Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome

Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period. Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated. Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: -0.53 to -0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account. Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising

Die iur.reform-Studie: Auswertung der größten Abstimmung unter Jurist:innen

Unter dem Kampagnennamen iur.reform hat das Bündnis zur Reform der juristischen Ausbildung e.V. die größte Studie zur Reform der juristischen Ausbildung in der Geschichte der Bundesrepublik Deutschland durchgeführt. Die Studie basiert auf den Ergebnissen einer Abstimmung über 43 Thesen, die vom 17.01.2022 bis zum 17.07.2022 durchgeführt wurde und an der 11.842 Personen teilgenommen haben. Die juristische Ausbildung gilt historisch als besonders schwer zu reformieren. Strukturell sind viele Akteur:innen an der Änderung der juristischen Ausbildung beteiligt und von einer solchen Änderung betroffen. Die einzelnen Akteur:innengruppen diskutieren aber vor allem untereinander, anstatt miteinander. Die letzte große Reform, die letztlich zurückgenommen wurde, basierte auf einem gemeinsamen mehrjährigen Prozess aller beteiligten Gruppen in Rahmen von Treffen in der Accademie Loccum. Mit der Kampagne iur.reform und der damit einhergehenden Abstimmung über 43 ermittelte Reformoptionen mit Blick auf die juristische Ausbildung, bündeln wir den zersplitterten Reformdiskurs. Die 43 Thesen, die zur Abstimmung gestellt wurden, entstammen der Auswertung aus über 200 Beiträgen in Fachzeitschriften und Artikeln aus den Jahren 2000 – 2020. Die Thesen wurden ausgewählt, weil sie regelmäßig diskutiert wurden. Die Abstimmung wurde in einem Stakeholderprozess unter Beteiligung von BRF, DAV, BRAK, DRB und elsa verbessert. Jede:r der:die einen Bezug zur juristischen Ausbildung hat war eingeladen die 43 Thesen auf einer Skala von 1 (volle Ablehnung) bis 5 (volle Zustimmung) zu beantworten. Alle Stimmen von Studierenden und Praktiker:innen jeder Art bis hin zu Verfassungsrichter:innen waren und sind relevant für eine gemeinsame Debatte über die gewünschten und befürworteten Reformen. Von den 11.842 Personen waren u.a. 5033 Studierende, 1653 Personen im Referendariat, 2089 Personen identifizierten sich als Rechtsanwält:innen, 937 als Richter:innen, 209 als Staatsanwält:innen, 245 als Professor:innen und 70 Personen als Mitarbeiter:innen in Justizprüfungsämtern (JPA), sowie 399 als Personen, die mit juristischer Ausbildung in der Verwaltung arbeiteten. Bei der Bewertung der Zahlen ist zu beachten, dass damit 4 % der Gesamtheit der Studierenden im Fach Rechtswissenschaften, knapp 1,48 % der Rechtsanwält:innen, 4 % der Richter:innen und 18 % aller Jura Professor:innen befragt wurden. In der Auswertung der Abstimmung berücksichtigen wir die Vielfalt der Stimmen. Wir zeigen auf, wo sich die Gruppen in ihrer Perspektive auf die verschiedenen Reformoptionen unterscheiden – und wo sie sich einig sind. Wir schlagen eine Zweipfadigkeit vor, die auf Grundlage unserer Ergebnisse beschritten werden kann. Einerseits lässt sich aus den Ergebnissen über alle befragten Gruppen hinweg ein Sofortprogramm ableiten. Die Thesen, die von allen Seiten mit absoluter Mehrheit befürwortet werden und eine unmittelbare positive Veränderung der juristischen Ausbildung an einzelnen Stellen zulassen sind besonders geeignet für eine unmittelbare Umsetzung nach unserem Sofortprogramm. Andererseits laden wir dazu ein, auf Grundlage der vorliegenden Ergebnisse zu Stimmungsbildern der einzelnen Aktuer:innen ergebnissoffen in einem Stakeholderprozess, angelehnt an die Accademie Loccum, eine gemeinsame Vision von einer neuen juristischen Ausbildung zu entwerfen. Für das Sofortprogramm haben wir aus den Thesen, die