exposure was completed by 514 seafarers. An experienced dermatologist inspected the whole-body skin status of all participants. The questionnaire revealed a pre-employment UV radiation exposure in 104 seafarers, sunbed use in 26 subjects and a median work-related UV radiation exposure at sea of 20 years. The diagnosis of actinic keratoses was made in 94 seafarers and the clinical diagnosis of skin cancers in 48 seafarers (28 basal cell carcinoma, 11 squamous cell carcinoma, 9 malignant melanoma). After age standardisation according to a European reference population, the male European seafarers in this study had a 1.80-fold increased risk of actinic keratosis. Actinic keratoses [OR 1.03 (1.01-1.05)] and squamous cell carcinoma [OR 1.07 (1.01-1.13)] were related to the duration of seafaring time in years. A significant association was also found between actinic keratosis/squamous cell carcinoma and sunlight exposure during home leave [OR 1.67 (1.03-2.81) and OR 6.19 (1.18-32.40)]. Furthermore, the engine room personnel-especially the technical officers-were at higher risk of developing actinic keratosis. Due to the high prevalence of actinic keratosis especially among older seafarers with fair skin, with longer duration of seafaring employment at sea and with higher UV exposure during home leave, more intensive advice should be given on sun protection both at sea and ashore.

Systematic review of maritime field studies about stress and strain in seafaring

PURPOSE

The aim of this study was to summarize and evaluate the current scientific literature on stress and strain on seafarers on board as defined by maritime field surveys.

METHODS

Using a systematic review, 109 studies on the stress and strain experienced by seafarers were identified for the period January 1990 to January 2012.

RESULTS

Only 13 of the identified maritime studies were conducted as field studies, and in 10 of these studies, the focus was on the watch system and/or on fatigue. According to the study results, sleepiness tends to be stronger in the 2-watch system than in the 3-watch system (particularly between 4:00 and 6:00 a.m.). Occasional short sleep episodes appear to provide adequate recovery. Fatigue does not appear to depend on the seafarers' age and is often associated with poor sleep quality; noise and night shifts are also considered to contribute to fatigue. Stress among the seafarers was primarily recorded in sleep diaries (9 times) and with devices for measuring physical activity (4 times). As a rule, a questionnaire was used to assess the strain on the crew on board; 7 studies also additionally recorded biometrical parameters. Only in 6 cases were several groups with different ranks on board investigated.

CONCLUSION

The conducted literature review makes it clear that most maritime field studies have focused on fatigue and watch systems in the shipping industry--in each case as univariate parameters. Thus, scientific field studies with comprehensive multivariate stress and strain analyses on board are required.

TLR13 recognizes bacterial 23S rRNA devoid of erythromycin resistance-forming modification

Host protection from infection relies on the recognition of pathogens by innate pattern-recognition receptors such as Toll-like receptors (TLRs). Here, we show that the orphan receptor TLR13 in mice recognizes a conserved 23S ribosomal RNA (rRNA) sequence that is the binding site of macrolide, lincosamide, and streptogramin group (MLS) antibiotics (including erythromycin) in bacteria. Notably, 23S rRNA from clinical isolates of erythromycin-resistant Staphylococcus aureus and synthetic oligoribonucleotides carrying methylated adenosine or a guanosine mimicking a MLS resistance-causing modification failed to stimulate TLR13. Thus, our results reveal both a natural TLR13 ligand and specific mechanisms of antibiotic resistance as potent bacterial immune evasion strategy, avoiding recognition via TLR13.

Burnout syndrome in seafarers in the merchant marine service

PURPOSE

As seafarers face a wide range of psychosocial stressors on board, they may be endangered to develop burnout syndrome. This study aims to investigate respective indicators.

METHODS

In a cross-sectional study, 251 seafarers were asked about demographic data and job-related stressors. Particularly, the subscale emotional exhaustion (EE) of the Maslach Burnout Inventory and the Epworth Sleepiness Scale were used to assess the respective risks of job-related burnout and daytime sleepiness among seafarers. The statistical analysis was carried out using multiple logistic regression.

RESULTS

Within the whole study group, the EE score was elevated in 10.8 %. A higher EE score was found in 10.7 % of officers, in 4.5 % of lower crew ranks and in 25.0 % of the galley staff (p = 0.05). Furthermore, long working days were associated with an elevated EE score [OR 3.83 (CI 1.46-10.03)]. Emotional exhaustion was associated with a subjective perception of enough sleep on board [OR 3.33 (CI 1.17-9.46)], lack of care taken by the shipboard superiors and/or the shipping company [OR 1.19 (CI 1.04-1.36)], with high responsibility for work organisation of those involved in leadership [OR 1.46 (CI 1.20-1.78)] and with social problems due to the long periods of separation from their families [OR 1.19 (CI 1.02-1.39)], taking into account relevant demographic parameters.

