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Die zunehmende Ausrichtung der Medizin an okonomischen Denkmustern birgt die Gefahr in sich, dass die Medizin sich allein an dem Kriterium der Profitabilitat orientiert und nach Gesichtspunkten bewertet wird, die nicht dem entsprechen, wofur Arzte angetreten sind und was kranke Menschen sich zu Recht von der Medizin erhoffen. Je mehr die Okonomie zur Steuerungsinstanz der Prioritaten in der Medizin mutiert, desto mehr verliert die Medizin ihren sozialen Charakter. Die Medizin zieht sich dann zuruck auf eine formalistische Korrektheit und bietet nur die Verfahren an, die auch rentabel sind. Die Patienten werden dann nicht mehr als leidende Menschen wahrgenommen, fur die man sich personlich zu engagieren und Verantwortung zu ubernehmen hat, sondern sie werden zu Konsumenten umdefiniert, die dazu da sind, dass man sich ihre Krankheit zunutze macht, um gute Zahlen zu generieren. Eine solche sukzessive Umwertung der Medizin kann allerdings nicht im Interesse der kranken Menschen und somit auch nicht im Interesse der Arzte sein. Daher wird fur eine Forderung genuin medizinischer Werte pladiert.

The aim of this study was to compare estradiol benzoate (EB) and GnRH for the induction of ovulation in a TAI protocol in buffalo during the nonbreeding season. In experiment 1, 141 buffaloes (56 cows and 85 heifers) received an intravaginal P4 device (1.0 g) plus EB (2.0-mg, intramuscular [im]) at random stage of the estrous cycle (Day 0). On Day 9, the P4 device was removed, and buffaloes were given PGF2α (0.53-mg im sodium cloprostenol) plus eCG (400-IU im). Buffaloes were then randomly allocated to one of three groups and treated as follows: EB24 (n = 47), EB (1.0 mg im) 24 hours after P4 device removal; EB36 (n = 50), EB 36 hours after P4 device removal; GnRH48 (n = 44), GnRH (10 μg im buserelin acetate) 48 hours after P4 device removal. Ultrasound examinations were performed on Day 0 to ascertain ovarian follicular status, Day 9 to measure follicular diameter, and from Day 11 to Day 14 (every 12 hours for 60 hours) to establish the time of ovulation. There were no significant differences between EB24, EB36, and GnRH48 for diameter of the ovulatory follicle (13.1 ± 0.3, 13.7 ± 0.3, and 13.7 ± 0.3 mm; P = 0.26) and ovulation rate (78.7%, 82.0%, and 84.1%; P = 0.93). When compared with heifers, cows had a greater diameter of the dominant follicle on Day 9 (10.3 ± 0.3 and 8.6 ± 0.2 mm; P = 0.0001), diameter of the ovulatory follicle (14.1 ± 0.3 and 13.1 ± 0.2 mm; P = 0.01), ovulation rate (91.1% and 75.3%; P = 0.02), and interval from P4 device removal to ovulation (76.3 ± 1.3 and 72.5 ± 1.4 hours; P = 0.05). In experiment 2, 511 buffaloes (354 cows and 157 heifers) were assigned to the same treatments described in experiment 1 (EB24, n = 168; EB36, n = 172; and GnRH48, n = 171), and all animals were submitted to timed artificial insemination (TAI) 64 hours after P4 device removal. Pregnancy diagnosis was undertaken 30 days after TAI. There were no significant differences between EB24, EB36, and GnRH48 for pregnancy rate (45.2%, 43.0%, and 49.7%; P = 0.46), and the pregnancy rate did not differ (P = 0.31) for cows (47.5%) and heifers (42.7%). The findings from the two experiments indicated that EB (24 or 36 hours) and GnRH (48 hours) induce comparable follicular responses, ovulation, and pregnancy rates in buffalo cows and heifers. Although there were some differences in the follicular responses between cows and heifers, the pregnancy rate to TAI was nonetheless similar.

