Assessment tools for counselling in long-term care at home

Beratung leistet einen wichtigen Beitrag zur Stärkung und Stabilisierung der häuslichen Pflege. Ein geeignetes Instrument zur Unterstützung einer systematischen Situationsanalyse und zur Erfassung des Beratungsbedarfes kann die Qualität der Beratung verbessern und auf ein einheitliches Niveau heben. Auf Basis einer systematischen Literaturrecherche werden in diesem Beitrag acht Assessmentinstrumente vorgestellt, die für die Beratungsangebote nach SGB XI in Frage kommen. Dabei zeigt sich Entwicklungsbedarf für ein Instrument, welches die Besonderheiten des intrapersonalen Beratungsprozesses berücksichtigt und unabhängig vom gesetzlich definierten Beratungsanlass zum Einsatz kommen kann.Counselling services contribute to strengthening and stabilising home care arrangements. Using an appropriate assessment instrument to support a systematic analysis of the care situation and the counselling needs may lead to improved and consistent quality of counselling services. Based on a systematic literature search, this paper presents eight assessment tools that can be used for counselling services within the regulatory framework of the German long-term care insurance system. It shows a need for the development of an assessment tool that takes into account the special features of the intra-personal counselling process and can be used independently of the legally defined reason for counselling

Biophysical properties of different GCAP1 Mutants associated with cone dystrophy

In the photoreceptor cell many processes are regulated by proteins, which are directly affected by the intracellular Ca2+ concentration. Among these calcium sensor proteins the guanylate cyclase-activating proteins (GCAPs) play a crucial role in the restoration of the dark adapted state of the photoreceptor cell. Subtle changes of the biophysical properties of GCAPs due to mutations can lead to a disturbed restoration of the dark adapted state and therefore to retinal dysfunction. Different mutations in the gene encoding for GCAP1 were found in patients suffering from cone dystrophies. How do these mutations change the biophysical and biochemical properties of the GCAPs? To address this question we heterologously expressed and purified the proteins and accessed these properties using different techniques. Ca2+ binding constants and -enthalpies of the GCAP1 mutants causing cone dystrophy, namely E89K, D100E, L151F and G159V were determined by isothermal titration calorimetry (ITC), showing a shift of Ca2+ affinity and binding enthalpy for all the mutants compared to the wildtype. The Ca2+-related conformational change was monitored by a recently presented technique based on the surface plasmon resonance phenomenon (SPR). With this technique a real time determination of conformational transition in GCAPs was achieved. In addition, the calcium sensor protein in muscle cells, troponin C, was used for control recordings. For example, the Ca2+-induced change of the hydrodynamic shell of troponin C and of GCAPs were determined by dynamic light scattering (DLS). Our results using the SPR technique opened up a broad range of applications, not limited to calcium sensor proteins in the phototransduction cascade

Structural effects of Mg2+ on the regulatory states of three neuronal calcium sensors operating in vertebrate phototransduction

