In einer prospektiven, randomisierten, doppelblinden, Placebo-kontrollierten Cross-over-Studie wurden hämodynamische und immunologische Effekte einer dreitägigen adjunktiven Therapie mit niedrig dosiertem Hydrocortison (HC) (100 mg Bolus + 10 mg/Stunde) bei 40 Patienten im septischen Schock untersucht. Die Therapie mit HC führte zum Anstieg des mittleren arteriellen Drucks und des systemischen Gefäßwiderstands sowie zur Reduktion des Herzzeitvolumens und der Herzfrequenz, die pulmonalvaskulären Widerstände blieben unverändert. Die Nitrit/Nitrat-Plasmaspiegel (Stickstoffmonoxid-Synthese) und der Katecholaminverbrauch nahmen ab. Die Immunreaktionen waren komplex: Abnahme proinflammatorischer (Interleukin-(IL)-6, 8) und antiinflammatorischer (IL-10, lösliche Tumor-Nekrosefaktor-Rezeptoren) Mediatoren, Anstieg proinflammatorischer Zytokine (IL-12 und Interferon-?), Reduktion der Endothel- (E-Selektin) und Granulozytenaktivierung (CD11b, CD64), Reduktion der T-Helfer- und Suppressorzellzahl und der eosinophilen und basophilen Granulozyen, die Monozytenzahl stieg an und die neutrophilen Granulozyten sowie die Gesamtleukozytenzahl blieben unverändert. Parameter der unspezifischen (Respiratory Burst, Phagozytose) und der spezifischen Immunreaktion (HLA-DR auf Monozyten, Antigenpräsentation) wurden nicht oder nicht wesentlich supprimiert, die Phagozytosefähigkeit von Monozyten nahm zu. Eine Beendigung der HC-Therapie führte zu ausgeprägten hämodynamischen und immunologischen Rebound-Phänomenen. Die Wirkung von niedrig dosiertem HC im septischen Schock kann daher als kreislaufstabilisierend und immunmodulatorisch charakterisiert werden, Zeichen einer ausgeprägten Immunsuppression fanden sich nicht. / In a prospective, double-blind, randomised, placebo-controlled cross-over study, hemodynamic and immune effects of a three-day adjunctive treatment with low doses of hydrocortisone (HC) (100 mg bolus followed by 10 mg per hour) were investigated in forty patients with septic shock. HC-therapy induced a rise of mean arterial pressure and systemic vascular resistance and a decline of cardiac index and heart rate without altering pulmonary vascular resistance. Both, nitrite/nitrate levels (nitric oxide formation) and cathecholamine requirement were reduced. Immune responses were complex and included: reduction of proinflammatory (interleukin-(IL)-6, 8) and antiinflammatory (IL-10, soluble tumor necrosis factor receptors) mediators, an increase of proinflammatory cytokines (IL-12 and interferon-?), a reduction of endothelial (E-selectin) and granulocyte activation (CD11b, CD64), and a decrease of T-helper and suppressor cells as well as eosinophil and basophil granulocytes; monocytes increased and total granulocyte and leukocyte counts remained unaltered. Parameters of innate (respiratory burst, phagocytosis) and adaptive immune responses (HLA-DR-expression on monocytes, antigen presentation) were not essentially affected, monocyte phagocytosis rather increased. HC-withdrawal induced marked hemodynamic and immunologic rebound effects. In conclusion, effects of low dose HC-therapy in septic shock is characterised by hemodynamic stabilisation and immunomodulation, without inducing severe immunosuppression.

