Development and evaluation of a patient education programme for children, adolescents, and young adults with differences of sex development (DSD) and their parents: study protocol of Empower-DSD

Background: Differences in sexual development (DSD) are rare diseases, which affect the chromosomal, anatomical or gonadal sex differentiation. Although patient education is recommended as essential in a holistic care approach, standardised programmes are still lacking. The present protocol describes the aims, study design and methods of the Empower-DSD project, which developed an age-adapted multidisciplinary education programme to improve the diagnosis-specific knowledge, skills and empowerment of patients and their parents. Methods: The new patient education programme was developed for children, adolescents and young adults with congenital adrenal hyperplasia, Turner syndrome, Klinefelter syndrome or XX-/or XY-DSD and their parents. The quantitative and qualitative evaluation methods include standardised questionnaires, semi-structured interviews, and participatory observation. The main outcomes (assessed three and six months after the end of the programme) are health-related quality of life, disease burden, coping, and diagnosis-specific knowledge. The qualitative evaluation examines individual expectations and perceptions of the programme. The results of the quantitative and qualitative evaluation will be triangulated. Discussion: The study Empower-DSD was designed to reduce knowledge gaps regarding the feasibility, acceptance and effects of standardised patient education programmes for children and youth with DSD and their parents. A modular structured patient education programme with four generic and three diagnosis-specific modules based on the ModuS concept previously established for other chronic diseases was developed. The topics, learning objectives and recommended teaching methods are summarised in the structured curricula, one for each diagnosis and age group. At five study centres, 56 trainers were qualified for the implementation of the training programmes. A total of 336 subjects have been already enrolled in the study. The recruitment will go on until August 2022, the last follow-up survey is scheduled for February 2023. The results will help improve multidisciplinary and integrated care for children and youth with DSD and their families. Trial registration: German Clinical Trials Register, DRKS00023096. Registered 8 October 2020 - Retrospectively registered

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome.

X chromosomes are unusual in many regards, not least of which is their nonrandom gene content. The causes of this bias are commonly discussed in the context of sexual antagonism and the avoidance of activity in the male germline. Here, we examine the notion that, at least in some taxa, functionally biased gene content may more profoundly be shaped by limits imposed on gene expression owing to haploid expression of the X chromosome. Notably, if the X, as in primates, is transcribed at rates comparable to the ancestral rate (per promoter) prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia of DNA Elements (ENCODE) and data from the Functional Annotation of the Mammalian Genome (FANTOM5) project. As predicted, the maximal expression of human X-linked genes is much lower than that of genes on autosomes: on average, maximal expression is three times lower on the X chromosome than on autosomes. Similarly, autosome-to-X retroposition events are associated with lower maximal expression of retrogenes on the X than seen for X-to-autosome retrogenes on autosomes. Also as expected, X-linked genes have a lesser degree of increase in gene expression than autosomal ones (compared to the human/Chimpanzee common ancestor) if highly expressed, but not if lowly expressed. The traffic jam model also explains the known lower breadth of expression for genes on the X (and the Z of birds), as genes with broad expression are, on average, those with high maximal expression. As then further predicted, highly expressed tissue-specific genes are also rare on the X and broadly expressed genes on the X tend to be lowly expressed, both indicating that the trend is shaped by the maximal expression level not the breadth of expression per se. Importantly, a limit to the maximal expression level explains biased tissue of expression profiles of X-linked genes. Tissues whose tissue-specific genes are very highly expressed (e.g., secretory tissues, tissues abundant in structural proteins) are also tissues in which gene expression is relatively rare on the X chromosome. These trends cannot be fully accounted for in terms of alternative models of biased expression. In conclusion, the notion that it is hard for genes on the Therian X to be highly expressed, owing to transcriptional traffic jams, provides a simple yet robustly supported rationale of many peculiar features of X's gene content, gene expression, and evolution

Vertragsschluß im Internet unter besonderer Berücksichtigung der E-Commerce-Richtlinie

Ernst G. Vertragsschluß im Internet unter besonderer Berücksichtigung der E-Commerce-Richtlinie. Recht der Neuen Medien; 38. Hamburg: Kovac; 2007