The effects of physiological concentration of magnesium on the switch states of the neuronal calcium sensor proteins recoverin, GCAP1 and GCAP2 were investigated. Isothermal titration calorimetry was applied for binding studies. Circular dichroism spectroscopy was used to characterize protein thermal stability, secondary and tertiary structure in conditions of high and low [Ca(2+)], mimicking respectively the dark-adapted and light-exposed photoreceptor states during the phototransduction cascade. Further, molecular dynamics (MD) simulations were run to investigate the dynamical structural properties of GCAP1 in its activator, inhibitor and putative transitory states. Our results confirmed that Mg(2+) is unable to trigger the typical Ca(2+)-induced conformational change of recoverin (myristoyl switch) while it decreases its thermal stability. Interestingly, Mg(2+) seems to affect the conformation of GCAP2 both at high and low [Ca(2+)], however the variations are more substantial for myristoylated GCAP2 in the absence of Ca(2+). GCAP1 is responsive to Mg(2+) only in its low [Ca(2+)] state and Mg(2+)-GCAP1 tertiary structure slightly differs from both apo and Ca(2+)-bound states. Finally, MD simulations suggest that the GCAP1 state harboring one Mg(2+) ion bound to EF2 acquires structural characteristics that are thought to be relevant for the activation of the guanylate cyclase. Moreover, all the putative Mg(2+)-bound states of myristoylated GCAP1 are structurally less flexible than Ca(2+)-bound states. GCAP1 acquires a more compact tertiary structure that is less accessible to the solvent, thereby inducing a different conformation to the myristoyl moiety, which might be crucial for the activation of the guanylate cyclase. This article is part of a Special Issue entitled: 13th European Symposium on Calcium.The effects of physiological concentration of magnesium on the switch states of the neuronal calcium sensor proteins recoverin, GCAP1 and GCAP2 were investigated. Isothermal titration calorimetry was applied for binding studies. Circular dichroism spectroscopy was used to characterize protein thermal stability, secondary and tertiary structure in conditions of high and low [Ca2+], mimicking respectively the dark-adapted and light-exposed photoreceptor states during the phototransduction cascade. Further, molecular dynamics (MD) simulations were run to investigate the dynamical structural properties of GCAP1 in its activator, inhibitor and putative transitory states.Our results confirmed that Mg2+ is unable to trigger the typical Ca2+-induced conformational change of recoverin (myristoyl switch) while it decreases its thermal stability. Interestingly, Mg2+ seems to affect the conformation of GCAP2 both at high and low [Ca2+], however the variations are more substantial for myristoylated GCAP2 in the absence of Ca2+. GCAP1 is responsive to Mg2+ only in its low [Ca2+] state and Mg2+-GCAP1 tertiary structure slightly differs from both apo and Ca2+-bound states. Finally, MD simulations suggest that the GCAP1 state harboring one Mg2+ ion bound to EF2 acquires structural characteristics that are thought to be relevant for the activation of the guanylate cyclase. Moreover, all the putative Mg2+-bound states of myristoylated GCAP1 are structurally less flexible than Ca2+-bound states. GCAP1 acquires a more compact tertiary structure that is less accessible to the solvent, thereby inducing a different conformation to the myristoyl moiety, which might be crucial for the activation of the guanylate cyclase. This article is part of a Special Issue entitled: 13th European Symposium on Calcium. (C) 2014 Elsevier B.V. All rights reserved

Structural effects of Mg2+ on the regulatory states of Neuronal Calcium Sensors operating in vertebrate phototransduction

Several lines of evidence suggest that free Mg2+ plays an important role in phototransduction, as the Neuronal Calcium Sensors (NCS) Recoverin and Guanylate Cyclase Activating Proteins 1 and 2 (GCAP1 and GCAP2) are also capable of binding Mg2+ via their EF-hand motifs. Previous studies showed that a Mg2+ -bound state is required for GCAP1 in order to activate GC and that Recoverin binds Mg2+ without triggering its physiological conformational change. No structural studies were performed so far about GCAP2, for which the effects that Mg2+ could exert were only hypothesized. Here we compared the effects of physiological [Mg2+] (1 mM) on the switch states of these three NCS in their myristoylated (myr) and non myristoylated (nonmyr) form over the extreme conditions of high and low [Ca2+], mimicking respectively dark and light states of the photoreceptor cell. We performed Circular Dichroism spectroscopy measurements to assess the differences in thermal stability, secondary and tertiary structure of all NCS in the aforementioned conditions. Intrinsic fluorescence spectroscopy titrations and Isothermal Titration Calorimetry were performed for monitoring the binding of Mg2+ to GCAP2. Molecular dynamics simulations (200 ns, all-atom force field) were performed to assess structural properties of GCAP1 in putatively activator, inhibitor and transitory states. Our results confirm that Mg2+ is unable to trigger the physiological conformational change of Recoverin (myristoyl switch) and that it decreases its thermal stability. Mg2+ induces a conformational change in GCAP2 both at high and low [Ca2+], however these variations are more substantial for apo-myrGCAP2. Apo-GCAP1 is responsive to Mg2+, acquiring a different tertiary structure from both apo and Ca2+-bound states, though this difference is lost when Ca2+ is saturating. GCAP1 seems to be stabilized by the presence of Mg2+ in solution, more notably its Ca2+-bound form. Molecular dynamics simulations point out that myrGCAP1 has a highly flexible loop (125-135) when at least one divalent cation is bound to EF-3. In line with experimental data, this is sufficient to stabilize the entire structure. Moreover all simulated transitory states show very similar dynamic properties, which differ from both apo and Ca2+- or Mg2+- loaded forms

