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To follow up on research conducted in several countries, in this paper, we look at the dilemmas middle-class parents face of being “good parents” by choosing the “best” school with a milieu-related environment for their child versus being “good citizens” by choosing a “local” public school with a large proportion of students from a working-class or migrant background. Analyzing semi-structured interviews with parents, the paper explores whether and how parents in Germany’s capital city of Berlin refer to this dilemma concerning primary school choice and how they resolve it and justify their decision. The parents interviewed applied strategies in deciding to be “good parents” or “good citizens” or at least to make it easier to solve the dilemma. All the strategies presented in other studies can be found in our sample as well. In addition, we identified two more parental strategies: the strategy of downward comparison and the strategy of choosing a private school. It is notable that the perceived proportion of children with a migrant background in the neighborhood played a major role in relation to the dilemma and the strategies chosen.

Der Beitrag untersucht anhand von Daten des IQB-Bildungstrends 2016 (N = 27.086 Schulerinnen und Schuler, N = 1395 Grundschulen) sowie einer qualitativen Zusatzuntersuchung (N = 115 Grundschulen), wie sich Schulen im Vergleich privat/offentlich und Stadt/Land bezuglich der sozialen Komposition der Schulerschaft und bereitgestellter extracurricularer Angebote unterscheiden. Hierbei zeigt sich, dass die Schulerschaft von Privatschulen positiv selegiert ist, aber auch Grundschulen in Stadten mit sozialer Segregation konfrontiert sind, die zusatzlich dadurch befordert werden konnte, dass extracurriculare Angebote bereitgestellt werden, die sich an den Vorlieben einer bestimmten Klientel orientieren. Abschliesend werden die Folgen schulischer Segregation und mogliche Losungsansatze diskutiert.

Schulwahl ist individuell. Warum Eltern eine bestimmte Grundschule fur ihr Kind wahlen, kann zahlreiche Ursachen und verschiedene Grunde haben. So ergeben sich individuelle Wege und Schulwahlprozesse, die sowohl den Besuch einer bestimmten Einzelschule zur Folge haben als auch zu unterschiedlichen Entscheidungen bezuglicher der Tragerschaft fuhren konnen. Im Folgenden wird die Wahl einer privaten Grundschule anhand von zehn Interviews, die mit der qualitativen Inhaltsanalyse ausgewertet wurden, naher beleuchtet. Ziel ist es zum einen mogliche Ausloser fur eine Abkehr vom staatlichen Schulsystem darzustellen, zum anderen eine Typisierung entlang der Begrundungsmechanismen und Schulwahlkriterien fur die Wahl einer bestimmten Privatschule zu erarbeiten, um die individuellen Schulwahlprozesse von Eltern in Berlin aufzuzeigen.

Objective To evaluate the perioperative course of urine levels of the renal damage biomarkers tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) and to evaluate the predictive value of elevated TIMP-2 × IGFBP7 concentrations to predict acute kidney injury (AKI) early after cardiac on-pump surgery. Design Prospective, observational cohort study. Setting University hospital. Participants The study comprised 110 consecutive patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) between January and March 2014. Interventions None. Measurements and Main Results Urinary TIMP-2 × IGFBP7 levels were quantified using a commercially available kit at the following measurement points: before surgery, 1 hour after starting CPB, 4 hours after weaning from CPB, and 24 hours after weaning from CPB (time points 1-4). Postoperative AKI was defined according to Kidney Disease Improving Global Outcomes criteria. AKI after cardiac surgery was diagnosed in 9 patients (8%). The perioperative course of TIMP-2 × IGFBP7 was significantly different in patients with and without postoperative AKI (p 0.40 (ng/mL) 2 /1,000 measured at 1 hour after starting CPB were found to be the optimal cut-off, with a sensitivity of 0.778 and a specificity of 0.641. The negative predictive value was 0.972. Conclusions Urine levels of TIMP-2 × IGFBP7 are predictive for AKI at an early time point (1 hour after starting CPB). Renal damage biomarkers such as TIMP-2 and IGFBP7 might be recommended as a supplement to traditionally used criteria of AKI prediction.

The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug-related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug-related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta-blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug-related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.

