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Aufgrund unterschiedlicher Zugänge und Ausbildungssysteme für Vollzeitstudierende und sogenannte Quer­einsteiger*innen entstand im österreichischen Schulwesen und Hochschulsektor ein Zweiklassen-Den­ken. Dadurch weitet sich ein Problemfeld für jene aus, die sich der Pädagogik erst auf einem späteren Bil­dungsweg widmen. Soll dem Stress entgegengewirkt werden, dem die Neo-Pädagog*innen aus­ge­setzt sind, muss es Ziel sein, dieses Zweiklassen-Denken wieder zu bereinigen und allen am Bildungs­pro­zess beteiligten Personen mit demselben Respekt und derselben Wertschätzung zu begegnen. Als hilf­reich hat sich auf diesem Weg die Implementation von Achtsamkeit herausgestellt, da die (angehen­­den) Lehrkräfte damit sich selbst und ihr Potenzial erkennen. So ist es ihnen möglich, sich selbst zu ach­ten und bewusst einen achtsamen Weg zum wertvollen und wertschätzenden Miteinander zu be­schrei­ten – sowohl im persönlichen Alltag als auch im universitären Bildungssystem.

In diesem Beitrag wird ein im Rahmen des Erasmus+ Projekts LS4VET (Lesson Study for Vocational Education and Training) entwickelter Online-Kurs vorgestellt, der dazu beitragen soll, die Lesson Study-Praxis im Bereich der Berufsbildung zu implementieren und so die Qualität der Lehr- und Lernprozesse in der beruflichen Bildung kontinuierlich zu verbessern. Lesson Study (LS) basiert auf der professionellen Kollaboration von Lehrkräften mit dem Ziel, das Lernen von Schüler*innen zu studieren und zu verbessern, was auch zur Weiterentwicklung der pädagogisch-didaktischen Kompetenzen der Lehrenden führt. Im Kontext von Schulentwicklung und Führung leistet der Lesson Study-Ansatz einen wichtigen Beitrag zur systematischen Qualitätsentwicklung und -sicherung und stellt eine wirksame Personalentwicklungsmaßnahme dar.

ZusammenfassungDer systemische Lupus erythematodes (SLE) ist eine Autoimmunerkrankung, die durch chronisch-rezidivierende Verläufe und ein breites Spektrum an klinischen Erscheinungsbildern gekennzeichnet ist. Pathophysiologisch wird dem B‑Lymphozyten, aufgrund seiner überschießenden Reaktion mit gestörter Autoantikörperproduktion, eine tragende Rolle in der Auslösung und der Aufrechterhaltung der Erkrankung zugeschrieben. Aufgrund unseres besseren Verständnisses über diese Krankheit und einer präziseren Labordiagnostik wurden 2019 die ACR(American College of Rheumatology)/EULAR(European Alliance of Associations for Rheumatology)-Klassifikationskriterien überarbeitet, um auch in der Frühphase des SLE Patient*innen rechtzeitig zu erkennen. Im Gegensatz zum diagnostischen Vorgehen sind neue Therapieansätze bisher nur begrenzt erfolgreich. Unsere Arbeitsgruppe beschäftigt sich intensiv mit der Charakterisierung der B‑Zell-Subpopulationen, ihrer Aktivität bei SLE sowie dem Ansprechen auf die medikamentöse Therapie. Ein erster Schritt war es, die verschiedenen B‑Zell-Subpopulationen im peripheren Blut (naive B‑Zellen, Prä- und Post-switch-B-Zellen, Gedächtnis-B-Zellen und Plasmablasten [Vorstufe von der Plasmazelle]) bei Patient*innen mit niedriger Krankheitsaktivität zu identifizieren und eine mögliche Korrelation zum weiteren Krankheitsverlauf des SLE zu eruieren. Es zeigte sich bei den Analysen, dass Patient*innen, die einen hohen Anteil an naiven B‑Zellen im Blut aufwiesen, nach 3 Jahren einen moderaten bis hochaktiven SLE hatten. Die Konsequenz daraus wäre, dass das therapeutische Ziel beim SLE neben der Induktion einer Remission bzw. einer niedrigen Erkrankungsaktivität auch die Verminderung der naiven B‑Zell-Population sein sollte. Dies müsste in einer prospektiven Studie aber noch bestätigt werden.