The main objective of this study was to evaluate the effect of intramuscular (I.M.) administration of different doses of kisspeptin (Kp) on the pattern of luteinizing hormone (LH) release in Bos taurus and Bos indicus prepubertal heifers. Holstein heifers weighing 215.1 ± 38.6 kg (n = 24; aged 5-8 mo) and Gyr heifers weighing 215.4 ± 31.4 kg (n = 24; aged 6-10 mo) were enrolled in this study. The animals were confirmed as non-cyclical by absence of a corpus luteum (CL) as determined by ultrasound scanning of the ovaries and low circulating P4 concentrations (1.0 ng/mL) evaluated at a 10-day interval (on day -10 and day 0). For each genetic group, heifers were randomly assigned to one of four treatments: Kp at 2.5 μg/kg body weight (Kp2.5), Kp at 5.0 μg/kg (Kp5), Kp at 10 μg/kg (Kp10), or gonadotropin-releasing hormone (GnRH) agonist (0.01 mg of buserelin acetate per heifer), all administered by I.M. injection. All animals responded to the treatments with an LH surge (P 0.01). There was an effect of breed (P 0.01) on induced LH release, with Holstein heifers having a greater area under the curve for LH (AUC; P 0.01) and greater LH peak amplitude (P 0.01) than Gyr heifers. Nevertheless, greater AUC for LH occurred in Kp10 heifers for both breeds. There was no effect of breed on LH AUC or LH peak amplitude after GnRH agonist treatment. For both breeds, heifers treated with Kp displayed an earlier (P 0.01) LH peak with a reduced amplitude of the LH peak (P 0.01) and reduced LH AUC (P 0.01) compared to heifers treated with GnRH agonist. Thus, both zebu and taurus immature heifers treated with I.M. Kp injection responded with a rapid and dose-dependent LH surge, although even large doses of the native Kp-10 did not mimic the magnitude or duration of the LH surge produced by the GnRH agonist. The early onset of the LH surge after Kp treatment and the short duration suggest that the effects of Kp were likely due to pituitary rather than hypothalamic action. Finally, there seems to be a greater responsiveness to Kp in Bos taurus than in Bos indicus prepubertal heifers, although LH release after GnRH agonist treatment was similar for the two breeds.

We aimed to evaluate the effects and the interaction of size of the preovulatory follicle (POF) and long-acting progesterone (P4) supplementation after timed-AI on CL function and pregnancy success in beef cows. In experiment 1, ovulations of beef cows were synchronized starting on Day -10, and cows were split to receive sodium cloprostenol (large follicle group; LF; n = 31) or nothing (small follicle group; SF; n = 35). Ovulations were induced on Day 0, and cows were inseminated. Ovulated cows were assigned to receive placebo (LF/control group, n = 14; and SF/control group, n = 9) or 150 mg of long-acting P4 on Day 4.5 (LF/P4 group, n = 13; and SF/P4 group, n = 12). Diameter of POF, blood flow in POF wall, ovulation rate, and size and vascularization of CL were greater (P 0.05) in LF group. In experiments 2 (unknown cyclic status) and 4 (noncycling), ovulations were synchronized, and beef cows received placebo or 150 mg of long-acting P4 on Day 4 after timed-artificial insemination. In experiment 2, pregnancy/AI (P/AI) did not differ (P 0.1) between P4-treated (53.2%; 209/393) and control cows (56.2%; 219/390), but P/AI was greater in cows with a CL 0.9 cm(2) on Day 4 that were P4-treated (57.9%, 22/38) versus placebo-treated (40.4%, 21/52; P 0.05). In Experiment 4, P/AI was greater (P 0.05) in P4-treated cows (55.6%, 105/189 vs. 46.0%, 86/187). In Experiment 3, cyclic-suckled beef cows were treated as described in Experiment 1 to generate animals with small (SF; n = 111) or large POF (LF; n = 109), and subdivided to receive placebo or P4 on Day 4. POF size, ovulation rate, CL area, and P/AI were greater (P 0.007) in the LF group. Pregnancy/AI in ovulated cows were lower (P = 0.05) in the SF/control group (41.5%, 17/41) compared to LF/control group (62%, 31/50) and were similar for the SF/P4 group (55.6%, 25/45) and LF/P4 group (57%, 28/49) compared to others. In summary, smaller and less vascularized POF results in less functional CL and reduces ovulatory rate and P/AI in cyclic beef cows; the long-acting P4 injection on Day 4 after timed-artificial insemination may attenuate the negative effects of small POF/CL; and postovulatory P4 supplementation improved fertility in anestrous beef cattle.