Der septische Schock geht bis heute mit einer hohen Mortalität einher und stellt für die Intensivmedizin ein schwer beherrschbares Krankheitsbild dar. Er ist die häufigste Todesursache auf nicht kardiologischen Intensivstationen und es wird davon ausgegangen, dass der Anteil septischer Patienten relativ wie absolut zunehmen wird. Das Ziel der vorliegenden Arbeit war, den Einfluss von Hydrokortison auf die Schockdauer und die Wirkung von Hydrokortison in Abhängigkeit der Nebennierenrindenfunktion sowie den Einfluss auf die Morbidität, gemessen am SOFA-Score zu untersuchen. Es wurden 41 Patienten mit frühem septischem Schock in eine doppelblinde, placebokontrollierte, randomisierte Studie eingeschlossen. Zur Beurteilung der Nebennierenfunktion wurde vor Beginn der Studie ein ACTH-Test durchgeführt und je nach Anstieg wurden die Patienten in „Non-Responder“ und „Responder“ unterteilt. Es zeigte sich, dass Hydrokortison zu einer signifikanten Verkürzung der Schockdauer führte. Die Frage nach dem unterschiedlichen Effekt von Hydrokortison bei „Respondern“ und „Non-Respondern“ konnte nicht abschließend geklärt werden; es zeigte sich bei den „Respondern“ und „Non-Respondern“, die Hydrokortison erhalten hatten, ein Trend zu einer kürzeren Schockdauer, der aber keine statistische Signifikanz erreichte, vermutlich weil die Gruppengröße durch die Aufteilung zu klein wurde. Die vorliegenden Ergebnisse sind insofern mit anderen Studien kongruent, bedürfen aber noch der weiteren Abklärung in Studien mit größeren Patientenkollektiven. Der SOFA-Score war unter Hydrokortison in den ersten 48 Stunden signifikant reduziert. In anderen Studien war dies mit einer geringeren Mortalität assoziiert. Die Behandlung mit Hydrokortison reduziert also die Schockdauer und stellt eine wichtige Therapierationale zur Vorbeugung des sepsis-induzierten Organversagens dar. / Up to the present day septic shock is often accompanied with high mortality. For the medical intensive care field it is a hardly controllable disease pattern. Septic shock is the most frequent cause of death at non-cardiological intensive care units. It is believed that the number of septic patients will increase relatively as well as absolutely. The aim of this paper was to examine the influence of hydrocortisone on shock duration, the effect of hydrocortisone dependent on the adrenal function and the influence on morbidity, measured with SOFA score. 41 patients with early septic shock participated in a double-blind, placebo-controlled, randomised study. In the beginning of the study an ACTH-test was conducted in order to assess the adrenal function. Dependent on the increase of ACTH, the patients were classified into "non-responder" and "responder". It became apparent that hydrocortisone leads to a significant reduction of shock duration. The question about the different effect of hydrocortisone on “responder“ and “non-responder“ could not cleared up conclusively. “Responder“ and „non-responder“ who received hydrocortisone showed a trend towards shorter shock duration. There was, however, no statistic significance, probably because the groups became too small because of the division. The present results are insofar congruent with other studies, but they need further clarification through studies with bigger patient groups. For those using hydrocortisone the SOFA score was significantly reduced during the first 48 hours. In other studies this fact was associated with less mortality. The treatment with hydrocortisone therefore reduces the shock duration and is an important therapy rationale for the prevention of septic induced multi-organ failure.

The lecture room instructional management competence of novice nurse educators (NNEs) in the Republic of South Africa (RSA) was investigated. No comprehensive set of generic roles, outcomes and competences for instructional management of nurse educators could be traced in the literature, therefore an analytical study was undertaken. Adhering to the principles for outcomes-based education, three models were established: Q a model for the professional development of nurse educators Q an Education, Training and Development nurse practitioner model, consisting of roles and outcomes for lecture room instructional management Q a model for lecture room instructional management that served as evaluation criteria used in the instrument during the quantitative survey These models were presented to, and evaluated by nurse educators of five universities. The influence of mentorship, reality shock, and professional development on the NNEs' lecture room competence was investigated. The target group consisted of NNEs, their mentors and students in nursing schools in the RSA. A number of respondents were also interviewed and observed. The analysed data indicated that NNEs were not competent when they started teaching, and needed support and supervision from mentors. Findings also indicated the positive influence of mentorship and professional development on competence acquisition. NNEs experienced reality shock requiring support to acquire competence. These aspects justify further research. The recommendations based on this study include that nursing schools use specific evaluation criteria for le<,1ure room competence and for in-service training of NNEs and mentors. Nursing schools should take a more active role in mentoring programmes. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

This article investigates the interrelations between the initial members of the Euro area and five important Central and Eastern European economies. We set up a theoretical open economy model to derive the Purchasing Power Parity, the Interest Rate Parity, the Fisher Inflation Parity, and an output gap relation. After taking convergence into account, they are used as restrictions on the cointegration space of a structural vector error correction model. We then employ generalized impulse response analysis to assess the dynamic effects of shocks in output and interest rates on the respective other area as well as the implications of shocks in the exchange rate and in relative prices on both areas. The results show a high degree of interconnectedness between the two economies. There are strong positive spillovers in output to the respective other region with the magnitude of the impact being similarly strong in both areas. Furthermore, we find a multiplier effect being present in Eastern Europe and some evidence for the European Central Banks' desire towards price stability. (author's abstract) / Series: Department of Economics Working Paper Series

Univ., Diss. u.d.T.: Harttgen, Kenneth: Four essays on the empirical analysis of determinants, distribution and dynamics of poverty--Göttingen, 2007. / Parallelt.: Four essays on the empirical analysis of determinants, distribution and dynamics of poverty.

