Der Weismannstadel in Hemau

Bei dem im Jahre 1824 erbauten Weismannstadel in der Dietfurter Straße 16 in Hemau handelt es sich um einen Jurastadel, also um eine Scheune mit Kalkplattendach. Bis in die Mitte des 20. Jahrhunderts haben Gebäude mit einer solchen Dachdeckung das Altmühlgebiet und damit auch die südwestliche Oberpfalz geprägt. Heute gibt es jedoch nur noch wenige Beispiele dieser einzigartigen ländlichen Baukultur. Auch der Weismannstadel sollte nach langem Leerstand abgerissen und durch eine Wohnanlage oder Parkplätze ersetzt werden. Die Familie Semmler aus Hemau hat ihn buchstäblich in letzter Minute vor diesem Schicksal bewahrt und zwischen 2011 und 2013 vorbildlich saniert. Der Band informiert über die Geschichte und Bedeutung des Stadels und dokumentiert seine denkmalgerechte Instandsetzung. Gedruckte Exemplare (Hardcover, 72 S., 21 x 27 cm) können für 11,80 € (zzgl. Porto) direkt beim Verlag Th. Feuerer bezogen werden

The disease-specific clinical trial network for primary ciliary dyskinesia: PCD-CTN

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients

Physician and Patient Predictors of Evidence-Based Prescribing in Heart Failure: A Multilevel Study

BACKGROUND: The management of patients with heart failure (HF) needs to account for changeable and complex individual clinical characteristics. The use of renin angiotensin system inhibitors (RAAS-I) to target doses is recommended by guidelines. But physicians seemingly do not sufficiently follow this recommendation, while little is known about the physician and patient predictors of adherence. METHODS: To examine the coherence of primary care (PC) physicians' knowledge and self-perceived competencies regarding RAAS-I with their respective prescribing behavior being related to patient-associated barriers. Cross-sectional follow-up study after a randomized medical educational intervention trial with a seven month observation period. PC physicians (n = 37) and patients with systolic HF (n = 168) from practices in Baden-Wuerttemberg. Measurements were knowledge (blueprint-based multiple choice test), self-perceived competencies (questionnaire on global confidence in the therapy and on frequency of use of RAAS-I), and patient variables (age, gender, NYHA functional status, blood pressure, potassium level, renal function). Prescribing was collected from the trials' documentation. The target variable consisted of ≥50% of recommended RAAS-I dosage being investigated by two-level logistic regression models. RESULTS: Patients (69% male, mean age 68.8 years) showed symptomatic and objectified left ventricular (NYHA II vs. III/IV: 51% vs. 49% and mean LVEF 33.3%) and renal (GFR<50%: 22%) impairment. Mean percentage of RAAS-I target dose was 47%, 59% of patients receiving ≥50%. Determinants of improved prescribing of RAAS-I were patient age (OR 0.95, CI 0.92-0.99, p = 0.01), physician's global self-confidence at follow-up (OR 1.09, CI 1.02-1.05, p = 0.01) and NYHA class (II vs. III/IV) (OR 0.63, CI 0.38-1.05, p = 0.08). CONCLUSIONS: A change in physician's confidence as a predictor of RAAS-I dose increase is a new finding that might reflect an intervention effect of improved physicians' intention and that might foster novel strategies to improve safe evidence-based prescribing. These should include targeting knowledge, attitudes and skills

Well-being and work satisfaction among German refugee helpers

We gathered socio-demographic data on German refugee helpers. Also, work satisfaction was examined and we screened for signs of depression or post-traumatic stress disorder (PTSD)

Metabolic programming of the renal leptin-npy system with renal function impairment after postnatal overfeeding