Made available in DSpace on 2018-11-26T17:42:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 LFEM Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) In cattle, early diestrus progesterone (P4) supplementation modulates endometrial function to exert pro and anti-pregnancy establishment effects; specifically, P4 stimulates conceptus growth, but also induces early onset of luteolysis. This paradoxical effect is frequently related to the inconsistent fertility outcomes that result from P4 supplementation experiments. Aim was to investigate the impact of exogenous estradiol (E2) treatment at the end of timed fixed AI (TAI) on frequency of early luteolysis and pregnancy of beef cows supplemented with P4. Ovulations (DO of study) of suckled multiparous (n = 643) and primiparous (n = 193) Nelore cows (Bos indices) were synchronized with an E2/P4-based protocol for TAI and assigned to receive 1.0 mg of estradiol cypionate (CP) or nothing (NoCP) on D-2 and 150 mg of injectable long-acting P4 (iP4) or Placebo (NoiP4) on D4 on a 2 x 2 factorial arrangement. On D15, the iP4 supplementation increased (P < 0.05) the frequency of early luteolysis (NoCP + iP4: 26.0%; [13/50] vs. NoCP: 8.0% [4/50]), but CP prevented this effect (CP + iP4: 8.3% [4/48] and CP: 6.4% [3/471). The CP improved pregnancy/AI (P/AI) of multiparous (CP: 51.6% [165/320] and NoCP: 35.0% [113/323]; P < 0.001) and primiparous cows (CP: 40.4% [40/99] and NoCP: 24.5% [23/94], P < 0.05), regardless of iP4 treatment. The iP4 supplementation affected P/AI of CP and NoCP treated cows according to follicle size at TAI. For the CP treated cows, the iP4 supplementation improved P/AI of sub-populations of cows with follicles = 12.35 mm (46.1% [35/76] vs. 58.7% [37/63]). In conclusion, strategies associating E2 and P4 supplementation decrease the incidence of early onset of luteolysis and improve P/AI of suckled beef cows with smaller follicles. (C) 2017 Elsevier Inc. All rights reserved. Univ Sao Paulo, Sch Vet Med & Anim Sci, Dept Anim Reprod, Pirassununga, SP, Brazil Univ Camilo Castelo Branco, Sch Vet Med, Dept Anim Reprod, Descalvado, SP, Brazil Ouro Fino Saude Anim, Ribeirao Preto, SP, Brazil Sao Paulo State Univ Julio de Mesquita Filho, Sch Vet Med Aracatuba, Dept Support Prod & Anim Hlth, Aracatuba, SP, Brazil Sao Paulo State Univ Julio de Mesquita Filho, Sch Vet Med Aracatuba, Dept Support Prod & Anim Hlth, Aracatuba, SP, Brazil LFEM: 225 FAPESP: 2011/03226-4 FAPESP: 2015/26215-9 CAPES: 33002010047P6

Summary Data of 31496 specimens of cavedano chub Squalius squalus were collected in 89 different waterbodies distributed geographically throughout Italy and used to provide length–weight and length–length relationship for this species. The linear relationship between total length (TL) and standard length (SL) was described by the equation TL (cm) = 4.007 + 0.874 SL (cm). The resulting total length–weight equation for cavedano chub in Italy was: log10 W = −2.121 + 3.083 log10 TL (cm).

Total length (L(T)) (range 24-1000 mm; mean ±S.E. = 170.21 ± 0.36 mm) and mass (W) (range 0.10-9590 g; mean ±S.E. = 76.03 ± 0.87 g) of 36,460 specimens of marble trout Salmo marmoratus were used to compute a standard mass (W(s)) equation for this species by means of the empirical percentile (EmP) method. The EmP W(s) equation calculated was: log(10) W(s) = -5.208 + 3.202 log(10) L(T) - 0.046 (log(10) L(T))(2) (L(T) range 90-570 mm) and it is valid throughout the species' area of distribution across Europe.

