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Plant-pathogenic bacteria are one of the major constraints on agricultural yield. In order to selectively treat these bacteria, it is essential to understand the molecular structure of their cell membrane. Previous studies have focused on analyzing hydrolyzed fatty acids (FA) due to the complexity of bacterial membrane lipids. These studies have highlighted the occurrence of branched-chain fatty acids (BCFA) alongside normal-chain fatty acids (NCFA) in many bacteria. As several FA are bound in the intact phospholipids of the bacterial membrane, the presence of isomeric FA complicates lipid analysis. Furthermore, commercially available reference standards do not fully cover potential lipid isomers. To address this issue, we have developed a reversed-phase high-performance liquid chromatography (RP-HPLC) method with tandem mass spectrometry (MS/MS) to analyze the phospholipids of various plant-pathogenic bacteria with a focus on BCFA containing phospholipids. The study revealed the separation of three isomeric phosphatidylethanolamines (PE) depending on the number of bound BCFA to NCFA. The validation of the retention order was based on available reference standards in combination with the analysis of hydrolyzed fatty acids through gas chromatography with mass spectrometry (GC/MS) after fractionation. Additionally, the transferability of the retention order to other major lipid classes, such as phosphatidylglycerols (PG) and cardiolipins (CL), was thoroughly examined. Using the information regarding the retention behavior, the phospholipid profile of six plant-pathogenic bacteria was structurally elucidated. Furthermore, the developed LC-MS/MS method was used to classify the plant-pathogenic bacteria based on the number of bound BCFA in the phospholipidome., (© 2024. The Author(s).)

Background:  Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable coronary artery disease who underwent CABG., Methods:  In our retrospective study, CABG patients were divided in: CABG preceded by PCI: PCI-first (PCF), and CABG-only (CO) groups. The PCF group was further divided in guideline-conform (GCO) and guideline nonconform (GNC) subgroups, according to the SYNTAX score (2014 European Society of Cardiology [ESC]/European Association for Cardio-Thoracic Surgery [EACTS] guidelines). Thirty days mortality, major adverse cardiac events, and QoL using the European Quality-of-Life-5 Dimensions were evaluated., Results:  A total of 997 patients were analyzed, of which 784 underwent CABG without (CO), and 213 individuals with prior PCI (PCF). The latter group consisted of 67 patients being treated in accordance (GCO), and 24 in discordance (GNC) to the 2014 ESC/EACTS guidelines. Reinfarction (PCF: 3.8% vs. CO: 1.0%; p  = 0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p  = 0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p  < 0.001) were observed more frequently in PCF patients. Also, patients reported better health status in the CO compared to PCF group (CO: 72.48 ± 19.31 vs. PCF: 68.20 ± 17.86; p  = 0.01). Patients from the guideline nonconform subgroup reported poorer health status compared to the guideline-conform group (GNC: 64.23 ± 14.56 vs. GCO: 73.42 ± 17.66; p  = 0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p  = 0.03). Also, GNC patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p  < 0.001) and showed higher preinterventional SYNTAX score (GCO: 18.63 ± 9.81 vs. GNC: 26.67 ± 5.07; p  < 0.001)., Conclusion:  PCI preceding CABG is associated with poorer outcomes such as reinfarction, re-angiography, and re-PCI, but also worse health status and higher rehospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart Team decision., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The marine metabolite diazonamide A exerts low nanomolar cytotoxicity against a range of tumor cell lines; however, its highly complex molecular architecture undermines the therapeutic potential of the natural product. We demonstrate that truncation of heteroaromatic macrocycle in natural diazonamide A, combined with the replacement of the challenging-to-synthesize tetracyclic hemiaminal subunit by oxindole moiety leads to considerably less complex analogues with improved drug-like properties and nanomolar antiproliferative potency. The structurally simplified macrocycles are accessible in 12 steps from readily available indolin-2-one and tert- leucine with excellent diastereoselectivity (99:1 dr) in the key macrocyclization step. The most potent macrocycle acts as a tubulin assembly inhibitor and exerts similar effects on A2058 cell cycle progression and induction of apoptosis as does marketed microtubule-targeting agent vinorelbine.