Context The effect of liraglutide in C-peptide–positive (C-pos) type 1 diabetes (T1D) patients during hypoglycemia remains unclear. Objective To investigate the effect of a 12-week liraglutide treatment on the body glucose fluxes during a hypoglycemic clamp in C-pos T1D patients and its impact on the alpha- and beta-cell responses during hypoglycemia. Design This was a randomized, double-blind, crossover study. Each C-pos T1D patient was allocated to the treatment sequence liraglutide/placebo or placebo/liraglutide with daily injections for 12 weeks adjunct to insulin treatment, separated by a 4-week washout period. Setting and Participants Fourteen T1D patients with fasting C-peptide ≥ 0.1 nmol/L. Intervention(s) All patients underwent a hyperinsulinemic-stepwise-hypoglycemic clamp with isotope tracer [plasma glucose (PG) plateaus: 5.5, 3.5, 2.5, and 3.9 mmol/L] after a 3-month liraglutide (1.2 mg) or placebo treatment. Main Outcome Measure(s) The responses of endogenous glucose production (EGP) and rate of peripheral glucose disposal (Rd) were similar for liraglutide and placebo treatment during the clamp. Results The numbers of hypoglycemic events were similar in both groups. At the clamp, mean glucagon levels were significantly lower at PG plateau 5.5 mmol/L in the liraglutide than in the placebo group but showed similar responses to hypoglycemia in both groups. Mean C-peptide levels were significantly higher at PG-plateaus 5.5 and 3.5 mmol/L after liraglutide treatment, but this effect was not reflected in EGP and Rd. Hemoglobin A1c and body weight were lower, and a trend for reduced insulin was seen after liraglutide treatment. Conclusions The results indicate that 3 months of liraglutide treatment does not promote or prolong hypoglycemia in C-pos T1D patients.

Introduction/Objectives: The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren's Syndrome (PSS). The EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient's symptom burden and has been used in several clinical trials. Surprisingly, the patient's perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow. Thus, we evaluated a newly developed assessment tool-the Primary Sjögren's Syndrome Quality of Life Questionnaire (PSS-QoL)—for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow.Methods: Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analyzed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer's test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). ESSDAI (EULAR Sjögren's Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) κ and λ, rheumatoid factor (RF) IgM and IgA were determined.Results: Data from 123 PSS patients were analyzed; 91.9% (n = 113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer's test (r = −0.31, p < 0.05) and SSF-test (r = −0.390, p < 0.01). In contrast, we found no significant correlation between ESSPRI-dryness and any objective dryness test. Lower perceived dryness was associated with higher immunological activity determined by increased levels of IgG, FLC and RF-IgA. Whereas patients with only subjective signs of dryness had lower immunological activity.Discussion: Patients' perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.

Introduction Scleroderma renal crisis (SRC) is a rare but one of the most recognised complications of systemic sclerosis (SSc). Corticosteroid (CS) use has been considered as a major risk factor for SRC. Several studies reported the efficacy of rituximab (RTX) with an acceptable safety profile in SSc. However, data on the long‐term effect of high‐dose CS concomitant to RTX on kidney function are lacking. Methods We retrospectively analysed SSc patients (n = 35) treated with a lower dosage and short‐interval RTX and concomitant high‐dose CS at the Department of Internal Medicine at the Medical University of Graz between 2010 and 2019. The kidney function was assessed using the estimated glomerular filtration rate (eGFR) at every RTX admission. The annual decline of kidney function was evaluated by linear mixed model analysis. Results At the RTX initiation, one patient had a decreased kidney function indicated by eGFR

Systemic sclerosis (SSc) is an intractable autoimmune disease characterized by vasculopathy and organ fibrosis. Autologous hematopoietic stem cell transplantation (AHSCT) should be considered for the treatment of selected patients with rapid progressive SSc at high risk of organ failure. It, however, remains elusive whether immunosuppressive therapies such as rituximab (RTX) are still necessary for such patients after AHSCT, especially in those with bad outcomes. In the present report, a 43-year-old man with diffuse cutaneous SSc received AHSCT. Despite AHSCT, SSc further progressed with progressive symptomatic heart failure with newly developed concomitant mitral and tricuspid valve insufficiency, thus the patient started on RTX 8 months after AHSCT. Shortly after initiation of RTX, clinical symptoms and organ functions ameliorated subsequently. Heart valve regurgitations were reversible after initiation of RTX treatment. Currently, the patient remains in a stable condition with significant improvement of clinical symptoms and organ functions. Reporting about therapies after AHSCT in SSc is a very important issue, as randomized controlled trials are lacking, and therefore this report adds to evidence that RTX can be considered as a treatment option in patients with SSc that do not respond to AHSCT.