1) Hintergrund und Ziele der Studie Sowohl in tierexperimentellen als auch in humanen Studien ist gezeigt worden, dass Adipositas zu einem erhöhten Risiko für eine chronische Niereninsuffizienz führt [20, 28, 47]. Es finden histologische Veränderungen im Sinne einer Obesity Related Glomerulopathy (ORG) [106] und eine niederschwellige systemische Inflammation statt [106, 125]. Dennoch ist es noch weitgehend ungeklärt, ob postnatale Hyperalimentation zu einem Funktionsverlust der Niere führt. Daher ist es das Ziel dieser Arbeit letzteres und eine sich eventuell entwickelnde profibrotische Neigung mit Inflammation sowie eine Veränderung von Signalwegen des Systems zwischen Leptin und dem sympathischen Kotransmitter Neuropeptid Y (NPY), zu untersuchen. 2) Methoden Die postnatale Hyperalimentation wurde durch eine Reduktion der primären Wurfgröße am postnatalen Lebenstag (P) 1 erreicht. Nach 24-stündiger Haltung in metabolischen Käfigen wurden die Tiere am Tag P70 getötet. Aus entnommenem Nierengewebe wurden Polymerase-Kettenreaktionen durchgeführt, um die Genregulation von NPY, seinen Rezeptoren, verschiedenen Adipozytokinen wie Leptin und Interleukin 6 zu untersuchen. Weiter wurden Western Blots von Interleukin-6, Signal transducer and activator of transcription 3 (STAT-3) und Suppressor of cytokine signaling 3 (SOCS-3) durchgeführt. Auch wurde eine Immunhistologie von Kollagen I angefertigt. 3) Ergebnisse und Beobachtungen Veränderungen betrafen nicht nur den Phänotyp der hyperalimentierten Tiere mit erhöhtem Körpergewicht, sondern sie manifestierten darüber hinaus eine eingeschränkte glomeruläre Nierenfunktion mit Veränderung der extrazellulären Matrix durch verstärkte Kollagen I Bildung, erhöhter Expression lokaler proinflammatorischer Zytokine wie IL-6 und des ebenso proinflammatorischen Peptidhormons Leptin. Im Gegensatz dazu war antiinflammatorisch wirkendes IL-10 vermindert. In hyperalimentierten Würfen kam es weiter zu einer verstärkten NPY-Expression mit einer Modifikation der Leptinsignalkaskade über STAT-3, da sowohl der Anteil an phosphoryliertem, also aktiven STAT-3 geringer und der Anteil des unphosphorylierten STAT-3 erhöht waren. Zusätzlich war mehr SOCS-3 messbar. 4) Praktische Schlußfolgerungen Zusammenfassend zeigt die vorgelegte Studie, dass postnatale Hyperalimentation vor allem bei einer Wurfreduktion auf sechs Tiere Veränderungen im renalen Leptin-NPY-System hervorruft, die am postnatalen Lebenstag P70 persistieren. Damit hat eine Programmierung des renalen Leptin-NPY-Systems stattgefunden. Wahrscheinlich kommt es im Rahmen der lokalen Leptinvermehrung zu einer Sympathikusaktivierung mit NPY-Freisetzung, das wiederum als Stimulus für eine IL-6-Sekretion aus zirkulierenden Makrophagen in Frage kommt. Die mögliche Sympathikusaktivierung könnte zur Modifikation der extrazellulären Matrix mit erhöhter Kollagen I Bildung in den Glomeruli beitragen, da Leptin profibrotisch wirkt. Die renale STAT-3/JAK-2 Signaltransduktion ist beeinträchtigt, erkennbar an einer verminderten Phosphorylierung von STAT-3 und erhöhter Messbarkeit von SOCS-3, einem Inhibitor des STAT-3/JAK-2 Weges. Dies deutet auf eine lokale Postrezeptor-Leptinresistenz hin. Alles in allem entsteht so das Bild einer ORG, die durch frühe postnatale Hyperalimentation getriggert wird. Adipositas ist eine Epidemie, die ein erhöhtes Risiko für chronische Niereninsuffizienz birgt. Daher sind diese Ergebnisse von großer Relevanz.1) Background It has been shown that obesity leads to an increased risk for chronic kidney disease in animals as well as in humans [20, 28, 47]. Histological changes that are characteristic of an obesity related glomerulopathy (ORG) [106] and a low grade systemic inflammation occur [106, 125]. Still it is unknown wether postnatal hyperalimentation leads to a reduction of kidney function. The aim of this study was to determine if postnatal hyperalimentation by litter size reduction has an influence on kidney function, local inflammation and renal fibrosis. Moreover changes in the signal transduction in the interaction of leptin and neuropeptid Y (NPY) should be analysed. 2) Methods Postnatal hyperalimentation was induced by litter size reduction (LSR) on postnatal day (P) 1. After keeping the rats in a metabolic cage for 24 hours they were sacrificed on day P70. Kidney material was used to perform polymerase chain reactions to evaluate gene regulation of NPY and its‘ receptors, different adipocytokines like leptin and interleukin-6 (IL-6). Furthermore, western blots of IL-6, signal transducer and activator of transcription 3 (STAT-3) and Suppressor of cytokine signaling 3 (SOCS-3) and an immunhistologic staining of collagen I were done. 3) Results Rats that were affected from LSR were heavier than animals from the control group. They also showed reduced glomerular kidney function and changes of the extracellular matrix with increased production of collagen I, increased production of proinflammatory cytokines like IL-6 and leptin, whereas anti-inflammatory IL-10 was reduced. In LSR rats NPY-expression was increased together with a modification of leptin signalling via STAT-3: phosphorylated, active STAT-3 was decreased, while unphosphorylated STAT-2 was elevated. Also SOCS-3 levels were higher in LSR animals. 4) Conclusions All in all, this study shows that postnatal hyperalimentation leads to changes in the leptin-NPY-system, especially in litters that were reduced to six animals. These changes persist until P70 which could be due to metabolic programming of the renal leptin-NPY-system. Probably local increase of leptin expression causes activation of the sympathetic nervous system and NPY secretion. NPY may stimulate IL-6 secretion in circulating macrophages. Consistent with leptin’s profibrotic function the activation of the sympathetic nervous system could then change glomerular extracellular matrix composition by increasing collagen I production. The renal STAT-3/JAK-2 pathway is impaired as phosphorylated STAT-3 levels are decreased and SOCS-3 levels are increased. SOCS-3 is a potent inhibitor of STAT-3/JAK-2 signalling. This indicates a local postceptor leptin resistance. Altogether early postnatal hyperalimentation creates an ORG. Obesity is a worldwide epidemic that involves a high risk of chronic renal failure. Because of that the results from this study are highly relevant and further work on this topic is necessary