von allen drei großen Gruppen (in Ausbildung [Studierende, Referendar:innen, Promovierende, u.a.], Praktiker:innen [Rechtsanwält:innen und Syndizi, Richter:innen, Staatsanwält:innen, u.a.], Ausbildende [Professor:innen, Lehrende, JPA-Mitarbeiter:innen]) mit absoluter Mehrheit befürwortet werden, ein Sofortprogramm entwickelt, wenn die Thesen zusätzlich zeitnah umsetzbar sind. Einig sind sich alle drei Gruppen (in Ausbildung / Praktiker:innen / Ausbildende) bei der mehrheitlichen Befürwortung der folgenden sechs Thesen: Unabhängige Zweitkorrektur der schriftlichen Examensprüfungen (90 % / 86 % / 52 %) Einführung des E-Examens (76 % / 58 % / 55 %) Neue Lerninhalte nur bei Streichung von Bestehenden (78 % / 68 % / 59 %) Zulassung anderer Prüfungs- und Unterrichtsformen neben Klausur und Vorlesung (69 % / 68 % / 61 %) Verbesserung des Betreuungsschlüssels an den Hochschulen (69 % / 63 % / 68 %) Regelmäßiges Monitoring des Jurastudiums im Hinblick auf etwaigen Reformbedarf (82 % / 50 % / 70 %) Keine Einigkeit unter den drei Gruppen bedeutet aber nicht, dass es keinen Reformbedarf gibt. Bei vielen Thesen stimmen einzelne Gruppen in absoluter Mehrheit zu, aber eben nicht alle. Bei vielen weiteren Thesen findet sich eine relative Mehrheit für eine Reform. Dies bedeutet es gibt endlich eine Grundlage für gemeinsame und spannende Diskussionen. Zum Beispiel: Insgesamt mehrheitlich sprechen sich die Abstimmenden für die Einführung eines integrierten Bachelors aus (55 %), aber diese These wird von Professor:innen und JPA-Mitarbeitenden nicht mehrheitlich unterstützt, aber auch nicht mehrheitlich abgelehnt wird. Ähnlich ist es bei der Forderung die Möglichkeit des Abschichtens bundesweit einzuführen. Knapp 70 % sprechen sich dafür aus, aber nicht in allen drei großen Gruppen gibt es mehrheitliche Zustimmung. Die Verwendung von Online-Datenbanken in Klausuren wird z.B. von einer Mehrheit der Personen in Ausbildung unterstützt (55 %), aber sowohl von Praktiker:innen als auch von Ausbildenden mehrheitlich abgelehnt. Die Verwendung von Handkommentaren wird von Personen in Ausbildung und von Praktiker:innen mehrheitlich unterstützt. Interessant war u.a. auch: Die Umstellung auf Bologna wird von einer absoluten Mehrheit abgelehnt, wenn auch 39 % der Studierenden sich dafür aussprechen. Die einstufige Juristische Ausbildung erhält von denjenigen, die sie selbst durchlaufen haben, Bestnoten (52 % stimmten vollständig („5“) einer Wiedereinführung zu). Insgesamt ist die juristische Welt zu je 40 % für und gegen die Einführung und 20 % sind unentschieden. Die Umstellung auf eine Laufbahnorientierte Ausbildung wird nicht mehrheitlich befürwortet. Außerdem sollte das Studium emotional entlastet werden. Eine Mehrheit spricht sich dafür aus, dass neuer Prüfungsstoff nur aufgenommen wird, wenn alter Prüfungsstoff gestrichen wird, tendenziell einig sind sich auch die Gruppen in ihrer Ablehnung von mehr Prozessrecht im ersten Examen. Eine Mehrheit fordert die diverse Zusammenstellung von Prüfungskommissionen und dass Leistungen aus dem Studium in die Examensnote aufgenommen werden sollten. Abgelehnt wird: Abschaffung des Freischusses (wo er noch besteht), Ausweitung der Anzahl an Klausuren im ersten Staatsexamen und die Einführung einer Examenshausarbeit. Doch bereits die Antworten auf die erste Frage zeigen, weshalb die Arbeit mit den Ergebnissen jetzt so wichtig ist: Mehrheitlich sind die Abstimmenden insgesamt unzufrieden mit der juristischen Ausbildung in ihrer jetzigen Form (52 %). Dies ist erst der Beginn einer gemeinsamen Diskussion über die Zukunft der juristischen Ausbildung, die nun auf einer soliden Datengrundlage geführt werden kann. Neben der Executive Summary können auf www.iurreform.de die Studie, eine einseitige Zusammenfassung für jede These und das Sofortprogramm heruntergeladen werden