Introduction: Self-harming behavior in prisoners is a prevalent phenomenon, with international studies estimating a 4% prevalence rate. However, studies on self-injurious behavior in the German prison system are currently lacking. Therefore, our study aims to conduct an initial assessment., Methods: The Criminological Service for the Berlin Prison System distributed questionnaires on incidents of self-harm to all Berlin prisons, except for juvenile detention centers. The questionnaires were supplemented with medical data, such as psychiatric diagnoses and medication., Results: 62 questionnaires were returned, which could be attributed to 52 inmates. Compared to the average population in the Berlin prison system, the study sample exhibited variations in age, gender distribution and nationality. 94% of the inmates received a psychiatric diagnosis. Two-thirds of the male inmates had substance use disorders, while 83% of the female inmates had emotionally unstable personality resp. borderline disorders. Prior to self-harm, 87% of the inmates were administered psychiatric medication., Discussion: Our study found similarities between the study population and international studies in the distribution of certain characteristics. We assume that many of the postulated risk factors can also apply to Berlin prisoners. However, the study is limited by the small number of cases and the absence of a control group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest., (Copyright © 2024 Blees, Jakobowitz, Hofer, Konrad, Krebs and Opitz-Welke.)

Background: Prevalence of substance use disorders, especially opioid use disorders, is high in patients admitted into forensic psychiatric settings. Opioid agonist treatment is a safe, well-established, and effective treatment option for patients that suffer from opioid dependence. Surprisingly, data on the availability and practice of opioid agonist treatment (OAT) options in German Forensic Clinics for Dependency Diseases is rare. Furthermore, essential data on the prevalence of critical incidents such as violent behavior, relapse, or escape from the clinic are missing for this particular treatment setting., Materials and Methods: We conducted an observational study on all forensic addiction treatment units in Germany (Sect. 64 of the German Criminal Code). A questionnaire on the availability and practice of OAT was sent to all Forensic Clinics for Dependency Diseases in Germany. Following items were assessed: availability and the total number of patients that received an OAT in 2018, available medication options, specific reasons for start and end of OAT, number of treatments terminated without success, number of successful treatments, and critical incidents such as violent behavior, relapse, escape and reoffending. We compared the forensic clinics that offered OAT with those that did not offer this treatment option. The data were analyzed descriptively. Mean and standard deviation was calculated for metric scaled variables. For categorical variables, absolute and relative frequencies were calculated. The two groups (OAT vs. Non-OAT institutions) were compared concerning the given variables by either using Fishers exact test (categorical variables), t -test (normally distributed metric variables), or Wilcoxon-test (metric variables not normally distributed)., Results: In total, 15 of 46 Forensic Clinics for Dependency Diseases participated in the study (33%). In total, 2,483 patients were treated in the participating clinics, 18% were relocated into prison due to treatment termination, and 15% were discharged successfully in 2018. 275 critical incidents were reported: violence against a patient (4%), violence against staff (1.6%), escape (4.7%) and reoffending in (0.5%). In seven clinics treating 1,153 patients, an OAT was available. OAT options in forensic clinics were buprenorphine/naloxone, buprenorphine, methadone, and levomethadone. Regarding critical incidents and successful discharge, no differences were detected in the clinics with or without an OAT. In the clinics that offered an OAT, we found a significantly higher rate of treatment termination without success ( p < 0.007) in comparison to clinics without an OAT program. Ninety-nine patients received an OAT, and this treatment was ended due to illegal drug abuse (57%), refusal to give a urine drug sample (71%), and cases where the OAT was given away to other patients (85%)., Conclusion: In Forensic Clinics for Dependency Diseases in Germany, OAT is not available in every institution, and thus, access is limited. Critical incidents such as violent behavior against staff or patients and escape are not uncommon in these forensic treatment settings. Further studies are needed to enhance the understanding of OAT practice and the risks for patients and staff., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Reiners, Opitz-Welke, Konrad and Voulgaris.)

