Ruhr-University Bochum Research Articles

Introduction to the special issue “Doxastic Agency and Epistemic Responsibility”

In our everyday life we are holding each other responsible for what we believe and for how we form beliefs. Since there are many similarities between holding an agent responsible for her actions and holding an agent responsible for her beliefs, some epistemologists think that we can model epistemic responsibility, i.e., responsibility for a belief, along the lines ofmoral responsibility, i.e., responsibility for performing an action. Research onmoral responsibility suggests that a person can be held responsible for an action she has performed only if she had control over performing that action. Even though our practice of holding each other responsible for our beliefs is similar to our practice of holding each other responsible for our actions, our formation of a belief appears to be different to our performance of an action when it comes to our capacity to exercise control over it. Beliefs are mostly taken to be more or less passive responses to how the world appears to us, while in performing an action we shape the world, often as we intend it to be. This difference between actions and beliefs raises a problem when it comes to establishing a viable notion of epistemic responsibility along the lines of the notion of moral responsibility. Thus, we need to rethink our notion of epistemic responsibility, the kind of control necessary for responsibility, as well as the connection between epistemic responsibility and doxastic control. This special issue partially documents results of the two-day workshop “Doxastic Agency and Epistemic Responsibility” which took place at the Ruhr University Bochum in June 2014. It addresses questions such as: do we have the same kind of control over our doxastic attitudes as we have over our actions, what kind of control do we have over our doxastic attitudes and how is epistemic responsibility related to notions such as epistemic justification and practical responsibility?Most of the authors

The sensitivity of ultrasound screening examination in detecting heterotopic ossification following spinal cord injury.

Retrospective chart review. To analyze the role of sonography in detecting heterotopic ossification (HO) following spinal cord injury (SCI). Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Germany. Between January 2003 and December 2013, 217 patients with HO of the hips met the inclusion criteria and were included in the final analyses. The diagnosis of HO was carried out in all cases using our hospital protocol. Primary outcome measure was to calculate the sensitivity of ultrasound screening examination in detecting HO following SCI. The diagnosis of HO was confirmed in 217 patients after a mean interval of 64.8 days (range from 8 to 295; s.d.=40.4) via computerized tomography or magnetic resonance imaging scan. In 193 out of 217 patients, suspicious HO signs were noted in the ultrasound screening examination (sensitivity=88.9%). The use of ultrasound for screening for HO in SCI patients is reliable and has a high sensitivity.

The Interdisciplinary Management of Brain Metastases.

20-40% of patients with malignant tumors have one or more brain metastases in the course of their illness. Brain metastases are the first manifestation of cancer in 5-10%. Manifestations such as intracranial hypertension or focal neurologic deficits are seen in over 80% of patients with brain metastases. Uncertainty surrounds the treatment of patients with intracranial metastases, as the existing data are derived from trials with low levels of evidence. This article is based on a selective literature review and on the authors' own experience of 100 consecutive patients who underwent surgery at the Department of Neurosurgery at Ruhr University Bochum (RUB), Germany. Multimodal treatment enables successful surgery for an increasing number of patients with brain metastases. The modalities and goals of treatment are established for each patient individually by an interdisciplinary tumor board. Drug therapy is usually indicated. Surgical resection followed by stereotactic radiotherapy prolongs mean survival by 3-6 months and lowers the risk of recurrence from 40% to 12.5%. In the authors' own experience, even seriously ill patients can benefit from the resection of brain metastases. The 30-day morbidity was 29%, accounted for mainly by medical complications such as pulmonary embolism, renal failure, and sepsis. Through the close interdisciplinary collaboration of neurosurgeons, radiation oncologists, and medical oncologists, the symptomatic state and the prognosis of patients with brain metastases can be improved. Longer overall survival implies that further studies will have to pay special attention to the toxicity of treatment.