Design Thinking: An Educational Model

Design creativity is one of the most relevant fields in design and innovation. To better understand the effectiveness and origin of it, this study draws attention to the question of how design creativity can be mediated via design education. Since institutes exist that focus on teaching design thinking, the question arises what the experts of education believe they achieve with their lessons and how they support students in developing a capability of thinking and acting creative. In the empirical part of this study we find that there are different levels of creative knowledge, skills and mindsets that can be achieved by design thinking education, culminating in a capability that is called ‘creative confidence’. Building on these results we demonstrate how design education contributes to both the development and understanding of design creativity. Furthermore we suggest a definition of “design thinking” as a learning model towards creative confidence

Do good, stay well. Well-being and work satisfaction among German refugee helpers: A national cross-sectional study.

BackgroundSince 2015, more than 3 million refugees have reached the European Union. In order to receive and integrate them, societies heavily rely on relief organizations and private initiatives. Yet the well-being, work-satisfaction and possible health implications for refugee helpers have not been adequately addressed.MethodsIn a German national cross-sectional study, we gathered socio-demographic data on refugee helpers. Work satisfaction was examined by means of Neuberger and Allerbeck's Work Description Inventory. We screened for depression by using the 5-item WHO Well-Being Index (WHO-5), and for post-traumatic stress disorder (PTSD) using the PTSD Short Screening Scale (PTSD-7). 1712 questionnaires were analyzed.ResultsFemales accounted for 73.4% (1235), the mean age was 52.0 years (SD: 14.4). 61.6% were academics (1042). 87.0% (1454) were voluntary helpers who invested 9.4 hours (SD: 8.9) per week. Refugee helpers were more satisfied with the content than with the conditions or the organization of their work. Their work satisfaction and overall life satisfaction reached higher values than in representative samples. The mean WHO-5 index for refugee helpers was 68.2 points (SD: 19.0). Positive depression screening was found in 17.3% (226). 982 (57.4%) had experienced a traumatic event in their past or witnessed it during their work in refugee aid. 33 (2.8%) of the helpers had a positive PTSD screening.ConclusionsRefugee helpers deliver invaluable services to migrants and receiving communities. Our data indicates above average well-being as well as work-satisfaction. Psychological traumatization is found frequently but fortunately PTSD is rare. All efforts should be made to uphold helpers' keen spirit and contributions. They should be screened regularly with regards to work satisfaction, well-being and mental health. As part of a comprehensive health promotion strategy they should be instructed about depression, psychological trauma, PTSD and ways to find help