Forensic mental health experts play a crucial role in criminal responsibility evaluations. However, the quality of these assessments has at time come under scrutiny and has been heavily criticized. A literature review revealed significant differences between countries concerning legal frameworks and procedures for conducting these assessments. The findings suggest that although some countries can be seen as a "role model", there still is room for improvement., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

In order to investigate the ability of bis(zinc octaethylporphyrin) ( bis-ZnOEP ) to discriminate cyclohexanohemicucurbit[n]urils ( cycHC[ n ] ) of different shapes and sizes, the self-assembly of barrel-shaped chiral cycHC[ n ] with bis-ZnOEP was studied by various spectroscopic methods (absorption, fluorescence, circular dichroism (CD), and NMR). While the binding of 6-membered cycHC[6] induced a tweezer-like conformation followed by the formation of anti- form of bis-ZnOEP upon further addition of cycHC[6] , the interaction of 8-membered cycHC[8] is more complex and proceeds through the featured syn -to- anti conformational change of bis-ZnOEP and further intermolecular self-assembly via multiple noncovalent associations between cycHC[8] and bis-ZnOEP . Whilst bis-porphyrins are known to be effective chemical sensors able to differentiate various guests based on their chirality via induced CD, their ability to sense small differences in the shape and size of relatively large macrocycles, such as chiral cycHC[6] and cycHC[8] , is scarcely examined. Both studied complexes exhibited characteristic induced CD signals in the region of porphyrin absorption upon complexation.

Prisoners have a high risk of dying by suicide and the highest suicide rates are recorded among prisoners on remand. A death by suicide is the most common single cause of death in German correctional institutions. This narrative overview first describes the prison population and its general healthcare needs by paying particular attention to psychiatric and substance use disorders. The main section attends to the prevalence, causes, and risk factors of prison suicide. Suicide prevention measures are presented.As in all parts of the world, the proportion of young men among prisoners in Germany is very high (94% in 2020). Most prisoners are young or middle-aged. The average annual suicide rates among men (105.8/100,000) and women (54.7/100,000) in German prisons are similar to those of most countries in the European Union (full census 2000-2011). Suicide rates among male German prisoners declined continuously from 2000-2013, regardless of age. In contrast, they increased among female prisoners; the reasons for this are not known. Evidence suggests that psychiatric disorders have not been identified.Important suicide prevention measures include shared accommodation and avoidance of solitary confinement, for example by offering work. In addition, validated German-language screening instruments are available to detect suicide risk at an early stage. For effective prison suicide prevention, identifying high-risk individuals, offering appropriate suicide prevention interventions, and developing team-based interventions among prison staff are required., (© 2021. The Author(s).)

Background: Coercive medical measures always represent an encroachment on the patient's basic right to physical integrity and right to self-determination. If a patient is imprisoned, his basic rights are already severely restricted, and the coercive measure must also take place in a correctional facility. This amounts to a special challenge for everyone involved-but especially for the psychiatrist in charge., Objectives and Methods: This article is aimed at describing the psychiatric care of people with mental disorders in prisons, explaining the legal requirements for compulsory medication and giving recommendations for suitable conditions., Results and Conclusions: In Germany, there is no legally regulated health-care solution for people with mental disorders in custody in accordance with the laws on the mentally ill of the German federal states (Psychisch-Kranken-Gesetze). Therefore, in the case of serious mental disorders, imprisoned patients cannot be regularly provided with inpatient psychiatric care. As a result, compulsory medication within the correctional system must be considered if the course of the mental disorder is unfavorable. Compulsory medication in the German prison system has a special position compared with compulsory medication in psychiatric clinics, as doctors in most federal states can prescribe such medication without judicial involvement. The state legislators should check whether a legal adjustment would be necessary or helpful here. As the circumstances (legal and care-related) for imprisoned patients differ greatly from those of patients in clinics, the general conditions for compulsory medication should be carefully considered. We recommend consulting ethical case counseling if the decision is made without judicial involvement, and moving imprisoned patients to a psychiatric or at least to a medical ward before the administration of compulsory medication.

