Variants of human chorionic gonadotropin from pregnant women and tumor patients recognized by monoclonal antibodies

In biological fluids, hCG and its free alpha- (hCG alpha) and beta-subunits (hCG beta), occur in multiple forms. These various forms differ at the molecular level primarily in glycosylation, but also differ in protein backbone modifications corresponding to the urinary low molecular weight fragment of the hCG beta-subunit (beta-core fragment). This microheterogeneous nature can be demonstrated by isoelectric focusing in which variants are separated into bands with different isoelectric points (pI). To determine whether such isoelectric variants differ in antigenicity and consequently might escape immunoassay detection due to overspecificity of monoclonal antibodies (MCA), urinary pregnancy hCG (NIH, CR123) and tumor hCG preparations, such as a tumor-specific acidic variant of hCG (hCGav) and the hCG beta-core fragment, were separated by isoelectric focusing in the absence or presence of 8 M urea, or by sodium docedyl sulfate-polyacrylamide gel electrophoresis and enzymatically immunostained using an MCA panel directed against 17 different hCG epitopes. MCA against 14 different epitopes accessible on holo-hCG recognized all pI variants of pregnancy holo-hCG or tumor-derived hCGav, as was true for the three MCA recognizing epitopes hidden on holo-hCG but accessible on the free subunits after hCG dissociation by urea. We conclude that each individual pI-isoform of holo-hCG and its free subunits expresses the entire set of epitopes recognized by our MCA panel. The carbohydrate moieties that form a biochemical basis for hCG heterogeneity seem to be neither of major antigenic relevance, nor are they structurally related to any particular epitope. Thus, various glycosylation forms of hCG, hCG alpha, hCG beta, and hCG beta-core in normal as well as in pathological samples should safely be detectable and measureable by immunoassays employing MCA with appropriate subunit specificity

Entwicklungstendenzen des deutschen Berufsbildungssystems und Folgerungen für die duale Ausbildung im Handwerk

Das Handwerk – und vor allem die Berufsausbildung im Handwerk – gelten als strukturkonservativ mit dem Ziel, Traditionen zu sichern. Nach wie vor spielt das »duale System« im Handwerk eine wichtige Rolle und nicht wenige Stimmen halten dieses für nicht mehr zeitgerecht, weil Fachkräfte nach dieser Auffassung nicht so ausgebildet werden, dass sie heutigen Mobilitäts- und Qualitätsanforderungen gerecht werden. Um diesem Vorwurf entgegen zu wirken, gibt es verschiedene Vorschläge für »Bildungsansätze im Handwerk«, die den handwerklichen, nationalen und internationalen Ansprüchen gerecht werden sollen. Dieser Spannungsbogen zwischen handwerklicher Tradition und heutigen Herausforderungen mit Blick auf die Berufsbildung wird in vorliegendem Band unter dem besonderen Gesichtspunkt der weiteren Entwicklung der Bildungszentren des Handwerks diskutiert. (DIPF/Orig.)Crafts and trade – and above all the vocational education and training (VET) within this field – is said to be structural-conservative in order to safeguard traditions. The »dual system« is still playing a predominant role in crafts and trade. Many critical voices think that this training system is no longer state-of-the-art and maintain that skilled workers today are not adequately trained to meet the current mobility and quality requirements. In order to counteract this allegation, there are several proposals for new »educational approaches in crafts and trade« aiming to meet the craft and trade related, national and international requirements. This spectrum between craft and trade tradition and current challenges with regard to VET are discussed in the present volume with special focus on the further development of the VET centers run by crafts and trade associations. (DIPF/orig.

Competency Proficiency Scaling

This chapter presents an overview of extant literature on competence proficiency scaling. To structure the field, the chapter distinguishes between three aspects of competence proficiency scaling: 1) methodological approaches to competence proficiency scaling and the methodological and conceptual critique of this phenomenon, 2) the contextual factors of competence proficiency scaling, including organizational and societal factors, and 3) the implications of competence proficiency scaling to the vocational and professional education and didactics. The chapter overviews a range of different approaches to competence proficiency scaling applied in the vocational education and training, higher education and human resource management by synthesizing the perspectives to competence proficiency scaling from the different disciplines, such as educations science, education sociology, work psychology, human resource management and development. Particular attention is paid to the variety of the functions and application fields of competence proficiency scaling, such as assessment of competence acquired in the learning and work process, identification and hierarchical structuring of the requirements of performance in the occupational fields, and identification of the potential of competence development and progression in the occupational fields

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201