Preface: The spatial dimensions of water management – Redistribution of benefits and risks

The response of the scientific community was very unevenly distributed. The most submissions were dedicated to the topics 2 and 4. Floods are hotspots of applied hydrology and so many different research questions were raised in these contributions, e.g. methods for design flood estimations, impact assessments and operational flood forecasting. The second main component of the conference were hydrological regionalization issues. It became evident that after the completion of the PUB-Initiative of IAHS, which was summarized by Gunter Bloschl at the conference, many research activities are still going on to transfer hydrologic information from gauged to ungauged basins by new methodological approaches. Surprisingly, the “classical” fields of water management, water supply and water scarcity, were less represented. This could be caused by two reasons: there are some tools available which are widely used (e.g. stochastic optimization) but not further improved, or (and this seems to be more probable) there is a low interest to apply new scientific tools in practical water management to optimize existing systems or to improve the planning of new ones. Nevertheless very interesting and (in some cases) sophisticated methodological approaches were presented in this field at the conference under the topics 1, 3 and 4. With regard to future challenges of water research, the dynamic interactions and feedbacks between water and people becomes more and more important. One part of the conference was dedicated to these questions. Unfortunately the interesting presentations and discussions cannot be reflected completely in the proceedings. Nevertheless the participants got a comprehensive overview about the problems of sociohydrology and the need for interdisciplinary research. This conference was organized the second time at the Ruhr-University Bochum. In September 2006 scientists from all over the world met in Bochum for the 3th IWRM Symposium. In that time the conference accounted for the heterogeneity of world water problems by addressing the basic questions of Integrated Water Resources Management. Now, ten years later, the coherence between surface and groundwater, water quality and quantity or water and ecosystems are widely accepted aspects of modern water management. However the differences between hydrological conditions and the human expectations are still in the focus of research. More and more we become aware that water management is not able to serve societies in the solution of their water problems in a sustainable way if interactions and feedbacks between hydrological conditions and societies are not considered. The stationarity assumption has long been compromised by human disturbances in river basins. The dynamics of changing societies will face water management with new and unexpected problems. To give an example: If a water poor

Thirty years of European Conference on Spectroscopy of Biological Molecules celebrated in Ruhr University Bochum

Thirty years of European Conference on Spectroscopy of Biological Molecules celebrated in Ruhr University Bochum

Kinetic Passivation Effect of Localized Differential Aeration on Brass.

Invited for this month's cover are collaborators from Ruhr University Bochum (Germany), Technical University Munich (Germany), and University of La Laguna, Tenerife (Spain). The cover picture shows the passivation effect of a liquid in a brass tube in the presence of oxygen in the gas phase. Read the full text of the article at 10.1002/cplu.201500398.

Prevention of Cardiovascular Disease in Diabetes Patients after the SPRINT- and ACCORDIONStudy – and a New Meta Analysis

Copyright: © 2016 Schatz H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. *Corresponding author: Univ.-Prof. Dr. med. Dr. H.C. Helmut Schatz, Ruhr-University Bochum, Buerkle-de-la-Camp-Pl. 1, D-44789 Bochum, Germany, Tel: +49-234-302 6324; Fax: +49-234302 6315; E-mail: helmut.schatz@rub.de

The roles of serum alkaline and bone alkaline phosphatase levels in predicting heterotopic ossification following spinal cord injury.

Retrospective chart review. To analyze the usefulness of serum alkaline phosphatase (AP) and bone alkaline phosphatase (BAP), as well as C-reactive protein (CRP) levels in predicting heterotopic ossification (HO). Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr University Bochum, Germany. Between January 2003 and December 2013, 87 patients with HO around the hips met the inclusion criteria and were included in the study. Alkaline phosphatase, CRP and BAP were assessed and interpreted at the time of HO diagnosis and after radiation therapy in all patients. At the time of HO diagnosis, 49 out of 87 patients (49.4%) had elevated alkaline phosphatase levels and 39 out of 87 patients (44.8%) had elevated BAP levels. Elevated CRP values were found in 67 patients (77.0%). Within 3 days after single-dose radiation therapy, elevated AP levels persisted in 38 patients (43.7%) and elevated BAP levels in 28 patients (32.2%). The results obtained show that the determination of CRP, AP and BAP levels may not be considered a reliable screening method for early HO detection, subsequent to spinal cord injury.