Background: Revascularization strategy in coronary artery bypass grafting (CABG) surgery usually depends on coronary dimension and stenosis severity. Little is known about the relation of preoperative evaluation of scarcely or invisibly chronic occluded coronary arteries (chronic total occlusion [CTO]) and revascularization rate or anastomosis quality. We aimed to evaluate the success rates of CTO revascularization in CABG surgery and determine the influence of coronary lumen visibility and collateralization in preoperative angiograms on revascularization rates, bypass blood flow, and target vessel diameter., Method: Preoperative coronary angiograms were evaluated for 938 consecutive patients who underwent isolated CABG surgery between 2014 and 2016 and screened for occluded coronary arteries. The occluded vessels were scored for visibility using the Rentrop grading of collateral filling. Intraoperatively, dimensions of the occluded arteries were measured using conventional vessel probes, and anastomosis quality was assessed by transit time flow measurement., Results: A total of 404 (43.1%) patients were identified with at least one CTO. Revascularization rates differed from 96.2% in the left anterior descending artery, to 85.0% in left circumflex artery-dependent vessels, and 78.8% in right coronary artery territory. Coronary visibility and grade of collateralization in the preoperative angiogram had no influence on intraoperatively measured coronary diameter. Bypass blood flow in grafts revascularizing CTOs lacking collateralization were not significantly lower than those grafts leading to CTOs with higher Rentrop scores., Conclusion: Preoperative coronary assessment often differs from intraoperative findings. Our study confirms that even patients with scarcely collateralized CTOs and impaired visibility in the coronary angiogram have a high chance of complete revascularization during CABG surgery., Competing Interests: None declared., (Thieme. All rights reserved.)

Surveys confirm risk factors for the incarceration of patients with psychosis including homelessness and comorbidity. There is also agreement that severe psychosis can lead to violence. Data describing prisoners with psychosis in Germany are scarce. We aimed to compare patients with psychosis in a prison hospital and patients with psychosis in a community hospital. Demographic data were collected, as well as comorbidity in the form of substance dependence and a psychiatric assessment using the German version of the 18-item Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). In the prison hospital group more patients were homeless (17 versus 2%) and non-German (36 versus 4%). There were also more patients with substance dependence or abuse in the prison hospital group. The total scores of BPRS and PANSS were lower in the prison hospital group (BPRS, 43.8 versus 51.2; PANSS, 71.5 versus 83.7). We assume that social disintegration for mentally disturbed offenders prior to incarceration hindered effective treatment. To avoid further social disintegration and possible further deterioration of mental health status of released offenders, which may lead to reoffending after imprisonment, discharge management after release from prison should be improved., (© 2020 John Wiley & Sons, Ltd.)

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, "FoVOx," and Mental Illness and Violence Tool, "OxMIV") were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)-for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80-0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry., (© 2020 John Wiley & Sons, Ltd.)

Background: Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT., Materials and Methods: We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention., Results: Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%., Conclusions: The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates., (Copyright © 2020 von Bernuth, Seidel, Krebs, Lehmann, Neumann, Konrad and Opitz-Welke.)

Chiral cyclohexanohemicucurbit[n]urils (n = 6, 8) (cycHCs) are able to bind guests through multiple "outer surface interactions", which in the case of planar zinc porphyrins leads to induction of chirality. Crystal structures of complexes of complementary sized hosts revealed social self-sorting, while in the solution phase one cycHC can accommodate up to three porphyrin molecules with log Ktotal 9.

A unified step-economical strategy for accessing histone deacetylase inhibitory peptides is proposed, based on the late-stage installation of multiple zinc-binding functionalities via the cleavage of the strained cyclopropane ring in the common pluripotent cyclopropanol precursor. The efficacy of the proposed diversity-oriented approach has been validated by short stereoselective synthesis of natural product chlamydocin, containing a challenging-to-install fragment of (2 S ,9 S )-2-amino-8-oxo-9,10-epoxydecanoic acid (Aoe) and a range of its analogues, derivatives of 2-amino-8-oxodecanoic and 2-aminosuberic acids.

The Federal Constitutional Court has emphasized the necessity of psychotherapy for offenders. Little is known about the actual situation of this field of work. Thus, an online survey was initiated.The survey was conducted through an online portal. The heads of forensic psychiatric facilities have been asked to participate by completing a questionnaire.The elicitation provided data from 27 institutions. A large part of patients receive psychotherapeutic treatment. Psychotherapy is predominantly shaped by psychologists. The majority of institutions apply approaches derived from behavioral therapy. To a large extent, manualized and modular procedures are being used; most of them in group settings. One problem stems from personnel deficiencies, leading to psychotherapy not taking place on a regular basis or not being performed in accordance to the guidelines of treatment programs.The prior allegation - impositions of forensic measures being characterized by custodial detention - is no longer valid for a high number of forensic psychiatric services., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment.