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Thraustochytrid hosts for expression of proteins relevant to SARS-CoV-2 intervention

The emergence of COVID-19 as a global pandemic had sharply illustrated the limitations of research and development pipelines and scaled manufacturing. Although existing vaccines were created in record time, global deployment remains limited by regional production scales. Similarly, the most effective treatments for infected COVID-19 patients are also constrained by production scales as well as by the cost of production and thus expense per treatment. The need to produce these interventions more cost-effectively, at larger scales, in less time while retaining high quality is paramount. The ConamaxTM platform is based on a Thraustochytrid–an order of microorganisms well established in industry for world-scale production of omega-3 fatty acids by fermentation. Thraustochytrids, and the species Aurantiochytrium acetophilum in particular, possess a number of innate qualities which make it ideal for production of monoclonal antibodies and other biotherapeutic proteins. In this study, the Conamax system was used to produce several targets which may be relevant as interventions in the fight against COVID-19; an anti-SARS-CoV-2 antibody (CR3022), tocilizumab, and the ACE2 receptor. Our system was capable of producing all of these targets and each was assayed in vitro for an activity which confirmed proper structural folding. Purified CR3022 antibody produced from Conamax was capable of reducing the cytopathic effect of SARS-CoV-2. Conamax-derived tocilizumab was shown to bind to its target IL6R. Both the full-length and soluble versions of ACE2 protein produced in the Conamax platform exhibited ACE2-specific proteolytic activity. These data indicate that the Conamax platform has great potential in the production of therapeutic agents

Thraustochytrid hosts for expression of proteins relevant to SARS-CoV-2 intervention

The emergence of COVID-19 as a global pandemic had sharply illustrated the limitations of research and development pipelines and scaled manufacturing. Although existing vaccines were created in record time, global deployment remains limited by regional production scales. Similarly, the most effective treatments for infected COVID-19 patients are also constrained by production scales as well as by the cost of production and thus expense per treatment. The need to produce these interventions more cost-effectively, at larger scales, in less time while retaining high quality is paramount. The ConamaxTM platform is based on a Thraustochytrid–an order of microorganisms well established in industry for world-scale production of omega-3 fatty acids by fermentation. Thraustochytrids, and the species Aurantiochytrium acetophilum in particular, possess a number of innate qualities which make it ideal for production of monoclonal antibodies and other biotherapeutic proteins. In this study, the Conamax system was used to produce several targets which may be relevant as interventions in the fight against COVID-19; an anti-SARS-CoV-2 antibody (CR3022), tocilizumab, and the ACE2 receptor. Our system was capable of producing all of these targets and each was assayed in vitro for an activity which confirmed proper structural folding. Purified CR3022 antibody produced from Conamax was capable of reducing the cytopathic effect of SARS-CoV-2. Conamax-derived tocilizumab was shown to bind to its target IL6R. Both the full-length and soluble versions of ACE2 protein produced in the Conamax platform exhibited ACE2-specific proteolytic activity. These data indicate that the Conamax platform has great potential in the production of therapeutic agents

