[Pathways of Invasive Ventilated Patients Released into Intensive Home Care: The Perspective of Home Care Providers]. / Wege invasiv beatmeter Patienten in die häusliche Beatmungspflege: Die Perspektive ambulanter Intensivpflegedienste.

INTRODUCTION: Over the past years, many home respiratory care services for invasively mechanically ventilated patients have been set up in Germany. However, little is known about the pathways used by these patients in order to access such specialized care. METHODS: A qualitative, exploratory study was undertaken. Semi-structured interviews with 15 leading experts or employees responsible for care transition were conducted and subjected to content analysis. RESULTS: Invasively ventilated patients' pathways into intensive home care tend to be highly random, risky and uncertain. Coordination and cooperation issues, as well as nontransparent and unclear interests of stakeholders and officials emerged. Rehabilitation opportunities do not seem to be systematically used to their full potential and demands for informed and participatory decision-making processes tend to be neglected. CONCLUSIONS: More attention will have to be paid to research and development needs regarding the provision of care to severely chronically ill and technology-dependent patients beyond the scope of individual health care sectors, organizations or professions.

[Appraisal of Educational Programmes and Qualifications of Health Occupations/Professions: A European Comparison - Main Results and Conclusions]. / Bestandsaufnahme der Ausbildung in den Gesundheitsfachberufen im europäischen Vergleich (GesinE) - zentrale Ergebnisse und Schlussfolgerungen.

INTRODUCTION: This is about some results of a study called "Appraisal of the educational programmes and qualifications of health professions: a European Comparison" (in short: GesinE). It was carried out in the years 2009-2013, commissioned by the BMBF and supported by the BIBB. It is focussed on Germany, France, Great Britain, the Netherlands and Austria. The objectives have been (i) an inventory and comparative international synoptic presentation of education programmes of 16 health professions, (ii) a comparative international qualification analysis for the professions of radiographer, physiotherapist and nurse and (iii) the exposure of key aspects of the health-care and education systems in the compared countries. METHODS: This is a comparative multi-sectional study for which a mixed methods approach with qualitative and quantitative elements was used. RESULTS: According to the results of this study it is necessary that current qualification paths and competence profiles of the health professions are developed continuously in Germany. In this process the German education and the secondary education sector should not be underrated. At the same time the results suggest that there are advantages in some aspects in the academic education (which is the norm for most of the analysed professions in the surveyed countries) compared to the existing education programmes in the secondary sector. This in particular applies to the competence for finding and transferring scientific knowledge into practice and for implementing reflected processes for decision making. CONCLUSIONS: The results improve the basis of the current debate in Germany about the development and reorganisation of the profiles of health professions and their qualification in a European context.

[Changes in the collagen structures of human heart valves in relation to age and hypertension]. / Veränderungen der kollagenen Strukturen menschlicher Herzklappen in Abhängigkeit von Alter und Hypertonie.

Using polarization microscopy and morphometrical methods, the influence of hypertension on the collagenous structures in the Lamina fibrosa of bicuspid valves of 14 middle-aged persons (30 to 50 years) were examined. The measurements were performed on histological sections. A group of 14 middle-aged subjects free from heart disease served as the control group. Furthermore, the results were compared to earlier findings on the histological biomorphosis of the atrioventricular valves. The following changes were observed and quantitatively determined: a) an enhancement of the percentage of the mechanically more resistant collagenous fibers (unsilvered, type I collagen), b) a stronger lateral aggregation of the collagenous fibrils of both types I and III collagen, c) a significant decrease of the total numbers of collagenous fibers per measuring area, and d) a significant decrease of the portion of silvered fibers (type III collagen) per measuring area for both sexes. The fiber density distributions confirm the observed changes: in the hypertension group the collagenous fibers are less densely distributed than in the control group. The observed regression of the content of collagenous fibers in the hypertension group is probably due to the anti-hypertensive treatment. Following the findings the turn-over of type III collagen is stronger influenced than that of type I collagen. The initial results determined in human heart valves confirm findings in animal models and characterize them with regard to the collagen types mentioned.

Rubrerythrin from Clostridium perfringens: cloning of the gene, purification of the protein, and characterization of its superoxide dismutase function.

The food-borne pathogen Clostridium perfringens, which is an obligate anaerobe, showed growth under conditions of oxidative stress. In protein extracts we looked for superoxide dismutase (SOD) activities which might scavenge highly toxic superoxide radicals evolving under such stress conditions. Using the classical assay to detect SOD activity on gels after electrophoresis of C. perfringens proteins, we obtained a pattern of three major bands indicating SOD activity. The protein representing the brightest band was purified by three chromatographic steps. On the basis of 20 amino acids determined from the N terminus of the protein, we designed a degenerate oligonucleotide probe to isolate the corresponding gene. We finally sequenced an open reading frame of 195 amino acids (molecular mass, 21,159 Da) with a strong homology to the Desulfovibrio vulgaris rubrerythrin; therefore, we assumed to have cloned a rubrerythrin gene from C. perfringens, and we named it rbr. The C-terminal region of the newly detected rubrerythrin from C. perfringens contains a characteristic non-heme, non-sulfur iron-binding site -Cys-X-X-Cys-(X)12-Cys-X-X-Cys- similar to that found in rubrerythrin from D. vulgaris. In addition, three -Glu-X-X-His- sequences could represent diiron binding domains. We observed SOD activity in extracts of Escherichia coli strains containing the recombinant rbr gene from C. perfringens. A biological function of rubrerythrin as SOD was confirmed with the functional complementation by the rbr gene of an E. coli mutant strain lacking SOD activity. We therefore suppose that rubrerythrin plays a role as a scavenger of oxygen radicals.