Multiple sclerosis and family planning.

Department of Neurology, St Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, DE–44791 Bochum, Germany *Author for correspondence: Tel.: +49 0234 0509 501; k.hellwig@klinikum-bochum.de Historically, women with multiple sclerosis (MS) were discouraged from becoming pregnant. Today, MS is being diagnosed at an earlier age and much more reliable data are available about the disease course during and after pregnancy. In general, patients with MS should not be discouraged from planning a family. However, physicians need to be fully aware of the relevant issues in order to counsel their patients appropriately. Some frequently encountered issues are the possible impact of disease modifying therapy on the fetus, postpartum advice including breastfeeding and information about assisted reproduction techniques.

Heterotopic ossification of the shoulder joint following spinal cord injury: an analysis of 21 cases after single-dose radiation therapy.

Retrospective chart review. Heterotopic ossification (HO) affecting the hips is a common complaint of patients suffering traumatic spinal cord injury. However, the incidence of HO of the shoulder is considerably rare. In this context, we report on our results of 13 patients with a total of 21 cases of shoulder HO and single-dose radiation therapy. Department of Spinal Cord Injury and Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. The study group consists of 12 male and 1 female patient with a mean age of 55.5 years (range from 24 to 81 years; s.d.=14.5). Primary outcome measures were defined as the number of HO relapses and the number of side or adverse effects in relation to the radiation therapy. At the time of latest follow-up during hospitalization, the mean shoulder flexion was 92.1° while mean abduction was 94.5°. The average external rotation was 26.4°. No HO recurrence occurred and none of the patients suffered any adverse effects related to radiation therapy. In conclusion, single-dose radiation therapy in the treatment of shoulder HO due to spinal cord injury is an effective and reliable method, although the risk of secondary side effects related to the radiation therapy remain unknown.

Correlation of inflammatory serum markers with disease severity in patients with hidradenitis suppurativa (HS)

Data regarding the association of routinely obtained serum markers of inflammation, namely C-reactive protein (CRP), white blood cell count, and neutrophil count, with disease severity of hidradenitis suppurativa (HS) according to a scoring system have not been reported to our knowledge. We sought to evaluate these inflammatory serum markers for assessing disease severity of HS. Medical files of 275 patients who were referred to the outpatient HS center of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, in 2013 were evaluated retrospectively. CRP levels and neutrophil count significantly differed among Hurley stages I, II and III (P < .0001, P = .0002, respectively). There were significant positive correlations among CRP levels (r = 0.496, P < .0001) and neutrophil count (r = 0.330, P = .0009) with modified Hidradenitis Suppurativa Score. CRP was a significant independent predictor for Hurley stage III (odds ratio 1.077, 95% confidence interval 1.013-1.145, P = .016). CRP and body mass index were significant independent predictors for severe disease according to modified Hidradenitis Suppurativa Score (odds ratio 1.065, 95% confidence interval 1.015-1.117, P = .009; and odds ratio 1.12, 95% confidence interval 1.009-1.243, P = .032, respectively). Files were analyzed retrospectively. These inflammatory markers, especially CRP, are effective for assessing the extent of disease severity and the grade of inflammation in patients with HS.