Made available in DSpace on 2013-09-27T14:54:13Z (GMT). No. of bitstreams: 1 WOS000306538100005.pdf: 677147 bytes, checksum: 85b60cc0df260829547c4b04d26d5950 (MD5) Previous issue date: 2012-08-01 Made available in DSpace on 2013-09-30T18:25:16Z (GMT). No. of bitstreams: 1 WOS000306538100005.pdf: 677147 bytes, checksum: 85b60cc0df260829547c4b04d26d5950 (MD5) Previous issue date: 2012-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:42:37Z No. of bitstreams: 1 WOS000306538100005.pdf: 677147 bytes, checksum: 85b60cc0df260829547c4b04d26d5950 (MD5) Made available in DSpace on 2014-05-20T13:42:37Z (GMT). No. of bitstreams: 1 WOS000306538100005.pdf: 677147 bytes, checksum: 85b60cc0df260829547c4b04d26d5950 (MD5) Previous issue date: 2012-08-01 Ourofino Agronegocio (Cravinhos, SP, Brazil) RG Genetica Avancada (Agua Boa, MS, Brazil) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) The effects of estradiol benzoate (EB) and estradiol cypionate (EC) on induction of ovulation after a synchronized LH surge and on fertility of Bos indicus females submitted to timed AI (TAI) were evaluated. In Experiment 1, ovariectomized Nelore heifers were used to evaluate the effect of EB (n = 5) and EC (n = 5) on the circulating LH profile. The LH surge timing (19.6 and 50.5 h; P = 0.001), magnitude (20.5 and 9.4 ng/mL; P = 0.005), duration (8.6 and 16.5 h; P = 0.001), and area under the LH curve (158.6 and 339.4 ng/mL; P = 0.01) differed between the EB and EC treatments, respectively. In Experiment 2 (follicular responses; n = 60) and 3 (pregnancy per AI; P/AI; n = 953) suckled Bos indicus beef cows submitted to an estradiol/progesterone-based synchronization protocol were assigned to receive one of two treatments to induce synchronized ovulation: 1 mg of EB im 24 h after progesterone (P4) device removal or 1 mg of EC im at P4 device removal. There was no difference (P > 0.05) between EB and EC treatments on follicular responses (maximum diameter of the ovulatory follicle, 13.1 vs. 13.9 mm; interval from progesterone device removal to ovulation, 70.2 vs. 68.5 h; and ovulation rate, 77.8 vs. 82.8%, respectively). In addition, P/AI was similar (P < 0.22) between the cows treated with EB (57.5%; 277/482) and EC (61.8%; 291/471). In conclusion, despite pharmacologic differences, both esters of estradiol administered either at P4 device removal (EC) or 24 h later (EB) were effective in inducing an LH surge which resulted in synchronized ovulations and similar P/AI in suckled Bos indicus beef cows submitted to TAI. (C) 2012 Elsevier B.V. All rights reserved. Univ São Paulo, FMVZ, Dept Anim Reprod, BR-09500900 São Paulo, Brazil APTA Vale Paraiba Reg Ctr, Pindamonhangaba, SP, Brazil Ouro Fino Saúde Anim, Ribeirao Preto, SP, Brazil UNESP, Dept Support Anim Prod & Hlth, Aracatuba, SP, Brazil Universidade Federal de Lavras (UFLA), Dept Anim Sci, Lavras, MG, Brazil UFPB, Ctr Vet Sci, Areia, PB, Brazil UNESP, Dept Support Anim Prod & Hlth, Aracatuba, SP, Brazil

The paper discusses the question whether it could be ethically appropriate to "resolve" the problem of scarce resources in health care via priority lists. It is argued that such a schematical priority list could only be undisputed in ethical respects if it represented a broad consensus on the question what a good life would be. Priority lists are always implicit decisions about specific concepts of the good life. Using a priority list only in consideration of a mere cost-benefit ratio means to accept a mere utilitarian way of defining good life. Such a definition goes with neglect of the interests of people with chronic diseases, of patients with incurable diseases, of patients with a limited life expectancy. To neglect the interests of these patients means to abandon the core of medical identity, because medicine has the mission to help those above all who are most in need and those who cannot help themselves. And so we have to realize that for medicine there are some values which are more important than economic considerations. The physician is a person who gives a promise, the promise to be there for the patient. If the physician now is becoming a businessman, this promise is no longer valid. The businessman doesn't give any other promise than not to act against the contract. But the main need of the patient, his longing for a human person whom he can trust, cannot become part of a contract. Especially in our time medicine has to fight for the core of its identity.