CONCLUSIONS

Compared with the majority of on-shore occupations, the burnout risk in seafaring seems to be moderate. To reduce the EE among seafarers, it is recommended to extend the sleeping time, to avoid long working hours, to improve the superiors' communication and leadership skills, to diminish the superiors' stress load caused by organisational duties and to support low-price telecommunication possibilities at home.

Intestinal aspartate proteases TiCatD and TiCatD2 of the haematophagous bug Triatoma infestans (Reduviidae): sequence characterisation, expression pattern and characterisation of proteolytic activity

Two aspartate protease encoding complementary deoxyribonucleic acids (cDNA) were characterised from the small intestine (posterior midgut) of Triatoma infestans and the corresponding genes were named TiCatD and TiCatD2. The deduced 390 and 393 amino acid sequences of both enzymes contain two regions characteristic for cathepsin D proteases and the conserved catalytic aspartate residues forming the catalytic dyad, but only TiCatD2 possesses an entire C-terminal proline loop. The amino acid sequences of TiCatD and TiCatD2 show 51-58% similarity to other insect cathepsin D-like proteases and, respectively, 88 and 58% similarity to the aspartate protease ASP25 from T. infestans available in the GenBank database. In phylogenetic analysis, TiCatD and ASP25 clearly separate from cathepsin D-like sequences of other insects, TiCatD2 groups with cathepsin D-like proteases with proline loop. The activity of purified TiCatD and TiCatD2 was highest between pH 2 and 4, respectively, and hence, deviate from the pH values of the lumen of the small intestine, which varied in correlation with the time after feeding between pH 5.2 and 6.7 as determined by means of micro pH electrodes. Both cathepsins, TiCatD and TiCatD2, were purified from the lumen of the small intestine using pepstatin affinity chromatography and identified by nanoLC-ESI-MS/MS analysis as those encoded by the cDNAs. The proteolytic activity of the purified enzymes is highest at pH 3 and the respective genes are expressed in the both regions of the midgut, stomach (anterior midgut) and small intestine, not in the rectum, salivary glands, Malpighian tubules or haemocytes. The temporal expression pattern of both genes in the small intestine after feeding revealed a feeding dependent regulation for TiCatD but not for TiCatD2.

Assessment of three conventional automated external defibrillators in seafaring telemedicine

BACKGROUND

Germany was the first country worldwide to issue a directive regulating the provision of automated external defibrillators (AEDs) on board merchant ships.

AIMS

To test the applicability and suitability for telemedicine in seafaring, including long-term electrocardiogram (ECG) monitoring, of three currently available AEDs.

METHODS

Sixty nautical officers were asked to record and transmit a one-lead ECG with one of three AEDs under test. Subsequently, they evaluated the user-friendliness of the devices.

RESULTS

The number of steps required for ECG transmission (as a pdf file) varied from three to six between the various AEDs. Correspondingly, differences were found in the subjects' understanding of the AED software. After theoretical instruction in the use of the AEDs, 55 officers (92%) succeeded in telemedical transmission of the pdf file without any help. At the time of our investigation, long-term ECG monitoring was possible with only one of the AEDs.

CONCLUSIONS

The study results suggest that most trained lay rescuers can use conventional AEDs effectively for ECG transmission.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Characteristics of source-separated household wastewater flows: a statistical assessment

Knowledge of concentrations or loads in wastewater flows is a basic prerequisite for the design of wastewater treatment units and the assessment of the environmental impacts. With respect to new sanitation concepts that are based on the source-separation of domestic wastewater flows not much general data is available yet on characteristics or design values of the different flows. A desk study of more than 130 references was carried out in order to arrive at design values for different source-separated wastewater flows including the fractions urine, faeces and greywater. The evaluation was carried out focussing on European data. The different values were analysed by the use of statistical parameters. In order to arrive at design values for different parameters, the median as well as minimum-maximum ranges of the available data were calculated. The collected data include volumes and characteristics like organic pollution (COD and BOD), nutrients (N, P, K & S) and heavy metals for the different source-separated flows. Loads and concentrations are listed respectively. A comparison is drawn between data from different regions in order to assess the impact of differences in nutrition and habits.

Partonic Flow and phi-Meson production in Au+Au collisions at sqrt radical sNN = 200 GeV

We present first measurements of the phi-meson elliptic flow (v2(pT)) and high-statistics pT distributions for different centralities from radical sNN=200 GeV Au+Au collisions at RHIC. In minimum bias collisions the v2 of the phi meson is consistent with the trend observed for mesons. The ratio of the yields of the Omega to those of the phi as a function of transverse momentum is consistent with a model based on the recombination of thermal s quarks up to pT approximately 4 GeV/c, but disagrees at higher momenta. The nuclear modification factor (R CP) of phi follows the trend observed in the K S 0 mesons rather than in Lambda baryons, supporting baryon-meson scaling. These data are consistent with phi mesons in central Au+Au collisions being created via coalescence of thermalized s quarks and the formation of a hot and dense matter with partonic collectivity at RHIC.