Application ranges of EPB shields in coarse ground based on laboratory research

Earth Pressure Balance (EPB-) Shields were originally used in fine-grained soils as well as in mixed-grained soils with a content of fines (d<0.06mm) of at least 30M%. In these soils, if an adequate consistency is given, an EPB-Shield can be used without additional ground conditioning. Further, the application ranges of EPB-Shields have successfully been extended to mixed-grained and coarse-grained soils by ground conditioning, see Herrenknecht et al. (2011). In these soils, foams, if required also foams with polymers, polymer suspensions or high density slurries, are applied to change the properties of the soil in the excavation chamber. So far, the application ranges of EPB-Shields in mixed-grained and coarse-grained soils were based on experience with former tunnelling projects with different hydro-geological boundaries and different conditioning agents. First investigations on the properties of soil–foam-mixtures were done in different laboratories (Mair et al., 2003; Borio et al., 2011; Bezuijen, 2011). In these investigations, the focus was on the determination of special properties of the conditioning agents and conditioned soils. These laboratory investigations were the basis for further examination. Laboratory research was carried out at the Institute for Tunnelling and Construction Management at the Ruhr-University Bochum, Germany, using selected methods for the reproducible determination of essential properties of foams, foams with polymer additives, polymer suspensions and high density slurries. The results are summarised in a doctoral thesis (Budach, 2012). These methods were tested systematically regarding their workability. Furthermore, coarse-grained soils were mixed with the selected conditioning agents and methods to determine the essential properties of the conditioned soils were developed and tested on their suitability as well. Based on the results of this research, application ranges for EPB-Shields were developed based on extensive laboratory research considering varying hydro-geological ground conditions and conditioning agents.

Density measurements on binary mixtures (nitrogen + carbon dioxide and argon + carbon dioxide) at temperatures from (298.15 to 423.15) K with pressures from (11 to 31) MPa using a single-sinker densimeter

A single-sinker densimeter was built to specifically investigate the (p,ρ,T,x) behavior of fluid mixtures relevant for carbon capture and storage (CCS). Due to the use of a magnetic-suspension coupling, the densimeter enables measurements over the temperature range from (273.15 to 423.15)K with pressures up to 35MPa. A comprehensive analysis of the experimental uncertainties was undertaken. The expanded uncertainties (k=2) are 35mK for temperature, 3.39kPa for pressure, and 0.033% for density determination. The apparatus was used for measurements on the binary systems (nitrogen+carbon dioxide) and (argon+carbon dioxide). The compositions for both systems were (0.05 and 0.01)mole fraction carbon dioxide. Density measurements were carried out at temperatures from (298.15 to 423.15)K with pressures from (11 to 31)MPa. The relative combined expanded uncertainty (k=2) in density was 0.15% for the (nitrogen+carbon dioxide) mixtures and 0.12% for the (argon+carbon dioxide) mixtures. A major contribution to this uncertainty emerged from the uncertainty in the gas mixture composition. The new experimental data were compared to the GERG-2008 equation of state (EOS) for natural-gas mixtures as implemented in the NIST REFPROP database and to the EOS-CG, another new Helmholtz energy model for CCS mixtures as implemented in the TREND software package of Ruhr-University Bochum. Relative deviations were mostly within 0.5%. The agreement of the new density values with the only available literature data closest to the composition range under study was better than 0.1%.

Sandra Hubert: The Impact of Religiosity on Fertility. A Comparative Analysis of France, Hungary, Norway, and Germany

The relationship between religiosity and fertility has attracted considerable attention in demographic and sociological research over the last decades. Various dimensions of religiosity, including attendance, commitment, and the centrality of religion in people’s lives, have been shown to be associated with multiple dimensions of family life such as marriage, divorce, and family size. The book comprises an important contribution to this field, presenting a multidimensional analysis on the role of religion and religiosity in shaping fertility patterns. It adopts a comparative approach between gender, generations, and countries (i.e., France, Hungary, Norway, and Germany) and combines macro and micro perspectives. The volume is based on Sandra Hubert’s dissertation defended at Ruhr-University Bochum, Germany, in 2014. The book is structured into seven chapters. After a first, introductory chapter, the second one outlines and compares family-related trends in France, Hungary, Norway, and (West and East) Germany. Then, chapter 3 defines religion and religiosity and introduces the multifaceted concept of religiosity. It also critically reviews previous evidence on the religiosity/fertility nexus. Chapter 4 theorizes the impact of religious affiliation and religiosity on fertility. Chapter 5 deviates from the general line of the book talking about micro and macro factors affecting fertility behaviors across space and time. Chapter 6 presents an empirical analysis on the link between religiosity and completed fertility in the selected countries based on the first waves of the Generations and Gender Surveys (GGS). Chapter 7 closes the paper with a summary of main findings.

Endocrinology – quo vadis?