S1 Raw images -

The emergence of COVID-19 as a global pandemic had sharply illustrated the limitations of research and development pipelines and scaled manufacturing. Although existing vaccines were created in record time, global deployment remains limited by regional production scales. Similarly, the most effective treatments for infected COVID-19 patients are also constrained by production scales as well as by the cost of production and thus expense per treatment. The need to produce these interventions more cost-effectively, at larger scales, in less time while retaining high quality is paramount. The ConamaxTM platform is based on a Thraustochytrid–an order of microorganisms well established in industry for world-scale production of omega-3 fatty acids by fermentation. Thraustochytrids, and the species Aurantiochytrium acetophilum in particular, possess a number of innate qualities which make it ideal for production of monoclonal antibodies and other biotherapeutic proteins. In this study, the Conamax system was used to produce several targets which may be relevant as interventions in the fight against COVID-19; an anti-SARS-CoV-2 antibody (CR3022), tocilizumab, and the ACE2 receptor. Our system was capable of producing all of these targets and each was assayed in vitro for an activity which confirmed proper structural folding. Purified CR3022 antibody produced from Conamax was capable of reducing the cytopathic effect of SARS-CoV-2. Conamax-derived tocilizumab was shown to bind to its target IL6R. Both the full-length and soluble versions of ACE2 protein produced in the Conamax platform exhibited ACE2-specific proteolytic activity. These data indicate that the Conamax platform has great potential in the production of therapeutic agents.</div

Fig 1 -

a. CE-PAGE profile of purified CR3022. The Conamax-produced antibody was purified to an apparent 100% purity by a single Protein A chromatography step. Red curve: non-reduced sample, blue curve: reduced, showing heavy and light chains. b. Antibody CR3022 produced by Conamax was able to inhibit induced cytopathy by SARS-CoV-2 in Vero 76 cells. The EC50 was 61 μg/ml in this assay. Data shown here are averages of three observations per concentration of CR3022.</p

Fig 3 -

a. Expression and secretion of ACE2. Strain sCX00037 produced full-length ACE2, while strains sCX00148 produced a truncated form of ACE2. After prolonged incubation, some clipping of the produced ACE2 is noticeable. The specificity of the detection antibody was confirmed by the absence of bands in the wildtype samples. b. Titers of produced ACE2. Titers were determined using a sandwich ELISA. A steady increase in titers was seen, but as the western blot shows, this came with an increase in clipped ACE2.</p

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The emergence of COVID-19 as a global pandemic had sharply illustrated the limitations of research and development pipelines and scaled manufacturing. Although existing vaccines were created in record time, global deployment remains limited by regional production scales. Similarly, the most effective treatments for infected COVID-19 patients are also constrained by production scales as well as by the cost of production and thus expense per treatment. The need to produce these interventions more cost-effectively, at larger scales, in less time while retaining high quality is paramount. The ConamaxTM platform is based on a Thraustochytrid–an order of microorganisms well established in industry for world-scale production of omega-3 fatty acids by fermentation. Thraustochytrids, and the species Aurantiochytrium acetophilum in particular, possess a number of innate qualities which make it ideal for production of monoclonal antibodies and other biotherapeutic proteins. In this study, the Conamax system was used to produce several targets which may be relevant as interventions in the fight against COVID-19; an anti-SARS-CoV-2 antibody (CR3022), tocilizumab, and the ACE2 receptor. Our system was capable of producing all of these targets and each was assayed in vitro for an activity which confirmed proper structural folding. Purified CR3022 antibody produced from Conamax was capable of reducing the cytopathic effect of SARS-CoV-2. Conamax-derived tocilizumab was shown to bind to its target IL6R. Both the full-length and soluble versions of ACE2 protein produced in the Conamax platform exhibited ACE2-specific proteolytic activity. These data indicate that the Conamax platform has great potential in the production of therapeutic agents.</div