Modern medicine has left its central purpose to heal patients and has developed into a mere instrumental discipline which sees its central aim as fulfilling wishes instead of relieving suffering or treating illness. Aesthetic surgery is one of the many examples of such a transformation of modern medicine. This paper starts from the concept of medicine as a promise to help people who are suffering and who are in need of help. This aim of helping defines medicine. When it abandons this aim and merely fulfills wishes, medicine becomes a mere enterprise. Such a transformation is not illegal, but it will lose the notion of medicine as a moral institution based on trust. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Acting ethically means above all acting in the interest of the patient. One must therefore ask whether offering aesthetic interventions is really acting in the interest of the patient. Many arguments are presented to show that the interest of the patient and the moral integrity of medicine are in danger if medicine makes wish-fulfilling and aesthetics into one of its main tasks.

This paper takes a critical look at pay for performance (P4P) as a model for introducing new incentives in psychiatry. This model is to be seen as a tool of commercialism, and such a restructuring of psychiatry represents a wide-reaching political maneuver which actively introduces economical parameters into the field and will have a great impact on psychiatry. P4P starts with the false premise that medicine has to be structured like industry. This premise is false because psychiatry has to do with relationships to patients, and not with the production of a product. Therefore, it is essential to reflect critically upon the premises and consequences of P4P for psychiatry. Only this critical reflection can help psychiatry to keep its identity as a humane service for suffering people.

Four experiments were designed to evaluate the effect of different circulating progesterone (P4) concentrations during a synchronization of ovulation protocol for the timed artificial insemination (TAI) of Bos indicus (Nelore) beef cattle. In the first trial, 13 ovariectomized Nelore heifers were randomly allocated into one of three groups using new P4 devices (New; 1.0 g P4), previously used P4 devices for 8 days (Used1x), and previously used P4 devices for 16 days (Used2x), in a crossover experimental design. The circulating P4 concentrations during the P4 device treatment were lower for Used1x (2.3 ± 0.1 ng/mL) and Used2x (2.0 ± 0.1 ng/mL) than those for New (3.8 ± 0.2 ng/mL; P = 0.001). In the second trial, the ovarian follicular dynamics of 60 anestrous cows were evaluated after the cows received the treatments described previously (New [n = 20], Used1x [n = 20], and Used2x [n = 20]). During the insertion of the P4 device, the cows were administered 2.0-mg estradiol benzoate. Eight days later, the P4 device was removed, and the cows were administered 0.53-mg sodium cloprostenol, 300 IU eCG, and 1-mg estradiol cypionate. There were no differences among the groups during the interval from P4 device removal to ovulation (73.7 ± 2.9 vs. 69.8 ± 2.4 vs. 68.4 ± 2.3 hours) or regarding the ovulation rate (70.0% vs. 80.0% vs. 85.0%). However, the maximum diameter of the largest follicle was greater (P = 0.06) in the Used2x (15.3 ± 0.4 mm) than that of New (13.5 ± 0.8 mm) and Used1x (14.9 ± 0.5 mm). In experiment 3, 443 anestrous cows were randomly assigned into one of the three treatments (New [n = 144] vs. Used1x [n = 167] vs. Used2x [n = 132]) and received a TAI 48 hours after the P4 device removal. The diameter of the largest follicle during the device removal (10.7 ± 0.3 vs. 11.2 ± 0.2 vs. 11.3 ± 0.3 mm) and the 30-day pregnancy rates (51.4% vs. 53.9% vs. 43.2%) did not differ among the experimental groups. In experiment 4, a field trial with 593 B indicus (Nelore) cows was conducted to evaluate the pregnancy per AI using different levels of P4 in a TAI protocol (New [n = 189] vs. Used1x [n = 203] vs. Used2x [n = 201]). The pregnancy per AI was similar between the treatment groups (63.5% vs. 57.6% vs. 62.7%). In conclusion, the low circulating P4 concentrations that were released from a used P4 device efficiently controlled the ovarian follicular growth and exhibited no detrimental effects on the pregnancy rates of the B indicus (Nelore) beef cattle.