Background:The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren’s Syndrome (PSS). The EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient’s symptom burden and has been used in several clinical trials. Surprisingly, the patient’s perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow.Objectives:Thus, we evaluated a newly developed assessment tool-the Primary Sjögren’s Syndrome Quality of Life Questionnaire (PSS-QoL) - for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow.Methods:Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analysed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer’s test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). Patients were categorized into groups based on the presence of subjective and/or objective dryness: 1) objective dryness only, 2) subjective dryness only, and 3) both, subjective and objective dryness. ESSDAI (EULAR Sjögren’s Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) ĸ and λ, rheumatoid factor (RF) IgM and IgA were determined.Results:Data from 123 PSS patients were analyzed; 91.9% (n=113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer’s test (r=-0.31, pTable 1.Comparison of perceived dryness-groups with clinical parametersPSS-QoL MouthpPSS-QoL Eyespsubjobj/subjsubjobj/subjEGA1.0 [0-5]2.0 [0-7]1.0 [0-3]2.0 [0-7]ESSDAI1.0 [0-144.0 [0-153.0 [0-74.0 [0-15nsESSPRI-pain3.0 [0-9]3.0 [0-10]ns4.0 [1-8]3.0 [0-10]RF-IgM19.0 [5-524]31.0 [7-417]ns10.0[5-33]26.0[7-524]FLC-λ15.1 [7.0-68.3]20.1 [2.6-124.0]13.4 [7.0-54.5]18.7[2.6-124.0]IgG11.9 [6.5-37.2]16.1 [7.4-33.8]ns12.8 [6.5-20.6]14.8[7.4-37.2]nsC40.2 [0.01-0.41]0.17 [0.00-0.43]0.2 [0.09-0.41]0.18 [0.00-0.43]nsRF-IgA11.0 [1-500]103 [0-500]4.5 [1-465]63 [0-500]C4=Complementfactor 4; EGA=Evaluators Global Assessment; ESSDAI=EULAR Sjögren Syndrome Disease Activity Index; ESSPRI=EULAR Sjögren Syndrome Patient Reported Index; FLC-λ=Free light chain Lambda; IgG=Immunoglobulin G; obj/subj=objective and subjective dryness-group; PSS-QoL=Primary Sjögren Syndrome Quality of Life Questionnaire; RF-IgA=rheumatoid factor Immunoglobulin A; RF-IgM=rheumatoid factor Immunoglobulin M; subj=subjective dryness-group.Conclusion:Patients’ perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.Disclosure of Interests:None declared

Background:B-cells play a major role in the pathogenesis and perpetuation of the immune response in systemic lupus erythematosus (SLE). So far, B-cell subtypes have been studied well, but the precise mechanisms of the B-cell alterations during disease activity and during remission, depending on different medication, are still unclear.Objectives:The aim of our study was to investigate the drug dependent alterations in the B-cell repertoire of SLE patients with low disease activity (SLEDAI – 2K ≤4).Methods:Peripheral blood samples from 39 patients suffering from SLE (mean±SD; age 43±13 years, 87.2% females, disease duration 11.1±7 years) were drawn over 2 years. All SLE patients were in remission or low disease activity (median±SE, SLEDAI of 2.0±1.5). B-cells were characterized using CD19, CD20, CD5, CD27 antibodies and were grouped in naïve (IgD+27-), non-switched memory (IgD+, CD27+), memory (IgD-,CD27+), B1 (CD5+27-) and MBL-like (CD5++) B-cells. A quantitative flow cytometric bead-based assay (QuantiBRITE PE kit from Becton Dickinson) was used for the estimation of CD19 antibodies bound per cell. Further, CD38 and CD86 antibodies were used to characterize the B-cell subsets. All cytometric measurements were performed using a standardized BD LSR Fortessa platform. After 3 years of follow-up, patients’ data about disease activity and current medication were obtained.Results:22 SLE patients were treated with hydroxychloroquine (85.8%) and 19 patients received mycophenolate mofetil (MMF; n=14; 54.6%) or azathioprine (AZA; n= 5; 19.5 %). 5 patients were treated with other DMARDs. Independently of hydroxychloroquine and/or MMF, no significant differences were seen in naïve, non-switched memory, post-switched memory, plasma blasts, B1- or MBL-like B-cells. Patients treated with AZA had significantly lower naïve B-cells (mean±SD, 39.3±6.7vs. 73.1±19.3 %; p = 0.028), but had significantly higher IgD-post switched B-cells (31.2±9.1 vs.12.5 ±9.2 %; p = 0.028, respectively) compared with no AZA-treatment. Interestingly, activated B-cells (5.5±1.5 vs. 1.8±1.1%; p = 0.009) were significantly higher in AZA-treated. After 3 years of follow-up, almost all patients were in remission (median±SE, SLEDAI of 2.0±2.0), except of 3 patients with a SLEDAI of ≥ 6. Interestingly, those patients had at baseline, statistically higher naïve B-cells (p = 0.041) and lower B1-like B-cells (p =0.020) compared with patients with low disease activity.Conclusion:Our results suggest that independently of hydroxychloroquine and/or MMF treatment, all patients with low disease activity had similar normal B-cell subsets. Interestingly, in the small group of patients who were treated with AZA, a reduced regeneration of B-cells was shown. Patients with higher disease and high naïve B-cells showed an increased disease activity after three years.Acknowledgments:The research was performed in “CBmed” and funded by the Austrian Federal Government within the COMET K1 Centre Program, Land Steiermark and Land Wien.Disclosure of Interests:None declared

