Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Anti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications. Case presentation: We report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange. Conclusions: Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.

七○年代以來，政策執行的研究愈來愈趨興盛，學者們或從行動的觀點論述，或從組 織的面向探討，但鮮有從中央與地方政府間關係（Intergover-nmental Relations） 的角度研究。事實上，政策方案的研行，或多或少都涉及政府間的合作、溝通、與協 調。大如環保政策的推動，小至違章建築的拆除，莫不經由中央規劃與地方執行的過 程。因此，本文的目的，旨在建之一政府間政策執行的概念架構，並透過台北市取締 違章工廠的個案，為觀察與解釋的對象，期望能為我國未來中央與地方共同執行政策 所遭遇的困境，提出一條可行的解決途徑。 全文共五章，約六萬餘言。 第一章：緒論；首先界定相關名詞，再述及所欲探討的問題，並檢討研究現狀，以及 研究所採用的方法，最後分析研究架構。 第二章：政策資源與目標：分析執行所需資源的分配情形，以及政策目標是否明確， 目標要求改變的程度如何？ 第三章：中央的政策系絡因素：探討中央政府如何透過溝通與地方政府協調，並且提 供何種誘因，促使地方政府執行。對於地方政府執行的監督，如何有效的達成。 第四章：地方的政策系絡因素：主要探討地方執行人員的心理意向，標的團體的態度 ，地方執行機構的特性，以及地方的經濟、社會條件。 第五章：結論：分析研究結果，歸納出結論，並進而提供建議，俾供參考。

Hur skapar man en framtid för en patient som befinner sig i en mycket utsatt situation, medvetslös och uppkopplad till maskiner? Detta är något som iscensätts när anestesiläkare talar med varandra om patienter vid rapporteringen till och från jouren på en intensivvårdsavdelning. Avhandlingen visar hur anestesiläkarna arbetar med att skapa bilder av patienten genom numeriska värden, social information och sin egen kunskap om och erfarenhet av hur andra patienter utvecklats. I överrapporteringssamtalen framkommer anestesiläkarnas arbete med patienters vård och framtid. Dessa samtal analyseras i avhandlingen som rutinmässiga, arbetsinriktade samtal som iscensätter relationer till patienten, till vården, till anestiläkarnas kollegor och till den egna professionella identiteten. Samtalen karaktäriseras av en professionell riktadhet, där patienten handskas med som en representation, ett kunskapsobjekt och ett behandlingsprojekt. Avhandlingen bygger på fältarbete bland anestesiläkare vid ett större sjukhus samt på analys av sjutton bandinspelade överrapporteringssamtal. Studien är tvärvetenskaplig, med inspiration från medicinsk sociologi, kommunikationsstudier och teknik och vetenskapsstudier. I studiens första empiriska del analyseras samtalens inramning som en kommunikativ verksamhet, dess karaktär och relationer till anestesiläkarnas övriga arbete. I den andra delen fokuseras hur läkarna talar om patienterna och vården. Centrala begrepp för att förstå läkarnas samtal kring de svårt sjuka patienternas diagnoser och framtida utveckling är ’mobiliseringsvärde’ och’ livsapparat’. / How does one create a future for severely ill patients, who are in a vulnerable condition, unconscious and connected to machines? This is a situation that is staged when anaesthetists talk to each other about patients when one work shift ends and a new one goes on duty in an intensive care unit. The thesis shows how the anaesthetists create images of the patient by means of numerical values, social information and their own knowledge and experience of other patients and their development. In the study, the talk is analysed as characterized by a professional orientation, where the patient is dealt with as a representation, an object of knowledge, and a project for care. The study is based on field work among anaesthetists in a major hospital and on an analysis of seventeen hand-over talks. It is interdisciplinary, with inspiration from medical sociology, communication studies, and social studies of technology. The first empirical part of the thesis discusses the framing of the talk as a communicative activity, its character and its relationship to the anaesthetists’ work outside of the meeting room. The second empirical part focuses on how anaesthetists construct the patient and their tasks in the talk. Excerpts from different talks are used to analyse how the doctors interpret different aspects of the patients’ past situation and care, present medical status, and possible future developments. Key concepts used are ‘mobilising worth’ and ‘life device’.

This diploma thesis The issue of inclusion in practice at a selected secondary vocational school and primary school in the district of Mělník deals issues of inclusion in elementary, lower secondary and vocational education of a student with specific educational needs. It allows zooming in the issue of the inclusion in practise especially from the point of the key pedagogical staff being involved in education of an included student. For a presentation of the development of her education a case study has been set. Defining a role of a teacher's assistant during the process of education. Comparing the running of inclusion of a student during lower secondary with vocational education. Issues of a student during practical training at the work place. Methods of a structured interview with key pedagogical staff were used in this theses with afterwards summary and interpretation of the results. The aim of this thesis is to conduct a survey of the issue of inclusion in practise, define same features and differences in the approach and in possibilities of an inclusion. At the end of thesis there are some questions and proposals for reflection on the matter from the side of the participating pedagogical staff asked. KEYWORDS A teacher's assistant, process of education, inclusion, practical training,...

Background: The shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction. - Case presentation: We present the case of a 16-year-old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain. - Conclusion: The pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.

Hadron Therapy (HT) exploits properties of ion radiation to gain therapeutic advantages over existing photon-based forms of external radiation therapy. However, its relative superiority and cost-effectiveness have not been proven for all clinical situations. Establishing a robust evidence base for the development of best treatment practices is one of the major challenges for the field. This thesis investigates two research infrastructures for building this essential evidence. First, the thesis develops main components of a metadata-driven software architecture for the collection of clinical information and its analysis. This architecture acknowledges the diversity in the domain and supports data interoperability by sharing information models. Their compliance to common metamodels guarantees that primary data and analysis results can be interpreted outside of the immediate production context. This is a fundamental necessity for all aspects of the evidence creation process. A metamodel of data capture forms is developed with unique properties to support data collection and documentation in this architecture. The architecture's potential to support complex analysis processes is demonstrated with the help of a novel metamodel for Markov model based simulations, as used for the synthesis of evidence in health-economic assessments. The application of both metamodels is illustrated on the example of HT. Since the biological effect of particle radiation is a major source of uncertainty in HT, in its second part, this thesis undertakes first investigations towards a new research facility for bio-medical experiments with ion beams. It examines the feasibility of upgrading LEIR, an existing accelerator at the European Organisation for Nuclear Research (CERN), with a new slow extraction and investigates transport of the extracted beam to future experiments. Possible configurations for the slow-resonant extraction process are identified, and designs for horizontal and vertical beam transport lines developed. The results of these studies indicate future research directions towards a new ion beam facility for biomedical research.