In the search for a globally binding ethical minimal consensus in dealing with research on human beings the awareness of the cultural specificity of such questions will be of central importance. France provides a good example of such cultural specificities. Three basic structures of French discussion on research ethics can be enumerated: first the particular weight placed on therapeutic benefit, second a particular accentuation on freedom and voluntarism, and third its lesser attention to the aspect of ability to give consent. The weak emphasis on the ability to give consent is rooted as much in the traditionally paternalistically imbued physician-patient relationship as in the French legal system, in which the doctrine of consent is not given the fundamental position of importance found in the Anglo-Saxon countries. As an important Roman country, a different accentuation in the ethical discussion on research on humans can be recognised, a discussion in which for a long time the right of self determination was less of a criterion for decision than the teleology of medical action. It is precisely this aspect of latent cultural influence in ethical convictions which is of decisive importance for future discussion on research on humans.

The fact of "being mortal" and mortality are of an existential meaning for every human being. The knowledge of death and the imagination of a finiteness of life have a crucial impact on the whole life. Today it has become a common approach to plan death, to organize and to regulate it. We tend to reduce death to a duty of management. With this rationalization of death we try to get within distance of it. Active euthanasia and assisted suicide seem to be the adequate answers to this approach but is death really well understood if we only try to handle it this way? Is autonomy really the only relevant principle to respect the concerns of dying individuals or desperate people who want to die? This contribution pleads for an emphasis on a new ethics of caring, because a truly human medicine is not possible without caring. It shows that care does not necessarily get in conflict with autonomy but that it is the prerequisite for autonomy.

Three experiments were designed to evaluate the effect of different circulating progesterone (P4) concentrations during synchronization of ovulation protocol for timed artificial insemination of seasonal anestrous buffalo cows. In the first trial, ovariectomized cows were randomly allocated into one of three groups: using new P4 devices (G-New; n = 8), using devices previously used for 9 days (G-Used1x; n = 8), and using devices previously used for 18 days (G-Used2x; n = 8). The P4 device was maintained for 9 days, and the circulating P4 concentration was measured daily. The circulating P4 concentrations during the P4 device treatment were the lowest for G-Used2x (1.10 ± 0.04 ng/mL), intermediate for G-Used1x (1.52 ± 0.05 ng/mL), and the highest for G-New (2.47 ± 0.07 ng/mL; P = 0.001). In the second trial, 31 anestrous cows had their ovarian follicular dynamics evaluated after receiving the treatments described previously (G-New [n = 10], G-Used1x [n = 11], and G-Used2x [n = 10]). At insertion of the P4 device, cows were administered 2.0 mg of estradiol benzoate. Nine days later, the P4 device was removed and cows were administered 0.53 mg of cloprostenol sodium plus 400 IU of eCG. Forty-eight hours after P4 device removal, 10 μg of buserelin acetate was administered. There were no differences among the groups (G-New vs. G-Used1x vs. G-Used2x) in diameter of the largest follicle at P4 device removal (9.0 ± 0.8 vs. 10.1 ± 0.9 vs. 8.6 ± 0.8 mm; P = 0.35), in interval from P4 device removal to ovulation (77.1 ± 4.5 vs. 76.5 ± 4.7 vs. 74.0 ± 4.4 hours; P = 0.31), or in ovulation rate (80.0% vs. 81.8% vs. 60.0%; P = 0.51). In experiment 3, 350 anestrous cows were randomly assigned into one of the three treatments described previously (G-New, n = 111; G-Used1x, n = 121; G-Used2x, n = 118) and received a timed artificial insemination for 16 hours after buserelin treatment. The 30-day pregnancy rates did not differ among groups (55.9% vs. 55.4% vs. 48.3%; P = 0.39). Thus, the low circulating P4 concentrations released from a used P4 device efficiently control the ovarian follicular growth and had no detrimental effect on the pregnancy rates of the seasonal anestrous buffalo cows.