Weiterentwicklung der gesetzlichen Qualitätssicherung in der Sozialen Pflegeversicherung

Seit Einführung der Pflegeversicherung wird intensiv zu Fragen der Qualitätssicherung der Pflege diskutiert und es hat vielfältige gesetzgeberische Aktivitäten gegeben, um Verfahren zu entwickeln, durch die ein Schutz pflegebedürftiger Menschen vor unsachgemäßer Pflege gewährleistet und eine Verbesserung der Pflegequalität erreicht werden kann. Der folgende Beitrag gibt einen Überblick über diese Aktivitäten und ihre Hintergründe. Im Fokus stehen dabei insbesondere die durch das Pflege-Weiterentwicklungsgesetz (PflWEG) und die Pflegestärkungsgesetze (PSG I und II) angestoßenen Entwicklungen.The introduction of the German long-term care insurance system has initiated a broad debate on quality assurance in long-term care. Several legal efforts have been made to develop procedures that ensure protection of people in need of long-term care against inappropriate professional services on the one hand and contribute to the improvement of nursing care. This chapter provides an overview over these activities and backgrounds. Particularly, developments caused by the reform acts of 2008 and 2015 will be addressed

Characterization of differently sized granule fractions of yellow pea, cowpea and chickpea starches after modification with acetic anhydride and vinyl acetate

The effect of reagent type on the properties of acetylated starches was studied for yellow pea, cowpea and chickpea starches after modification with acetic anhydride and vinyl acetate. Samples modified with vinyl acetate showed higher swelling volume and peak viscosity than those acetylated with acetic anhydride for the same starch. In addition, the reagents reacted differently towards granules having different sizes as present in un-fractionated starch. After sieving of the acetylated starches, the degree of substitution (DS) differed for the differently sized starch granules acetylated by the rapidly reacting acetic anhydride but not for the size fractions obtained from the starches acetylated by the slowly reacting vinyl acetate. Smaller size granule fractions exhibited larger swelling volume and higher peak viscosity as compared with the corresponding larger size fractions. The reagent type and granule size are important factors for pasting and swelling behaviours of acetylated granular starches

Conformational Changes in Calcium-Sensor Proteins under Molecular Crowding Conditions.

Fundamental components of signaling pathways are switch modes in key proteins that control start, duration, and ending of diverse signal transduction events. A large group of switch proteins are Ca2+ sensors, which undergo conformational changes in response to oscillating intracellular Ca2+ concentrations. Here we use dynamic light scattering and a recently developed approach based on surface plasmon resonance to compare the protein dynamics of a diverse set of prototypical Ca2+ -binding proteins including calmodulin, troponin C, recoverin, and guanylate cyclase-activating protein. Surface plasmon resonance biosensor technology allows monitoring conformational changes under molecular crowding conditions, yielding for each Ca2+ -sensor protein a fingerprint profile that reflects different hydrodynamic properties under changing Ca2+ conditions and is extremely sensitive to even fine alterations induced by point mutations. We see, for example, a correlation between surface plasmon resonance, dynamic light scattering, and size-exclusion chromatography data. Thus, changes in protein conformation correlate not only with the hydrodynamic size, but also with a rearrangement of the protein hydration shell and a change of the dielectric constant of water or of the protein-water interface. Our study provides insight into how rather small signaling proteins that have very similar three-dimensional folding patterns differ in their Ca2+ -occupied functional state under crowding conditions