Literatur

Ohne Zusammenfassung     

The use of rapid diagnostic test of procalcitonin serum levels for the postmortem diagnosis of sepsis

Because serum Procalcitonin is reported to be a valid postmortem marker of sepsis, this prospective study was carried out to determine whether the semi-quantitative PCT-Q((R))-Test (B.R.A.H.M.S., Germany) is a reliable indicator of postmortem Procalcitonin (PCT) serum levels, thus enabling a quick "tableside" diagnosis of sepsis. Postmortem PCT-levels of 70 forensic and 78 clinical-pathological autopsy cases (n=148) were examined using the B.R.A.H.M.S-PCT-Q-Test during autopsy. 27 cases were categorized as the cases of sepsis according to the ACCP/SCCM Consensus Conference criteria. 121 cases were assigned to the non-sepsis group. Among the 148 cases, 18 samples could not be analyzed by the reason of strong hemolysis. Using a cut-off point of 2 ng/ml, 20 cases of sepsis were identified (true positive) whereas 3 cases of sepsis were not detected (false negative). In the non-sepsis group (107 cases) 6 cases showed a positive testing (false positive). When applied within 48 h postmortem, the PCT-Q-Test showed a sensitivity of 86.96% and a specificity of 94.39% (at cut-off 2 ng/ml). Likelihood ratios and positive predictive values proved to be lower in the forensic autopsy group (PPV: 59.3% in forensic case vs. 85.1% in clinicopathological cases; NPV: 98.73% in forensic cases vs. 95.2% in clinicopathological cases). The PPVs using a cut-off point of 10 ng/ml were 100% in both groups independent of sepsis prevalences. The results show, that a high NPV for prevalences ranging from 3% to 30% can be reached using a 2 ng/ml cut-off point, whereas a cut-off of 10 ng/ml ensures a high PPV for the respective prevalences in the absence of exclusion criteria. The study provides strong evidence that the introduction of rapid diagnostic test (RDTs) of postmortem PCT serum levels may be useful in achieving rapid distinction between sepsis and non-sepsis-related causes of death, especially in conjunction with the medical case history and further autopsy results. In addition, the use of RDTs enables clinicians to conduct an evidence-based validation of clinical diagnosis, thus facilitating future clinical decision-making.     

Comment on Andreas von Hirsch: The Roles of Harm and Wrongdoing in Criminalisation Theory

Whereas liberals tend to emphasize harm as the decisive criterion for legitimizing criminalisation, moralists take a qualified notion of wrongfulness as sufficient even when no harm is at hand. This comment takes up Andreas von Hirsch’s “dual element approach” requiring both harm and wrongfulness as necessary conditions for criminalisation and argues that Joel Feinberg’s account of harming as violation of moral rights is perfectly compatible with it. Subsequently, two issues from the liberalism-moralism debate on criminalisation are examined: The difficulty of how to determine wrongfulness beyond the scope of harming, and the so far disregarded question of whether the democratic legislator is free within the framework of constitution to criminalise whatever conduct he wants to prevent irrespective of philosophical constraints.     

Economic aspirations, well-being and political support in recession and boom periods: the case of West Germany

Abstract. Usually the aggregate over-time relationship between economics and politics is empirically reduced to a simple one equation regression model which specifies political support as the dependent, and several economic indicators as independent variables. Here more comprehensive causal model is tested for West Germany. Economic aspirations, personal well-being, fear of the direct effects of economic crisis and political demands are introduced as intervening causal structures between the state of the economy and political support. It is demonstrated that the strength of the relationship between the economy and political support is quite different in recession and boom periods, depending on the subjective importance of economic concerns and the degree of fear of losing one's job. As the analysis of four different economic periods reveals, the effects of inflation and unemployment on political support are strongest when these indicators have an upward tendency. If they are stationary at a low or a higher level, their influences disappear.     

Application of likelihood ratios for firearm and toolmark analysis

Historically firearm and toolmark examiners have rendered categorical or inconclusive opinions and eschewed probabilistic ones, especially in the United States. We suggest this practice may no longer be necessary or desirable, and outline an alternative approach that is within a comprehensive logical/Bayesian paradigm. Hypothetical forensic and non-forensic examples are provided for readers who are practicing firearm and toolmark examiners, and the strengths and weaknesses of both approaches are considered.