Anticholinergic drugs are known to cause physical and cognitive impairment, particularly in older patients. The total of all anticholinergic influences to which a patient is exposed is referred to as anticholinergic load. Because the anticholinergic load is defined in various ways, this review aimed to describe differences in the development and evaluation of available methods calculating the anticholinergic load. From September 2014 to August 2015, two reviewers performed a literature search in PubMed considering relevant items of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We aimed to identify articles which calculated the anticholinergic load with a scale or equation and investigated its association with patient-related outcomes. From the included studies, we descriptively analyzed the identification and scoring criteria of the scales and equations with a main emphasis on their association to the reported outcomes. Out of 465 articles, 55 were included referring to 12 scales and one equation. Main discrepancies were located in eight different identification criteria for anticholinergic drugs, two different scoring principles, and 118 tests used for assessing outcomes. The methods most frequently detecting a significant association between the anticholinergic load and outcomes took into account the drugs’ dosages and anticholinergic potencies. Interestingly, none of the methods included the patient’s susceptibility for anticholinergic effects and they only rarely considered modulators of drug exposure. Due to hugely varying tests for assessing outcomes, the methods are scarcely comparable. For a more valuable comparison, the anticholinergic load should be calculated with all scales and the equation and correlated with patient-related outcomes.

The present review assessed the evidence on risk factors for the occurrence of adverse health outcomes after discharge (i.e. unplanned readmission or adverse drug event after discharge) that are potentially modifiable by clinical pharmacist interventions. The findings were compared with patient characteristics reported in guidelines that supposedly indicate a high risk of drug‐related problems. First, guidelines and risk assessment tools were searched for patient characteristics indicating a high risk of drug‐related problems. Second, a systematic PubMed search was conducted to identify risk factors significantly associated with adverse health outcomes after discharge that are potentially modifiable by a clinical pharmacist intervention. After the PubMed search, 37 studies were included, reporting 16 risk factors. Only seven of 34 patient characteristics mentioned in pertinent guidelines corresponded to one of these risk factors. Diabetes mellitus (n = 11), chronic obstructive lung disease (n = 9), obesity (n = 7), smoking (n = 5) and polypharmacy (n = 5) were the risk factors reported most frequently in the studies. Additionally, single studies also found associations of adverse health outcomes with different drug classes {e.g. warfarin [hazard ratio 1.50; odds ratio (OR) 3.52], furosemide [OR 2.25] or high beta‐blocker starting doses [OR 3.10]}. Although several modifiable risk factors were found, many patient characteristics supposedly indicating a high risk of drug‐related problems were not part of the assessed risk factors in the context of an increased risk of adverse health outcomes after discharge. Therefore, an obligatory set of modifiable patient characteristics should be created and implemented in future studies investigating the risk for adverse health outcomes after discharge.

Segregation in schools and educational inequality can be caused by various issues: stratification of the school system, gender, ethnicity and social status related with personal resources like social networks, time, money, information, cultural preferences and their influence in decision making and school choice. But segregation in schools is deeply connected with neighbourhoods and the place of residence as well. Segregation practices and school choice decisions especially by middle class parents are linked to neighbourhood effects, the housing market, or spatial and socio-spatial opportunities.

Objective A patient's risk for anticholinergic adverse effects is frequently estimated by instruments evaluating the drugs included in his medication profile. It remains unknown, however, which characteristics should be included in such an assessment instrument aiming to reliably predict adverse anticholinergic outcomes. Design Cross-sectional study. Setting ESTHER cohort (Germany). Participants Home-dwelling participants (N = 2,761) aged between 60 and 87 years. Measurements The association between anticholinergic load calculated with nine different instruments and four anticholinergic adverse outcomes was investigated in univariate and multivariate analyses. Therefore, linear models complemented with Kendall's tau rank correlation coefficients (ԏ) were applied for continuous outcomes and generalized linear models were used to derive odds ratios (ORs) with 95% confidence intervals (CIs) for binary endpoints. Results Based on the respective identification criteria for anticholinergic drugs, the nine instruments identified between 245 (9%) and 866 (31%) anticholinergic drug users (mean age ± SD: 73 ± 6 years; Mini-Mental State Examination [MMSE] score: 28.3 ± 2.07; Barthel Index: 97.1 ± 7.5; 291 reporting falls; 29 taking laxatives [surrogate for constipation]). In the multivariate analysis, only two instruments indicated a significant association between anticholinergic load and all four outcomes. The instrument considering the prescribed dose showed the strongest association with MMSE scores (ԏ = −0.10), falls (OR: 2.30; 95% CI: 1.50–3.52), and the use of laxatives (OR: 3.11; 95% CI: 1.04–9.36). Conclusions Instruments most reliably predicted anticholinergicadverse events if they were either based on the drugs' serum anticholinergic activity and the suggestions of clinician experts or considered the actual prescribed dose.