Calif., Univ., Diss.--Berkeley, 2004. / Kopie, ersch. im Verl. UMI, Ann Arbor, Mich. - Enth. 3 Beitr.

Calif., Univ. of California, Diss.--Berkeley, 2002. / Kopie, ersch. im Verl. UMI, Ann Arbor, Mich. - Enth. 3 Beitr.

The lecture room instructional management competence of novice nurse educators (NNEs) in the Republic of South Africa (RSA) was investigated. No comprehensive set of generic roles, outcomes and competences for instructional management of nurse educators could be traced in the literature, therefore an analytical study was undertaken. Adhering to the principles for outcomes-based education, three models were established: Q a model for the professional development of nurse educators Q an Education, Training and Development nurse practitioner model, consisting of roles and outcomes for lecture room instructional management Q a model for lecture room instructional management that served as evaluation criteria used in the instrument during the quantitative survey These models were presented to, and evaluated by nurse educators of five universities. The influence of mentorship, reality shock, and professional development on the NNEs' lecture room competence was investigated. The target group consisted of NNEs, their mentors and students in nursing schools in the RSA. A number of respondents were also interviewed and observed. The analysed data indicated that NNEs were not competent when they started teaching, and needed support and supervision from mentors. Findings also indicated the positive influence of mentorship and professional development on competence acquisition. NNEs experienced reality shock requiring support to acquire competence. These aspects justify further research. The recommendations based on this study include that nursing schools use specific evaluation criteria for le<,1ure room competence and for in-service training of NNEs and mentors. Nursing schools should take a more active role in mentoring programmes. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

This paper considers the linkages between output growth and output volatility for the sample of G7 countries over the period 1958M2-2011M7, thereby paying particular attention to spillovers within and between countries. Using the VAR-based spillover index approach by Diebold and Yilmaz (2012), we identify several empirical regularities: i) output growth and volatility are highly intertwined, with spillovers taking place into all four directions; ii) the importance of spillovers has increased after the mid 1980s and reached unprecedented levels during the recent financial and economic crisis; iii) the US has been the largest transmitter of output and volatility shocks to other countries. Generalized impulse response analyses point to moderate growth-growth spillovers and sizable volatility-volatility spillovers across countries, suggesting that volatility shocks quintuplicate in the long run. The cross-variable effects turn out negative: volatilty shocks lead to lower economic growth, growth shocks tend to reduce output volatility. Our findings underline the increased vulnerability of the G7 countries to destabilizing shocks and their detrimental effects on economic growth, which are sizeably amplified through international spillover effects and the associated repercussions. / Series: Department of Economics Working Paper Series

Background: The current goal of treatment after acute ischemic stroke is the increase of cerebral blood flow (CBF) in ischemic brain tissue. Intra-aortic balloon pump (IABP) counterpulsation in the setting of cardiogenic shock is able to reduce left ventricular afterload and increase coronary blood flow. The effects of an IABP on CBF have not been sufficiently examined. We hypothesize that the use of an IABP especially enhances cerebral blood flow in patients with pre-existing heart failure. Methods: In this pilot study, 36 subjects were examined to investigate the effect of an IABP on middle cerebral artery (MCA) transcranial Doppler (TCD) flow velocity change and relative CBF augmentation by determining velocity time integral changes (ΔVTI) in a constant caliber of the MCA compared to a baseline measurement without an IABP. Subjects were divided into two groups according to their left ventricular ejection fraction (LVEF): Group 1 LVEF >30% and Group 2 LVEF ≤30%. Results: Both groups showed an increase in CBF using an IABP. Patients with a LVEF ≤30% showed a significantly higher increase of ΔVTI in the MCA under IABP augmentation compared to patients with a LVEF >30% (20.9% ± 3.9% Group 2 vs.10.5% ± 2.2% Group 1, p<0,05). The mean arterial pressure (MAP) increased only marginally in both groups under IABP augmentation. Conclusions: IABP improves cerebral blood flow, particularly in patients with pre-existing heart failure and highly impaired LVEF. Hence, an IABP might be a treatment option to improve cerebral perfusion in selected patients with cerebral misperfusion and simultaneously existing severe heart failure.