In the present study, we examined the effects of implementing the suicide risk screening instrument SIRAS in a pre-trial detention facility for men in Berlin. Within a period of 3 months, all newly arriving prisoners were screened ( n = 611) by social workers or prison officers. Cases of elevated suicide risk were immediately referred to a psychologist or medical staff the same day. Follow-up over a 6-month period showed that 14% of all incoming prisoners were classified as high-risk individuals. These individuals received significantly more psychological and psychiatric treatment and were significantly more likely to be accommodated in crisis intervention rooms and emergency community accommodation (shared prison cells). In addition, it was found that despite the increased amount of treatment in the high-risk group, the number of specific measures did not increase significantly compared to the pre-implementation phase ( N = 1,510).

Background: Infectious diseases, substance dependencies, and dental diseases are the most important health problems affecting incarcerated persons. In Germany, for example, prisoners are 48 to 69 times more likely to be infected with the hepatitis C virus (HCV) than the general population, and 7 to 12 times more likely to be infected with the human immunodeficiency virus (HIV). The prevalence of mental illnesses is also markedly higher in the incarcerated than in the general population., Methods: This review is based on pertinent publications retrieved by a selective search in two databases (PubMed and Google Scholar) for any of the terms "health care," "primary health care," "mental health care"; "infectious disease," "opioid maintenance treatment," and "severe mental disorder" in conjunction with "prison," "jail," "detention," and "incarceration.", Results: Among prisoners in German prisons, approximately 20% consume heroin, 20-50% suffer from alcohol dependency and abuse, and 70-85% smoke. The prevalence of tuberculosis in German prisons in 2002 was 0.1%. The provision of needles to incarcerated persons has a preventive effect on infection with hepatitis C, hepatitis B, and HIV, yet programs of this type have been discontinued in most penal facilities. In a systematic review, psychotic disorders were found in 3.6% (95% confidence interval [CI]: [3.1; 4.2]) of male inmates and 3.9% [95% CI: 2.7; 5.0] of female inmates. 25% of incarcerated persons suffer from attention-deficit-hyperac- tivity disorder. Persons recently released from prison have an above average mortality, largely due to drug intoxication., Conclusion: An analysis of medical prescribing data reveals deficiencies in the provision of HCV treatment to all affected persons and in the provision of substitution treatment to persons with opiate dependency. In view of the known risks associated with imprisonment, greater emphasis should be placed on the provision of treatment for infectious diseases, substance dependencies, and mental illness, both in prison and in outpatient care after release.

Background: There is limited international as well as national research on suicide events in prisons and in forensic psychiatric hospitals. This retrospective study compares completed suicide events within these two high-risk populations in state institutions over a time period of 5 years from 2000 to 2004. Material and Methods: Data was collected through a nationwide survey: all forensic psychiatric hospitals within Germany were contacted via postal mail and received a questionnaire concerning the suicide events from 2000 to 2004. All federal lands of Germany were similarly assessed by a survey endorsed by the respective federal ministries of justice. All prison institutions (100%) participated in the survey, while 84% (53 units) of the forensic psychiatric hospitals nationwide contributed. A comparative statistical analysis was conducted using Fisher's exact test or the Mann-Whitney U-test (age). A multivariate logistic regression analysis was done to assess adjusted effects. For the Kaplan-Meier analysis, the months until suicide were analyzed followed by a Cox-regression analysis. Results: There was no statistically significant difference between the mean suicide rate in forensic psychiatric hospitals (123/100.000, 95% confidence interval: [0.00103, 0.00147]) and in the prison system (130/100.000, 95% confidence interval: [0.00109, 0.00154]). Patients who committed suicide in the forensic hospitals were, in comparison to the prison system, more likely to have committed a violent offense and have had a prior history of suicide attempts. The duration from admission into the institution to the suicide event was significantly shorter in the prison group. Also, younger people commited suicide earlier during their stay in a forensic psychiatric hospital or prison. Conclusions: While the results suggest a necessity to optimize data collection in the prison system (prior suicide events and history of mental disorder), it is important to discuss the current discharge arrangements within the forensic hospitals.