Transverse momentum and centrality dependence of high-pT nonphotonic electron suppression in Au+Au collisions at sqrt[s NN]=200 GeV

The STAR collaboration at the BNL Relativistic Heavy-Ion Collider (RHIC) reports measurements of the inclusive yield of nonphotonic electrons, which arise dominantly from semileptonic decays of heavy flavor mesons, over a broad range of transverse momenta (1.2<p(T)<10 GeV/c) in p+p, d+Au, and Au+Au collisions at sqrt[s_{NN}]=200 GeV. The nonphotonic electron yield exhibits an unexpectedly large suppression in central Au+Au collisions at high p(T), suggesting substantial heavy-quark energy loss at RHIC. The centrality and p(T) dependences of the suppression provide constraints on theoretical models of suppression.

Scaling properties of hyperon production in Au+Au collisions at square root [sNN]=200 GeV

We present the scaling properties of Lambda, Xi, and Omega in midrapidity Au+Au collisions at the Brookhaven National Laboratory Relativistic Heavy Ion Collider at sqrt[s_{NN}]=200 GeV. The yield of multistrange baryons per participant nucleon increases from peripheral to central collisions more rapidly than that of Lambda, indicating an increase of the strange-quark density of the matter produced. The strange phase-space occupancy factor gamma_{s} approaches unity for the most central collisions. Moreover, the nuclear modification factors of p, Lambda, and Xi are consistent with each other for 2<p_{T}<5 GeV/c in agreement with a scenario of hadron formation from constituent quark degrees of freedom.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part II: cost comparison of different sanitation systems

The experience from the EU demonstration project was used for a cost analysis of different sanitation systems with regard to nutrient recycling. The analysis was made for an existing residential area, for which the different sanitation systems have been applied. The cost calculations were made for a lifetime of 50 years. The multiple sewer systems cause higher investment costs, mainly for the installation of the additional facilities; the investment costs for the treatment are lower. The cost analysis did not prove lower costs for the new sanitation concepts in this special case in comparison with the conventional system. Economic benefits are demonstrated for the operation costs. The result will be reinforced by the consideration of an increase of the energy costs. The revenues for the nutrient related products have only a very small impact on the result.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part I: results

The main aim of this EU demonstration project was to test two new sanitation concepts to determine if these concepts are more sustainable, compared with the conventional sanitation system, particularly with regard to nutrient recycling. Two different sanitation concepts were tested. One concept comprised the use of gravity separation toilets, the other used vacuum separation toilets. Results from a life-cycle-assessment investigation show that the new sanitation concepts are more sustainable. A cost analysis for an existing residential area did not prove lower costs for the new sanitation concepts in this special case. The experience from this demonstration project shows that prior to a widespread use of the new sanitation concepts, several improvements have to be made. One important issue is the improvement of separation toilets. Since nutrient recycling, water saving and reuse as well energy reduction become more and more important, further research should be undertaken in this field.

Longitudinal double-spin asymmetry and cross section for inclusive jet production in polarized proton collisions at square root of s = 200 GeV

We report a measurement of the longitudinal double-spin asymmetry A(LL) and the differential cross section for inclusive midrapidity jet production in polarized proton collisions at square root of s = 200 GeV. The cross section data cover transverse momenta 5 < pT < 50 GeV/c and agree with next-to-leading order perturbative QCD evaluations. The A(LL) data cover 5 < pT < 17 GeV/c and disfavor at 98% C.L. maximal positive gluon polarization in the polarized nucleon.

Direct observation of dijets in central Au+Au collisions at sqrt[sNN]=200 GeV

The STAR Collaboration at the Relativistic Heavy Ion Collider reports measurements of azimuthal correlations of high transverse momentum (pT) charged hadrons in Au+Au collisions at higher pT than reported previously. As (pT) is increased, a narrow, back-to-back peak emerges above the decreasing background, providing a clear dijet signal for all collision centralities studied. Using these correlations, we perform a systematic study of dijet production and suppression in nuclear collisions, providing new constraints on the mechanisms underlying partonic energy loss in dense matter.

Identified baryon and meson distributions at large transverse momenta from Au + Au collisions at square root sNN=200 GeV

Transverse momentum spectra of pi+/-, p, and p up to 12 GeV/c at midrapidity in centrality selected Au + Au collisions at square root sNN=200 GeV are presented. In central Au + Au collisions, both pi +/- and p(p) show significant suppression with respect to binary scaling at pT approximately >4 GeV/c. Protons and antiprotons are less suppressed than pi+/-, in the range 1.5 approximately < pT approximately < 6 GeV/c. The pi-/pi+ and p/p ratios show at most a weak pT dependence and no significant centrality dependence. The p/pi ratios in central Au + Au collisions approach the values in p + p and d + Au collisions at pT approximately >5 GeV/c. The results at high pT indicate that the partonic sources of pi+/-, p, and p have similar energy loss when traversing the nuclear medium.

