Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model

There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position.     

Analysis of the governance architecture to regulate GHG emissions from international shipping

Despite the substantial and likely increasing contribution of greenhouse gas (GHG) emissions from international shipping and the related adverse impacts on global climate change, GHG emissions from international shipping are yet neither regulated by the Kyoto Protocol, nor through any other legally binding, internationally accepted regulation. This paper is looking into the governance architecture that is currently in place to regulate GHG emissions from international shipping with a view to analyze whether the institutional degree of fragmentation within this architecture is contributing to the current situation where no legally binding, internationally accepted regulation has been set up yet. Following the hypothesis that the degree and the characteristics of governance fragmentation have a crucial impact on the effectiveness and performance of a governance system, this paper focuses on the current architecture of climate change governance in international shipping and the institutional interplay between its actors. Therefore, the analytical framework builds on approaches from international environmental governance, regime theory, institutional interplay, and fragmentation in international governance architectures.     

Klagebefugnis aus dem allgemeinen Willkürverbot bei einem Versto? gegen die Staatszielbestimmung Umweltschutz

Nach einer Entscheidung des Bayerischen Verfassungsgerichtshofs kann ein Bauleitplan wegen Versto? gegen das Willkürverbot aus Gründen des Umweltschutzes nichtig sein. Diese auf eine Popularklage ergangene Entscheidung er?ffnet die Frage, ob der Verfassungsgrundsatz des Willkürverbots auch im Rahmen von Verwaltungsakten herangezogen werden kann. Der Beitrag bejaht diese M?glichkeit.     

Participation and independence of consumers in a health systems agency

Health Systems Agencies (HSAs) were mandated to include representation of the community, broadly conceived. The implicit intention of the law was to include consumers as important and co-equal participants with providers in health planning. This paper is an examination of consumer participation in one ESA. Contrary to expectations derived from the literature, citizens in this HSA exercised independent judgment regarding the major issue to confront them. We conclude his was a function of the following: talents and skills of the consumer members; natural interest in health care policy by consumer board members, sympathetic and supportive provider board members; and the homogenous character of the population in the region served.     

High thyroglobulin (Tg) concentrations in fatal traumatic brain injuries

It is well known that under physiological conditions, the Tg molecule is the substrate for the hormones triiodothyronine and thyroxine. Its function outside the thyroid gland is unknown. Under certain pathologic conditions, an increase in Tg concentrations in the blood can occur, a phenomenon that is used in the clinical diagnosis of certain thyroid disorders. However, fatal traumatic brain injuries (TBI) can also produce a raised Tg concentration in blood. In such cases, mean (n=151) Tg concentrations of 405.8+/-353.3 ng/mL have been observed, with the values in 57% of these cases exceeding 200 ng/mL. Since it was possible to rule out specifically any thyroid disorders in these cases, the raised values may be explained by the effect of TSH in the spectrum of the "hypothalamic-pituitary-thyroid axis." This assumption has been substantiated by immunohistochemical tests for TSH and Tg. Compared with the controls (sudden unnatural deaths: Tg 23.3+/-27.6 ng/mL), the raised Tg values in the TBI cases were usually accompanied by a reduction in the intensity of immunohistochemical reactions relating to TSH and Tg. The hypophysis showed evidence of significant damage with morphologic changes such as edema, hemorrhages, and focal necrosis in association with reduced TSH levels.