Tertiary cyclopropanols easily available from carboxylic esters have been used in the synthesis of distally fluorinated ketones. Cyclopropane ring cleavage reactions in methanol with aqueous tert-butyl hydroperoxide in the presence of a copper(ii) acetate catalyst and sodium triflinate (Langlois reagent) afford β-trifluoromethyl ketones in 16-74% isolated yields. Sodium triflinate serves as a precursor of reactive trifluoromethyl copper species, enabling ring-opening trifluoromethylation, as evidenced by mechanistic studies. We also demonstrate here that other sulfinate salts, such as sodium 1,1-difluoroethanesulfinate, sodium 2-(4-bromophenyl)-1,1-difluoroethanesulfinate and sodium 1-(trifluoromethyl)cyclopropanesulfinate, can be used as fluoroalkylation reagents, resulting in the corresponding fluorinated ketones.

Specific risk factors for suicide among female prisoners were examined using an exhaustive sample of all suicides in German prisons between 2000 and 2013. The rate of prison suicide was lower among female (53,5/100,000) than among male prisoners (101/100,000). Differences between the genders regarding the various risk factors for prison suicide are few. Significant differences were observed only for bullying among men and higher percentages of drug withdrawal syndrome among women. Factors specific to the prison setting that contribute to suicide risk in incarcerated women should be examined., (Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Purpose of Review: The concept of paraphilia still carries an 'unwanted burden' of sexual norms because the pathologization of some sexual practices as paraphilic disorders is still based on the assumption that normal sexuality should be genitally organized with the aim of reproduction. The aim of this review is to give an impression of the ongoing discussion about the changes introduced with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the results of recent research in this area., Recent Findings: The release of DSM-5 in the spring of 2013 introduced a distinction between paraphilias and paraphilic disorders, implying a destigmatization of consenting adults engaging in unusual sexual behaviour. According to DSM-5 diagnostic criteria, paedophilic disorder is the only paraphilic disorder without an 'in remission' and an 'in a controlled environment' specifier. Today, antiandrogen treatment is offered to sex offenders in many countries as an additional treatment strategy alongside psychotherapy., Summary: The introduction of DSM-5 offers the possibility to distinguish between paraphilia and paraphilic disorders. The aetiology of paraphilias is still unknown. Paraphilias are much more common in men than in women, but the reasons for this difference remain unknown. So far there is no clear consent on the best therapeutic approach for a paraphilic disorder.

Introduction: Several studies have pointed to high rates of substance use disorders among female prisoners. The present study aimed to assess comorbidities of substance use disorders with other mental disorders in female prisoners at admission to a penal justice system., Methods: A sample of 150 female prisoners, consecutively admitted to the penal justice system of Berlin, Germany, was interviewed using the Mini-International Neuropsychiatric Interview (MINI). The presence of borderline personality disorder was assessed using the Structured Clinical Interview II for DSM-IV. Prevalence rates and comorbidities were calculated as percentage values and 95% confidence intervals (CIs)., Results: Ninety-three prisoners (62%; 95% CI: 54-70) had substance use disorders; n=49 (33%; 95% CI: 24-42) had alcohol abuse/dependence; n=76 (51%; 95% CI: 43-59) had illicit drug abuse/dependence; and n=53 (35%; 95% CI: 28-44) had opiate use disorders. In the group of inmates with substance use disorders, 84 (90%) had at least one other mental disorder; n=63 (68%) had comorbid affective disorders; n=45 (49%) had borderline or antisocial personality disorders; and n=41 (44%) had comorbid anxiety disorders., Conclusions: Female prisoners with addiction have high rates of comorbid mental disorders at admission to the penal justice system, ranging from affective to personality and anxiety disorders. Generic and robust interventions that can address different comorbid mental health problems in a flexible manner may be required to tackle widespread addiction and improve mental health of female prisoners., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