How to justify Non-Resuscitation? The question whether to resuscitate or not belongs to the most controversial issues of medical ethics. This paper wants to give an insight into the German way of discussion on this topic. First it gives an overview of the most important codifications concerning resuscitation. Then it treats the question who is to be involved in do-not-resuscitate-decisions. The central point of the paper is the question of futile treatment and the question of the normative structures which are present in German discussion.

Two factors (pressure and temperature) varied over three levels were optimized for the extraction of PCDD/F from native contaminated soil with toluene-modified supercritical carbon dioxide. Temperature had a strong positive effect on the recovery. The most efficient extraction was achieved at 120 degrees C. This is in contrast to the influence of the temperature on the extraction of HCH, where a higher recovery is obtained at 60 degrees C than at 150 degrees C. The optimized conditions found for this soil were applied to the analysis of a BCR (European Commission) reference material prepared from contaminated industrial soil. The results are in good agreement with those of an interlaboratory study.

Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.

Between May 1982 and June 1996 at the Department of Urology of Padua University, 13 patients (12 women and 1 man) underwent augmentation/substitution cystoplasty for interstitial cystitis (CI) refractory to conservative management. Median bladder capacity was 70 ml (less than 400 ml under anesthesia in all cases). Two patients underwent subtotal cystectomy and substitution cystoplasty using sigmoid segment; in 7 patients a supratrigonal cystectomy and substitution cystoplasty with sigma (2 cases) and ileum (5 cases) was performed; in 4 patients simple bladder augmentation after large longitudinal bladder incision was performed. Mean post-operative follow-up was 84 months (range 4-173). Post operative median spontaneous bladder capacity was 290 ml and a subjective and objective good result was obtained in 10 out of 13 patients. Four patients had 5 post operative complications: one stenosis of the sigmoido-vesical junction, one ileal segment retraction, one septic temporary acute renal failure, two persistent complete urinary retention. The first two cases needed reoperation and the last two clean intermittent self-catheterization. Supratrigonal cystectomy with substitution enterocystoplasty, using detubularized/configured bowel segment, is the best surgical option in patients with CI with decreased bladder capacity and pain correlated to bladder filling. Post-operative clean intermittent self-catheterization must always be considered during preoperative evaluation.

Strategic supplementation of P4 may be used to increase conception rates in cattle, but timing of supplementation in relation to ovulation, mass of supplementary P4 and formulation of the P4-containing supplement has not been determined for beef cattle. Effects of supplementation of long-acting progesterone (P4) on Days 2 or 3 post-ovulation on development, function and regression of corpus luteum (CL) were studied in beef cattle. Cows were synchronized with an oestradiol/P4-based protocol and treated with 150 or 300 mg of long-acting P4 on Day 2 or 3 post-ovulation (6-7 cows/group). Colour-doppler ultrasound scanning and blood sample collection were performed from Day 2-21.5. Plasma P4 concentrations were greater (p 0.05) from Day 2.5-5.5 in the Day 2-treated groups and from Day 3.5-5.5 in the Day 3-treated cows than in the control group. CL area and blood flow during Day 2-8.5 did not differ (p 0.05) among groups, suggesting no effect of P4 treatment on luteal development. The frequency of cows that began luteolysis before Day 15 was greater (p 0.04) in cows treated with 300 mg than in the controls, but there were no differences between non-treated and 150 mg-treated cows. The interval from pre-treatment ovulation to functional and structural luteolysis was shorter (p 0.01) in the combined P4-treated groups than in the control cows. In conclusion, was showed for the first time that long-acting P4 supplementation on Day 2 or 3 post-ovulation increases P4 concentrations for ≥3 day, has no effect on luteal development, but anticipates the beginning of luteolysis in beef cattle.