Context Complete loss of β-cell function in patients with type 1 diabetes mellitus (T1DM) may lead to an increased risk of severe hypoglycemia. Objective We aimed to determine the impact of C-peptide status on glucagon response and endogenous glucose production (EGP) during hypoglycemia in patients with T1DM. Design and Setting We conducted an open, comparative trial. Patients Ten C-peptide positive (C-pos) and 11 matched C-peptide negative (C-neg) patients with T1DM were enrolled. Intervention Plasma glucose was normalized over the night fast, and after a steady-state (baseline) plateau all patients underwent a hyperinsulinemic, stepwise hypoglycemic clamp with glucose plateaus of 5.5, 3.5, and 2.5 mmol/L and a recovery phase of 4.0 mmol/L. Blood glucagon was measured with a specific and highly sensitive glucagon assay. EGP was determined with a stable isotope tracer technique. Main Outcome Measure Impact of C-peptide status on glucagon response and EGP during hypoglycemia. Results Glucagon concentrations were significantly lower in C-pos and C-neg patients than previously reported. At baseline, C-pos patients had higher glucagon concentrations than C-neg patients (8.39 ± 4.6 vs 4.19 ± 2.4 pmol/L, P = 0.016, mean ± standard deviation) but comparable EGP rates (2.13 ± 0.2 vs 2.04 ± 0.3 mg/kg/min, P < 0.391). In both groups, insulin suppressed glucagon levels, but hypoglycemia revealed significantly higher glucagon concentrations in C-pos than in C-neg patients. EGP was significantly higher in C-pos patients at hypoglycemia (2.5 mmol/L) compared with C-neg patients. Conclusions Glucagon concentrations and EGP during hypoglycemia were more pronounced in C-pos than in C-neg patients, which indicates that preserved β-cell function may contribute to counterregulation during hypoglycemia in patients with T1DM.

Continuous and flash glucose monitoring (GM) systems have been established in diabetes care. We compared the sensor performance of 3 commercially available GM systems. A total of 12 patients with type 1 diabetes were included in a single-centre, open-label study in which the sensor performance of the Abbott FreeStyle libre (Abbott), Dexcom G4 Platinum (Dexcom) and Medtronic MiniMed 640G (Medtronic) systems over 12 hours was compared during mimicked real-life conditions (meals, exercise, hypo- and hyperglycaemia). Sensor performance was determined by fulfilment of ISO 15197:2013 criteria, calculating mean absolute relative difference (MARD), and was also illustrated using Parkes error grid and Bland-Altman plots. Sensor performance during changes in metabolic variables (lactate, betahydroxybutyrate, glucagon, non-esterified-fatty-acids) was determined by Spearman's rank correlation coefficient testing. The systems fulfilled ISO 15197:2013 criteria by 73.2% (Abbott), 56.1% (Dexcom) and 52.0% (Medtronic). The MARDs ± standard deviation in the entire glycaemic range were 13.2% ± 10.9% (Abbott), 16.8% ± 12.3% (Dexcom) and 21.4% ± 17.6% (Medtronic), respectively. All sensors performed less accurately during hypoglycaemia and best during hyperglycaemia. We did not observe an influence of metabolic variables on sensor performance.