Copyright: © 2015 Schatz H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited *Corresponding author: Helmut Schatz, Professor, Media Spokesman of the German Endocrine Society, Ruhr University Bochum, Buerkle-de-la-Camp-Platz 1, D 44789 Bochum, Germany, Tel: +49-234-302 6324; Fax: +49-234-302 6315; E-mail: helmut.schatz@rub.de

Earliest Bedside Assessment of Hemodynamic Parameters and Cardiac Biomarkers: Their Role as Predictors of Adverse Outcome in Patients with Septic Shock.

Background: Early assessment and aggressive hemodynamic treatment have been shown to increase the survival of patients in septic shock. Current and past sepsis guidelines recommend a resuscitation protocol including central venous pressure (CVP), mean arterial blood pressure (MAP), urine output and central venous oxygen saturation (ScvO2) for resuscitation within the first six hours. Currently, the established severity score systems like APACHE II score, SOFA score or SAPS II score predict the outcome of critically ill patients on the bases of variables obtained only after the first 24 hours. The present study aims to evaluate the risk of short-term mortality for patients with septic shock by the earliest possible assessment of hemodynamic parameters and cardiac biomarkers as well as their role for the prediction of the adverse outcome.Methods: 52 consecutive patients treated for septic shock in the intensive care unit of one centre (Marien Hospital Herne, Ruhr University Bochum, Germany) were prospectively enrolled in this study. Hemodynamic parameters (MAP, CVP, ScvO2, left ventricular ejection fraction, Hematocrit) and cardiac biomarkers (Troponin I) at the ICU admission were evaluated in regard to their influence on mortality. The primary endpoint was all-cause mortality within 28 days after the admission.Results: A total of 52 patients (31 male, 21 female) with a mean age of 71.4±8.5 years and a mean APACHE II score of 37.0±7.6 were enrolled in the study. 28 patients reached the primary endpoint (mortality 54%). Patients presenting with hypotension (MAP <65 mmHg) at ICU admission had significantly higher rates of 28-day mortality as compared with the group of patients without hypotension (28-day mortality rate 74 % vs. 32 %, p<0.01). Furthermore, the patients in the hypotension present group had significantly higher lactate concentration (p=0.002), higher serum creatinin (p=0.04), higher NTproBNP (p=0.03) and after the first 24 hours higher APACHE II scores (p=0.04). A MAP <65 mmHg was the only hemodynamic parameter significantly predicting the primary endpoint (OR: 4.1, CI: 1.1 - 14.8, p=0.008), whereas the remaining hemodynamic variables CVP, ScvO2, Hematocrit, Troponin I and left ventricular ejection fraction (LVEF) seemed to have no influence on survival. Besides, non-survivors had a significantly higher age (74.1±9.0 vs. 68.4±6.9, p=0.01). If hypotension coincided with an age ≥72 years, the 28-day mortality rate escalated to 88%.Conclusions: In our study, we identified a risk group with an exceedingly high mortality rate: the patients with an age ≥72 years and presenting with hypotension (MAP <65 mmHg). These data can be easily obtained at the time of the very first patient contact. As a result, an aggressive and a more effective treatment can be initiated within the first minutes of the primary care, possibly reducing organ failure and short-term mortality in this risk group.