In recent years, the number of occupied beds in German forensic-psychiatric hospitals has continued to rise. Diversion refers to the removal of offenders from the criminal justice system at any stage of the procedure and court proceedings. There are no specific diversion programs in Germany but diversion does in fact happen via legal regulations that are based on the construct of legal responsibility. The assessments of responsibility as well as risk are the core tasks of forensic-psychiatric expert witnessing in Germany. Recommendations of an interdisciplinary working group serve as a guide to operationalize this forensic-psychiatric task. These recommendations list formal minimum requirements for expert reports on the question of criminal responsibility and risk assessment as well as minimum standards regarding content and in writing the report., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

In many countries, suicide is the most frequent cause of prison deaths; moreover, the respective national penal suicide rates are consistently several times higher than the suicide rates in the general population. To assess the situation in German prisons, an assessment of all suicides in German prisons by means of a survey was carried out for the time from 2000 to 2011. The mean rate per year of prison suicides in Germany from 2000 to 2011 was 105.8 per 100,000 male inmates and 54.7 per 100,000 female inmates. Male prisoner suicide rates significantly declined during the period under investigation; no significant trend was evident for female prisoners in pre-trial detention but a noteworthy increase was apparent in the suicide rate of female sentenced prisoners. A significant positive relationship can be demonstrated between occupation density and the suicide rate for both men and women. These results should be taken as a challenge for further research on the reasons for the unexpected increase of suicide rate in female sentenced prisoners and as well on the effect of population density on prison suicide rate., (Copyright © 2013. Published by Elsevier Ltd.)

Purpose of Review: Prison psychiatry is a secluded area of the psychiatric care system, which in fact often provides treatment for those who do not have access to community-based healthcare systems. The aim of this review is to give an impression of the special challenges of psychiatric work behind bars and to emphasize current trends in prison psychiatry., Recent Findings: In prisoners, mental disorders are more common than in the general population. There is evidence that prison suicide rates do not reflect general population suicide rates, suggesting that variation in prison suicide rates possibly also reflects differences in the provision of psychiatric care. Good transitional preparation preceding release seems to be necessary to reduce the risk of poor health outcome, but is hard to achieve. Up to now, there is no clear decision on whether it is useful or possible to treat adult prisoners with attention-deficit/hyperactivity disorder with stimulants., Summary: Prison psychiatry has to deal with a disproportionate burden of psychiatric disease in prisoners. Adequate psychiatric treatment options may reduce suicide behind bars. Further research should focus on the special needs of individuals who are out of reach of the conventional community-based health system.

In early 2008 the penal system of Lower Saxony established a specialised department responsible for risk assessment regarding all prison inmates in that state. The department generates approximately 200 risk assessment expert reports per year, mainly on questions such as the inmates' aptitude for social therapy, relaxation of imprisonment conditions, and transfer to an open prison. Prof. Dr. Konrad and Dr. Heering (from the Charité's Institute for Forensic Psychiatry) have been accompanying the work of this department scientifically for at least 2 years by offering a scientific exchange and by reviewing random samples of the risk assessments and verifying the application of current standards. It is of particular interest to examine which methods are used and which topics are discussed with the inmates during the exploration for risk assessment expert reports, whether or not standardised risk scales are applied, and finally which conclusions are drawn from the results of the exploration and the information which could be gathered from court and prison files., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Mentally disordered prisoners in Germany are subject to special legal regulations, which can be traced back to the 1933 "Dangerous Habitual Offenders and their Detention and Rehabilitation Act". There are no special diversion programs in Germany but diversion does in fact happen via legal regulations that are based on the construct of legal responsibility. Diversion refers to the removal of offenders from the criminal justice system at any stage of the procedure and court proceedings. In recent years the number of occupied beds in forensic psychiatric hospitals has continued to rise. At the same time the number of people in prisons has slightly decreased while there has been a slight increase in the number of available beds in general psychiatry. Germany experienced public and media concern about the risk posed by conditionally released mentally ill offenders and other perceived inadequacies in the criminal justice system. Therefore the way in which prisoners or forensic patients are supervised after they have been discharged was reformed in 2007 in order to assure a more efficient control of their conduct after their release from custody by means of mandatory treatment and monitoring. Special outpatient clinics were to assist discharged patients in complying with the conditions of probation and parole. However organisational structures for these specialised outpatient institutions vary within Germany because of its federal administration. This results in regional differences in conditions of treatment and probably in differences in quality as well, but surveys about the effects, efficacy or effectiveness of forensic outpatient treatment in Germany are scarce., (Copyright 2010 Elsevier Ltd. All rights reserved.)