Forward neutral pion production in p + p and d + Au collisions at square root sNN=200 GeV

Measurements of the production of forward pi0 mesons from p + p and d + Au collisions at square root sNN=200 GeV are reported. The p + p yield generally agrees with next-to-leading order perturbative QCD calculations. The d + Au yield per binary collision is suppressed as eta increases, decreasing to approximately 30% of the p + p yield at eta =4.00, well below shadowing expectations. Exploratory measurements of azimuthal correlations of the forward pi0 with charged hadrons at eta approximately 0 show a recoil peak in p + p that is suppressed in d + Au at low pion energy. These observations are qualitatively consistent with a saturation picture of the low-x gluon structure of heavy nuclei.

Strange baryon resonance production in sqrt s NN=200 GeV p+p and Au+Au collisions

We report the measurements of Sigma(1385) and Lambda(1520) production in p+p and Au+Au collisions at sqrt[s{NN}]=200 GeV from the STAR Collaboration. The yields and the p(T) spectra are presented and discussed in terms of chemical and thermal freeze-out conditions and compared to model predictions. Thermal and microscopic models do not adequately describe the yields of all the resonances produced in central Au+Au collisions. Our results indicate that there may be a time span between chemical and thermal freeze-out during which elastic hadronic interactions occur.

Distributions of charged hadrons associated with high transverse momentum particles in pp and Au+Au collisions at sqrt[sNN]=200 GeV

Charged hadrons in [EQUATION: SEE TEXT] associated with particles of [EQUATION: SEE TEXT] are reconstructed in pp and Au+Au collisions at sqrt[sNN]=200 GeV. The associated multiplicity and p magnitude sum are found to increase from pp to central Au+Au collisions. The associated p distributions, while similar in shape on the nearside, are significantly softened on the awayside in central Au+Au relative to pp and not much harder than that of inclusive hadrons. The results, consistent with jet quenching, suggest that the awayside fragments approach equilibration with the medium traversed.

Multistrange Baryon elliptic flow in Au+Au collisions at square root of sNN=200 GeV

We report on the first measurement of elliptic flow v2(pT) of multistrange baryons Xi- +Xi+ and Omega- + Omega+ in heavy-ion collisions. In minimum-bias Au+Au collisions at square root of s(NN)=200 GeV, a significant amount of elliptic flow, comparable to other nonstrange baryons, is observed for multistrange baryons which are expected to be particularly sensitive to the dynamics of the partonic stage of heavy-ion collisions. The pT dependence of v2 of the multistrange baryons confirms the number of constituent quark scaling previously observed for lighter hadrons. These results support the idea that a substantial fraction of the observed collective motion is developed at the early partonic stage in ultrarelativistic nuclear collisions at the Relativistic Heavy Ion Collider.

Multiplicity and pseudorapidity distributions of photons in Au+Au collisions at square root of (S(NN)) = 62.4 GeV

We present the first measurement of pseudorapidity distribution of photons in the region 2.3 < or = eta < or = 3.7 for different centralities in Au+Au collisions at square root of (S(NN)) = 62.4 GeV. We find that the photon yield scales with the number of participating nucleons at all collision centralities studied. The pseudorapidity distribution of photons, dominated by pi0 decays, has been compared to those of charged pions, photons, and inclusive charged particles from heavy-ion and nucleon-nucleon collisions at various energies. The photon production has been shown to be consistent with the energy and centrality independent limiting fragmentation scenario.

[Therapy of enchondroma in long bones]

The treatment of enchondroma in long tubular bones has been the subject of controversial discussions for several years. Whereas secondary malignancy is very rare when the enchondroma is located in a hand, a position near to the trunk represents a high risk of transformation into a chondrosarcoma. For an enchondroma in long tubular bones, authors recommend a whole variety of approaches ranging from regular controls to radical en bloc resection. Between 1989 and 2001 we followed a concept of intralesional resection and cement filling. After an interval without recurrences, the cement was extracted and replaced by a spongiosaplasty. Of 16 patients 12.5% suffered from an intralesional fracture in the course of the treatment, and 25% complained of persistent pain and loss of function after surgery. These complications led us to change our concept. Though there were two cases of secondary transformation into chondrosarcoma G1, we now prefer to keep the patients under close clinical and radiological control without performing surgery.

[Tumor-like bone lesions of the forearm after karate training]

INTRODUCTION

Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods.

METHODS

We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm.

RESULTS

A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique.

DISCUSSION

The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.