Clostridium difficile in visceral surgery

For surgeons the early identification of patients with clostridium difficile infections (CDI) is important, because the incidence and virulence of this potentially life-threatening disease are increasing. The aim of this study was to describe the frequency of CDI among surgical patients, to analyze which treatment was successful and to define which factors were associated with mortality. A retrospective analysis of patients with CDI was performed. From January 2004 to June 2012 the overall incidence of CDI among all departments at the St. Josef Hospital, Ruhr University Bochum was 0.6 % (1669 out of 301,919 patients). In 2004 the number of surgical patients with CDI was 1 which increased to 41 in 2011. Before the diagnosis of CDI was made 84 % (151 out of 179) of patients had received an antibiotic treatment. Conservative management of CDI was performed with metronidazole in 75 % (134 out of 179), 60 % (107 out of 179) received vancomycin, while 44 % (79 out of 179) received a combination of metronidazole and vancomycin, tygecycline or fidaxomidin. The overall mortality was 7 % (12 out of 179). There was a significant association with mortality for patients with sepsis, readmission to the intensive care unit (ICU), requirement for vasopressor therapy and intubation with mechanical ventilation. In 4 % of patients (7 out of 179) colectomy was carried out. Despite maximum intensive care management, 86 % (6 out of 7) of patients who underwent colectomy ultimately died. Although conservative management is successful for most patients with CDI, the mortality is high for patients who require intensive care management secondary to CDI. Mortality after colectomy for CDI is almost 100 %, mostly because the operation is usually only performed as a last resort in patients with sepsis. The most important risk factor for CDI is a prior antibiotic therapy.

A new phenomenon of bi-stability: experimental and numerical evidence

Bistable flows around circular cylinders typically occur in the critical range of the Reynolds number (Re), due to the formation of a laminar separation bubble and its subsequent collapse on one side of the cylinder only. In turbulent flows, as well as on a rough cylinder at slightly higher Re, bistable flows tend to disappear. However, this paper gives experimental evidence of a new type of bistable flow, which is induced around a circular cylinder of finite length even at moderately high Re. Stiffening rings, applied along the height of a circular cylinder at a distance smaller than the diameter (d = 2/3D in the case of study), were found to be responsible for the phenomenon. This was demonstrated and then cross-checked by wind tunnel experiments on a H/D = 6.7 circular cylinder. The experiments were performed in two different wind tunnels, at WiSt (Ruhr University Bochum) and at CRIACIV (University of Florence). A numerical study of the latter experimental test case is also presented in this paper. A finite volume approach based on the iterative solution of the unsteady Reynolds-averaged Navier–Stokes equations has been used. Turbulence has been modelled using the SST model by Menter. The numerical results confirm the physical fundament of the phenomenon, which likely finds its explanation in the key role of the flow over the cylinder tip.

Rituximab postprogressive multifocal leukoencephalopathy: a Feasible therapeutic option in selected cases.

Rituximab postprogressive multifocal leukoencephalopathy: a Feasible therapeutic option in selected cases.

Investigating the annealing dependency of Al/Si distribution in Eifel sanidine

Sanidine is the monoclinic high-T modification of K-rich alkalifeldspars. Annealing at T &gt; 9000C usually causes disordering of Al/Si distribution at the two non-equivalent tetrahedral sites, but it is supposedly possible to disorder samples of sanidine from Volkesfeld/Eifel at notably lower temperatures and shorter times [1]. To investigate this behavior and compare various approaches to obtain the Al/Si distribution, samples from different Eifel locations and Madagascar have been studied. Al/Si order was determined by direct and indirect methods, including X-ray and neutron diffraction of powder and single crystal samples. Neutron powder diffraction experiments were executed at the Fine Resolution Neutron Powder Diffractometer E9, single crystal neutron diffraction at the 4-circle Diffractometer E5 and diffuse neutron scattering experiments at the Flat-Cone Diffractometer E2, all located at the Berlin Research Reactor BERII. The Al/Si distribution was determined directly, refining site occupancies by applying Rietveld analysis to powder diffraction data and XTAL for single crystal data. This approach is inapplicable when using X-ray data, due to similar atomic form factors of Al3+ and Si4+, thus indirect methods [2,3,4] were applied. X-ray powder diffraction was performed at Helmholtz Centre Berlin, single crystal X-ray diffraction was done at Ruhr-University Bochum. The obtained data was processed using Rietveld refinement and ShelXL software, respectively. It was possible to verify a dependency of decreasing Al/Si order on increasing annealing times and temperatures. Interestingly we observed different results from direct and indirect methods, regardless whether samples were untreated or annealed. Applying the direct determination method, a stronger change of Al/Si distribution during annealing was revealed. Moreover, diffuse scattering of untreated and annealed samples was detected, which may arise from hydron incorporated in the crystal lattice.