The paper discusses the question whether it could be ethically appropriate to "resolve" the problem of scarce resources in health care via priority lists. It is argued that such a schematical priority list could only be undisputed in ethical respects if it represented a broad consensus on the question what a good life would be. Priority lists are always implicit decisions about specific concepts of the good life. Using a priority list only in consideration of a mere cost-benefit ratio means to accept a mere utilitarian way of defining good life. Such a definition goes with neglect of the interests of people with chronic diseases, of patients with incurable diseases, of patients with a limited life expectancy. To neglect the interests of these patients means to abandon the core of medical identity, because medicine has the mission to help those above all who are most in need and those who cannot help themselves. And so we have to realize that for medicine there are some values which are more important than economic considerations. The physician is a person who gives a promise, the promise to be there for the patient. If the physician now is becoming a businessman, this promise is no longer valid. The businessman doesn't give any other promise than not to act against the contract. But the main need of the patient, his longing for a human person whom he can trust, cannot become part of a contract. Especially in our time medicine has to fight for the core of its identity.

The recovery of chlorobenzenes (di- to hexachoro) and hexachlorocyclohexane (HCH) isomers from supercritical carbon dioxide by trapping in cold solvent was studied. By changes in supercritical pressure, flow rate, nature and temperature of the solvent, and trap geometry, recoveries of chlorobenzenes varied in the range 80-100%, and those of HCH in the range 50-94%. For the optimum set of variables, the average recovery of all compounds was 95%. With these trapping conditions, an environmental soil sample gave average supercritical fluid extraction (SFE) recoveries (compared to Soxhlet extraction) of 60-85%, depending on the SFE conditions

Pharmacological neuroenhancement is an attempt to increase cognitive performance in healthy humans. Learning and memory, attention and vigilance or mood and social interaction are targeted by a modulation of brain plasticity. Firstly, an analysis of the current state of research shows that, until now, clinical trials of neuroenhancing drugs have demonstrated only limited efficacy and long-term side effects remain largely unexplored. Secondly, we argue that, from an ethical perspective, neuroenhancement differs from socially mediated methods of learning. Pharmacological neuroenhancement is based on notions of efficacy and control that threaten to undermine other important aspects of mental capacities.

Today the physician is often reduced to a mere technician who is fulfilling the wish of the patient. Such a concept is lacking the aspect of care which is essential for the identity of the physician and which is important for patients in need. It is suggested to understand care as a prerequisite to respect autonomy. Autonomy without care is not medicine.

Modern medicine has left its central purpose to heal patients and has developed into a mere instrumental discipline which sees its central aim as fulfilling wishes instead of relieving suffering or treating illness. Aesthetic surgery is one of the many examples of such a transformation of modern medicine. This paper starts from the concept of medicine as a promise to help people who are suffering and who are in need of help. This aim of helping defines medicine. When it abandons this aim and merely fulfills wishes, medicine becomes a mere enterprise. Such a transformation is not illegal, but it will lose the notion of medicine as a moral institution based on trust. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Acting ethically means above all acting in the interest of the patient. One must therefore ask whether offering aesthetic interventions is really acting in the interest of the patient. Many arguments are presented to show that the interest of the patient and the moral integrity of medicine are in danger if medicine makes wish-fulfilling and aesthetics into one of its main tasks.

Predicting the structure of fish assemblages in rivers is a very important goal in ecological research, both from a purely theoretical point of view and from an applied one. Moreover, it will play a relevant role in the definition of reference conditions in the light of the EU Directive 2000/60/EC (i.e. the Water Framework Directive). Estimates of the probability of presence/absence of fish species have been obtained so far using different approaches. Although conventional statistical tools (e.g. logistic regression) provided interesting results, the application of artificial neural networks (ANNs) has recently outperformed those techniques. ANNs are especially effective in reproducing the complex, non-linear relationships that link environmental variables to fish species presence and/or abundance. In this chapter some new developments in ANN training procedures will be presented, which are specifically aimed at solving ecological problems related to the way the errors are computed in species composition models. The resulting improvements in species prediction involve not only the accuracy of the models, but also their ecological consistency. A case history about fish assemblages in the rivers of the Veneto region (NE Italy) is presented to demonstrate how the enhanced modelling strategy improved the accuracy of the predictions about fish assemblages.

Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.