I'm still here - Training for the Siblings of Chronically Ill or Handicapped Children

Background Siblings of chronically ill or handicapped children are exposed to increased stress as a result of their special life situation. This can lead to psychological abnormalities. International studies show that programs for siblings can reduce this risk. In Germany, there is a lack of compact educational programs for siblings. Such an offer was tested with this workshop. In the one-day group training, coping strategies were developed and disease knowledge conveyed in order to reduce fears. The parents receive parallel training. Methods Altogether 19 sibling workshops were held. Before and six weeks after the training, standardized questionnaires were used to record sibling distress, mental health problems, and their health-related quality of life as well as family burden. T-tests for dependent samples were used to check the changes before and after training. Results Ninety-two children (average age 9.6 years; 54% female) and their parents took part in the training. From the parents' point of view, 32.5% of the children initially had an increased risk of psychological distress because of the family situation. After the training, this was reduced to 25.3%. The mental health problems were significantly reduced, as was the overall family burden. According to the self-assessment, the quality of life of the children improved. Discussion The families seem to benefit from the compact training. The workshop was applicable for families of children with different diseases and in different settings

Transitionsorientierte Patientenschulung bei Adoleszenten und jungen Erwachsenen mit ADHS

Hintergrund: Der Übergang von der kind- zur erwachsenenzentrierten Behandlung birgt bei chronischen Erkrankungen zahlreiche Herausforderungen. Dies kann bei Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS) durch krankheitsspezifische Charakteristika zusätzlich erschwert werden. Ziel dieser Sekundäranalyse war die Evaluation eines Transitionsworkshops bei Betroffenen mit ADHS. Methodik: Insgesamt wurden 56 Adoleszente und junge Erwachsene mit ADHS (Alter M = 17.3 Jahre, SD = 1.1, 17.9 % weiblich) und ihre Eltern quasirandomisiert einer Kontroll- (KG, n = 28) oder Interventionsgruppe (IG, n = 28) zugewiesen. Die KG erhielt die reguläre medizinische Versorgung, während die IG zusätzlich an einem eineinhalbtägigen Transitionsworkshop (ModuS-T) teilnahm. Vor Beginn sowie vier Wochen nach der Intervention wurden die Transitionskompetenz mit der 'Transitionskompetenzskala' (TKS), die Patientenaktivierung mit der 'Patient Activation Measure 13 for Adolescents' (PAM® 13) und die Versorgungszufriedenheit mit dem 'Fragebogen zur Patientenzufriedenheit' (ZUF-8) erfasst. Ergebnisse: Die IG wies eine signifikant verbesserte Transitionskompetenz (p <= .001) gegenüber der KG auf. Hinsichtlich der Patientenaktivierung zeigte sich kein bedeutsamer Interventionseffekt (p = .194). Insgesamt wies die IG eine hohe Zufriedenheit mit dem Workshop auf. Diskussion: Bislang wurden Transitionsworkshops überwiegend bei somatischen Erkrankungen evaluiert. Diese Sekundäranalyse deutet darauf hin, dass ein generisch konzipierter Workshop auch bei psychischen Erkrankungen mit einer verbesserten Transitionskompetenz und hohen Versorgungszufriedenheit assoziiert ist. Die Integration derartiger Angebote in den Versorgungsalltag ist zu diskutieren

Native and artificial forisomes : functions and applications

Forisomes are remarkable protein bodies found exclusively in the phloem of the Fabaceae. When the phloem is wounded, forisomes are converted from a condensed to a dispersed state in an ATP-independent reaction triggered by Ca(2+), thereby plugging the sieve tubes and preventing the loss of photoassimilates. Potentially, forisomes are ideal biomaterials for technical devices because the conformational changes can be replicated in vitro and are fully reversible over a large number of cycles. However, the development of technical devices based on forisomes has been hampered by the laborious and time-consuming process of purifying native forisomes from plants. More recently, the problem has been overcome by the production of recombinant artificial forisomes. This is a milestone in the development of forisome-based devices, not only because large quantities of homogeneous forisomes can be produced on demand, but also because their properties can be tailored for particular applications. In this review, we discuss the physical and molecular properties of native and artificial forisomes, focusing on their current applications in technical devices and potential developments in the future