Well-being and PTSD in German emergency medical services - A nationwide cross-sectional survey.

BackgroundEmergency medical service (EMS) can be a burdensome occupational field, and employees can be confronted with traumatizing events. Posttraumatic stress disorder (PTSD) and depression rates among paramedics are considered higher than those in the general population. In the German setting of a physician-based EMS system, the literature provides little data on PTSD or non-PTSD-related mental health or on the correlation between PTSD and well-being.MethodsThe study collected data through a nationwide cross-sectional questionnaire survey of the German EMS. Next to gathering sociodemographic data, it used the 5-item World Health Organization Well-Being Index (WHO-5) and the Short Screening Scale for the DSM-IV-PTSD to assess well-being and identify indicators of depression and PTSD.ResultsA total of 2,731 paramedics and emergency physicians participated in the survey; 2,684 questionnaires were submitted to analysis. The average WHO-5 score was 53.15%. A total of 43.4% of participants screened positive for possible depression, as indicated by a WHO-5 score below 50%. Female gender, older age, higher total years spent working in EMS and increased body mass index were significantly correlated with lower well-being. A total of 5.4% of respondents had a positive PTSD screening result. In particular, older employees were significantly more likely to test positive for PTSD (12.2% of those over 50 years, compared to 2.8% of those under 30 years). Positive PTSD screening results were associated with significantly lower well-being. Over an average period of 1 year, the paramedics reported perceiving a median of 2 emergency missions as mentally distressing.ConclusionLow well-being and PTSD seem to be relevant experiences among German EMS despite their perception of low numbers of emergency responses as mentally distressing. Paramedics who have been diagnosed with PTSD should be investigated for depression and vice versa, as correlations in both directions exist. Special attention should be paid to older employees, who have significantly lower well-being and higher PTSD rates compared to younger employees

Charakterköpfe

Die Schweiz hat mehr zu bieten als Schokolade und hohe Berge: Sie ist Ursprungsland grossartiger Ideen und Heimat vieler smarter und kantiger Persönlichkeiten. Menschen, die etwas bewirken, ihr Umfeld mitreißen und uns als Gesellschaft vorwärtsbringen. Frauen und Männer, die wissen, was es bedeutet, etwas in Bewegung bringen zu wollen, und die durchaus als Vorbild für viele von uns dienen können. 30 von ihnen werden durch Studentinnen und Studenten der ZHAW (Zürcher Hochschule für Angewandte Wissenschaften) in diesem Buch in Wort und Bild vorgestellt. Ob Spitzensportlerin, Unternehmer oder Bio-Winzer; ob Regisseurin, Professor für Nachhaltigkeit, Präsident der Käsegenossenschaft oder gar ein Mythos – die in diesem Buch versammelten Charakterköpfe stehen ein für ihre Ideale, sie realisieren ihre Ideen, berichten von Erfolgen wie Niederlagen. Sie sprechen offen mit den jungen Studierenden, stellen sich auch kritischen Fragen und lassen sich »über die Schulter« schauen. Ausgewählt wurden sie von den jungen Studierenden selbst, berücksichtigt wurden Charakterköpfe aus allen Lebensbereichen: Bildung & Wissenschaft, Klima & Natur, Kunst & Kultur, Sport & Bewegung, Soziales & NGO, Wirtschaft & Unternehmertum. Entstanden sind anregende, packende Porträts von Menschen, die sich engagieren, die nicht aufgeben und die erfahren haben, wie sie ihre Fähigkeiten sinnvoll nutzen können. Sie repräsentieren Vielfalt, wie sie in der Schweiz heute gelebt wird