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of "serious" vs. "non-serious" and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of "low seriousness" (i.e. low lethality and low suicidal intent) and of "high seriousness". Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.

The amendment of the law limiting the professional secrecy of physicians and psychologists toward the prison authorities has triggered a discussion on the consequences involved for treatment practice in the prison system. To reduce the lack of empirically based arguments in this discussion, our study deals with the question of whether and to what extent psychotherapy in conjunction with prison health care offers also contributions to preventing recidivism. A quasi-experimental control group study showed that especially for serious violent offenses delinquents of the Tegel detention center who underwent at least 20 hours of therapy at the psychotherapeutic consultation and treatment service had a markedly lower recidivism rate a mean of four years after release from prison than an untreated group. If changes in the penal code jeopardize a regular therapeutic setting with professional secrecy, they carry the risk of excluding prisoners primarily requiring psychotherapy who have thus far apparently also derived benefit especially from prevention-oriented therapy.

Objective: The study was intended to provide information on the frequency and general condition of inpatient and outpatient treatment of mentally disturbed prisoners in general psychiatry in Germany., Methods: Directors of psychiatric institutions and chief physicians of prisons in Nordrhein-Westfalen and Rheinland-Pfalz were interviewed via a standardized questionnaire., Results: The use of inpatient psychiatric treatment was approximately 0.1 to 2.3% in 1997 with reference to the total admissions in 1997., Conclusion: The rare use of psychiatric beds in general psychiatry may reflect obstacles concerning the status of prisoners and reservations regarding difficult patients.

To the extent to which comparisons have been undertaken with the general population, a greatly raised prevalence of psychiatric illness amongst prisoners has been found across countries and across diagnostic groups. Thus, one would expect a greater level of need for treatment in the penal system. In accordance with the conditions of modern psychiatric care, cooperation between impatient, part-impatient and outpatient services in the sense of integration should be guaranteed.

Connections between transsexualism and delinquency have been considered in only a few publications to date. The authors report on a forensic psychiatric case with a transsexual development after committing an offence based on sexual deviations. Transsexualism in this context seems to represent an attempt for the symbolic solution of a conflict of identity. This should be interpreted in the context of psychotherapy and not be misunderstood as a symptom proving the diagnosis of manifest transsexualism by orientation on pure phenomenological criteria.

In the light of many years' experience in hemodialysis access surgery, the different methods of creating vascular access for dialysis treatment in the pediatric population are described. After presenting the various access types using autologous blood vessels and also heterologous grafts, their specific spectrum of complications is discussed in detail. Summarizing our experience it has to be emphasized that there is no specific angioaccess for children and adolescents, and that most vascular access procedures used in adults are also suitable for use in the young.

The psychiatric-psychological judging neurotic disorders is presented under following aspects: the diagnostical guidelines considering international classification systems and the definition of disease given by the jurisdiction. In order to judge the degree of severity of a neurotic disorder with regard to professional fitness this paper proposes Raschs structural social conception of disease.

External respiratory function was examined in 27 patients aged 5 to 17 years suffering from alveolitis. Of these, 10 children were diagnosed to have idiopathic fibrosing alveolitis and 17 exogenous allergic alveolitis. The functional examination included investigation of the static pulmonary volumes by helium dilution method, spirography, body plethysmography, measurements of lung elasticity, diffusion capacity of the lungs and blood gases. It has been established that in alveolitis, restrictive ventilatory disorders prevail, whereas in acute and subacute exogenous allergic alveolitis, obstructive disorders may occur. In all the patients examined, lung diffusion capacity was found to be reduced.

Patients in forensic psychiatry and their relatives are both doubly stigmatized by the labels psychiatric disturbance and delinquency. In an expert-guided group for relatives of forensic patients at Karl-Bonhoeffer-Psychiatric Hospital Berlin choice of topic and frequency of attendance indicated enormous guilty feelings. Defense against these guilty feelings could only be kept up by great effort. Support of relatives in forensic psychiatry seems advisable also for the rehabilitation of the patients themselves and prevention of relapse.