Assessing empowerment as multidimensional outcome of a patient education program for adolescents with chronic conditions:A latent differences core model

ObjectivesThe current study aims to examine the construct of empowerment in the context of a transition education program. Patient education programs strive to empower adolescents with chronic conditions to take responsibility for their own health care to manage their transition from pediatric to adult medicine. Our study aimed to identify the core components of patient empowerment and examined whether its components are responsive to a patient education program.MethodsData was collected in two longitudinal studies involving N = 723 adolescents with chronic conditions. We used Latent Difference Score models (LDSm) of: 1) self-efficacy (GSE), 2) transition competence (TCS), and 3) patient activation (PAM) to quantify the latent variable of patient empowerment (PE). Additionally, the LDSm were extended to analyze the effects of group affiliation (intervention vs. control) and participants' age on empowerment.ResultsPE was identifiable by the three components. The intervention group developed significantly higher scores of PE compared to the control group. Age (13-21 years) did not moderate the relation between group affiliation and PE.ConclusionsWe quantified PE successfully using a psychometric modeling of change. Patient empowerment is measureable and utilizable in the specific context of transition of adolescents with chronic conditions

Parental Disease Specific Knowledge and Its Impact on Health-Related Quality of Life

Objective: Structured education programs have been shown to improve somatic outcome and health-related quality of life (HRQOL) in a variety of chronic childhood diseases. Similar data are scarce in paediatric liver transplantation (pLTx). The purpose of this study was to examine the relationship of parental disease-specific knowledge and psychosocial disease outcome in patients after pLTx. Methods: Parents of 113 children (chronic liver disease n = 25, after pLTx n = 88) completed the transplant module of the HRQOL questionnaire PedsQL, the “Ulm quality of life inventory for parents of children with chronic diseases” ULQUI, and a tailor-made questionnaire to test disease-specific knowledge. Results: Parental knowledge was highest on the topic of “liver transplantation” and lowest in “basic background knowledge” (76% and 56% correct answers respectively). Knowledge performance was only marginally associated with HRQOL scores, with better knowledge being related to worse HRQOL outcomes. In contrast, self-estimation of knowledge performance showed significant positive correlations with both PedsQL and ULQUI results. Conclusion: Patient HRQOL and parental emotional wellbeing after pLTx are associated with positive self-estimation of parental disease-specific knowledge. Objective disease-specific knowledge has little impact on HRQOL. Parental education programs need to overcome language barriers and address self-efficacy in order to improve HRQOL after pLTx

P-proteins in Arabidopsis are heteromeric structures involved in rapid sieve tube sealing

Structural phloem proteins (P-proteins) are characteristic components of the sieve elements in all dicotyledonous and many monocotyledonous angiosperms. Tobacco P-proteins were recently evidenced to be encoded by the widespread SEO gene family, and tobacco SEO proteins were shown to be directly involved in sieve tube sealing thus preventing the loss of photosynthate. Analysis of the two Arabidopsis SEO proteins (AtSEOa and AtSEOb) indicated that the corresponding P-protein subunits do not act in a redundant manner. However, there are still pending questions regarding the interaction properties and specific functions of AtSEOa and AtSEOb as well as the general function of structural P-proteins in Arabidopsis. In this study, we characterized the Arabidopsis P-proteins in more detail. We used in planta bimolecular fluorescence complementation assays to confirm the predicted heteromeric interactions between AtSEOa and AtSEOb. Arabidopsis mutants depleted for one or both AtSEO proteins lacked the typical P-protein structures normally found in sieve elements, underlining the identity of AtSEO proteins as P-proteins and furthermore providing the means to determine the role of Arabidopsis P-proteins in sieve tube sealing. We therefore developed an assay based on phloem exudation. Mutants with reduced AtSEO expression levels lost twice as much photosynthate following injury as comparable wild-type plants, confirming that Arabidopsis P-proteins are indeed involved in sieve tube sealing