"Schulen der Macht?" : Governance Schools in Deutschland

„Governance Schools“ lassen sich als multidisziplinäre, praxisorientierte Ausbildungseinrichtungen verstehen, die Studierende unmittelbar für den Berufsalltag in einem weit verstandenen Feld von „Politik“ in Staat, Wirtschaft und Zivilgesellschaft qualifizieren wollen. Bildungspolitisch stellen sie keine Konkurrenz, sondern eine Ergänzung zu den stärker wissenschaftlich-disziplinären Angeboten der öffentlichen Universitäten dar und können dabei allenfalls den Anspruch erheben, ein wenig „Hefe“ im derzeit – aus guten Gründen – stark gärenden „Teig“ der deutschen Bildungslandschaft zu sein. Gleichwohl könnten Governance Schools als Hochschulen mit großer Autonomie als Impulsgeber in der gegenwärtigen Reformdiskussion fungieren. Hinsichtlich der möglichen Effekte auf die Elitenrekrutierung sollten Governance Schools angesichts des derzeitigen Standes der Zugangsstrukturen insbesondere zu öffentlichen Leitungspositionen in Deutschland nicht dramatisiert werden. Statt der befürchteten, selbstreferentiellen Abschottung politischer Eliten mit homogenen Ausbildungshintergrund können sie u.U. sogar dem Leistungsprinzip Vorschub leisten, dass sowohl unter Effektivitäts- als auch unter Legitimitätsgesichtspunkten zu einer Verbesserung gegenüber dem Status quo führt. Angesichts der noch immer in den meisten Bereichen existierenden Juristendominanz und der zentralen Rolle der Parteien in der Elitenrekrutierung wollen „Governance Schools“ in Deutschland zunächst andere Vereinseitigungen der politischen Elitenrekrutierung aufbrechen. Der Blick auf die negativen Auswüchse von „Schulen der Macht“ in anderen Ländern Europas macht gleichwohl deutlich, dass erstens eine Umkehrung der Verhältnisse im Sinne eines fast vollständigen Monopols der Elitenausbildung durch entsprechende Einrichtungen nicht wünschenswert sein kann und dass zweitens den Aufnahmeverfahren besondere Aufmerksamkeit zu widmen ist, um den Offenheitsanspruch des Leistungsprinzips in der Elitenrekrutierung aufrecht zu erhalten

Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet

<p>Abstract</p> <p>Objectives</p> <p>To analyze risk factors for chylothorax in infants after congenital heart surgery and the efficacy of median chain triglyceride diet (MCT). To develop our therapeutic pathway for the management of chylothorax.</p> <p>Patients and methods</p> <p>Retrospective review of the institutional surgical database and patient charts including detailed perioperative informations between 1/2000 and 10/2006. Data analyzing with an elimination regression analysis.</p> <p>Results</p> <p>Twenty six out of 282 patients had chylothorax (=9.2%). Secondary chest closure, low body weight, small size, longer cardiopulmonary bypass (242 ± 30 versus 129 ± 5 min) and x-clamp times (111 ± 15 versus 62 ± 3 min) were significantly associated with chylothorax (p < 0.05). One patient was cured with total parenteral nutrition (TPN) and one without any treatment. 24 patients received MCT-diet alone, which was successful in 17 patients within 10 days. After conversion to regular alimentation within one week only one chylothorax relapsed. Out of 7 patients primarily not responsive to MCT-diet, 2 were successfully treated by lysis of a caval vein thrombosis, 2 by TPN + pleurodesis + supradiaphragmatic thoracic duct ligation, one by octreotide treatment, and two patients finally died.</p> <p>Conclusions</p> <p>Chylothorax may appear due to injury of the thoracic duct, due to venous or lymphatic congestion, central vein thrombosis, or diffuse injury of mediastinal lymphatic tissue in association with secondary chest closure. Application of MCT alone was effective in 71%, and more invasive treatments like TPN should not be used in primary routine. After resolution of chylothorax, MCT-diet can be converted to regular milk formula within one week and with very low risk of relapse.</p

Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet

Objectives To analyze risk factors for chylothorax in infants after congenital heart surgery and the efficacy of median chain triglyceride diet (MCT). To develop our therapeutic pathway for the management of chylothorax. Patients and methods Retrospective review of the institutional surgical database and patient charts including detailed perioperative informations between 1/2000 and 10/2006. Data analyzing with an elimination regression analysis. Results Twenty six out of 282 patients had chylothorax (=9.2%). Secondary chest closure, low body weight, small size, longer cardiopulmonary bypass (242 ± 30 versus 129 ± 5 min) and x-clamp times (111 ± 15 versus 62 ± 3 min) were significantly associated with chylothorax (p < 0.05). One patient was cured with total parenteral nutrition (TPN) and one without any treatment. 24 patients received MCT-diet alone, which was successful in 17 patients within 10 days. After conversion to regular alimentation within one week only one chylothorax relapsed. Out of 7 patients primarily not responsive to MCT-diet, 2 were successfully treated by lysis of a caval vein thrombosis, 2 by TPN + pleurodesis + supradiaphragmatic thoracic duct ligation, one by octreotide treatment, and two patients finally died. Conclusions Chylothorax may appear due to injury of the thoracic duct, due to venous or lymphatic congestion, central vein thrombosis, or diffuse injury of mediastinal lymphatic tissue in association with secondary chest closure. Application of MCT alone was effective in 71%, and more invasive treatments like TPN should not be used in primary routine. After resolution of chylothorax, MCT-diet can be converted to regular milk formula within one week and with very low risk of relapse

Clinical and histopathological features of patients with systemic sclerosis undergoing endomyocardial biopsy.

Cardiac involvement in systemic sclerosis (SSc) is associated with a variable phenotype including heart failure, arrhythmias and pulmonary hypertension. The aim of the present study was to evaluate clinical characteristics, histopathological findings and outcome of patients with SSc and a clinical phenotype suggesting cardiac involvement.25 patients with SSc and clinical signs of cardiac involvement were included between June 2007 and December 2010. They underwent routine clinical work-up including laboratory testing, echocardiography, left and right heart catheterization, holter recordings and endomyocardial biopsy. Primary endpoint (EP) was defined as the combination of cardiovascular death, arrhythmic endpoints (defined as appropriate discharge of implantable cardioverter defibrillator (ICD)) or rehospitalization due to heart failure. The majority of patients presented with slightly impaired left ventricular function (mean LVEF 54.1±9.0%, determined by echocardiography). Endomyocardial biopsies detected cardiac fibrosis in all patients with a variable area percentage of 8% to 32%. Cardiac inflammation was diagnosed as follows: No inflammation in 3.8%, isolated inflammatory cells in 38.5%, a few foci of inflammation in 30.8%, several foci of inflammation in 15.4%, and pronounced inflammation in 7.7% of patients. During follow up (FU) (22.5 months), seven (28%) patients reached the primary EP. Patients with subsequent events showed a higher degree of fibrosis and inflammation in the myocardium by trend. While patients with an inflammation grade 0 or 1 showed an event rate of 18.2%, the subgroup of patients with an inflammation grade 2 presented with an event rate of 25% versus an event rate of 50% in the subgroup of patients with an inflammation grade 3 and 4, respectively (p=0.193). Furthermore, the subgroup of patients with fibrosis grade 1 showed an event rate of 11%, patients with fibrosis grade 2 and 3 presented with an event rate of 33% and 42% respectively (p = 0.160).Patients with SSc and clinical signs of cardiac involvement presented with mildly impaired LVEF. Prognosis was poor with an event rate of 28% within 22.5 months FU and was associated with the degree of cardiac inflammation and fibrosis