Objective The anticholinergic activity (AA) assay is a common method to determine a patient's anticholinergic load. Several limitations, however, are expected when applying the AA assay to patients or using drug scales to estimate anticholinergic burden based on AA levels. This study aims to demonstrate common pitfalls in an experimental setting and outline their clinical consequences. Methods The AA was analyzed for five drugs with reported interaction with muscarinic receptors. Concentration-response curves were constructed for furosemide (weak anticholinergic), diphenhydramine (moderate anticholinergic), the strong anticholinergic amitriptyline and its metabolite nortriptyline, and the cholinergic pilocarpine. The Combination Index (CI) was used to assess the interaction of three drug combinations with amitriptyline. Results All compounds displaced the radioactive tracer from its receptor binding site in a concentration-dependent manner, and full displacement was reached for all compounds except furosemide (E max 16%). The CI indicated that amitriptyline and thioridazine have antagonistic effects (CI = 1.46) at low and synergistic effects (CI = 0.88) at higher concentrations (p Conclusion When the patient's anticholinergic load is estimated using AA levels, the actual exposure, combination of anticholinergic drugs, their active metabolites, and also drugs with an opposite pharmacologic action will contribute to AA levels, whereas weak anticholinergic drugs in therapeutic concentrations are rather negligible.

Ecotoxicology 24(6), 1385-1394 (2015). doi:10.1007/s10646-015-1490-0, Published by Springer Science + Business Media B.V, Dordrecht [u.a.]

Background The risk of physical and cognitive adverse events caused by the patient’s anticholinergic drugs is referred to as anticholinergic load. Currently, the anticholinergic load can be calculated according to 12 diverse scales, which use different principles for defining the anticholinergic properties of drugs. In addition, one equation (Drug Burden Index) is available which considers the actual prescribed dose. Purpose Due to varying identification and scoring criteria for anticholinergic drugs, the patient’s load calculated as the sum of the drugs’ scores differs with the scale used, thus questioning their usefulness. To illustrate the extent of variation, we applied the scales to five medication profiles typical of elderly patients. Material and methods We set up five exemplary medication profiles each containing between 2 and 4 anticholinergic drugs: regularly prescribed drugs (doxepine, amitriptyline), as needed medication (cetirizine) and specific dosage forms (fentanyl patch). The drugs’ anticholinergic properties were classified into scoring categories according to the scales and the resulting total load was calculated for each medication. Results The 12 scales included 17–154 drugs with scores ranging from 0.7 to 1470 (most scales: score 1–3). On average, the medications’ total load was calculated with 6 (of 12) scales as the drugs were not considered in all scales. Amitriptyline in medication one was the only drug rated similarly by 8 of 12 scales (score of 3). In medication two, the score for doxepine (0–50) and the total load (0–100) varied extensively. Medication profile three included as needed medication (score 0–2 for cetirizine) and medication four contained a specific dosage form (score 0–1 for fentanyl patch) both revealing a total load between 0 and 4. The anticholinergic drug tiotropium (medication five) is not considered in any scale and hence the total load varied only from 0 to 2. Conclusion The scales used revealed extensive differences in identifying and scoring anticholinergic drugs and yielded diverse load values in the set up medication profiles. Hence the anticholinergic load strongly depends on the scale used, and further research must clarify which concept of calculation best predicts anticholinergic load. Conflict of interest.

Disturbance of peroxisome function can lead to various degenerative diseases during ageing. Here, we show that in yeast deletion of PEX6, encoding a protein involved in a key step of peroxisomal protein import, results in an increased accumulation of reactive oxygen species and an enhanced loss of viability upon acetic acid treatment and during early stationary phase. Cell death of ageing-like yeast cells lacking PEX6 does not depend on the apoptotic key players Yca1p and Aif1p, but instead shows markers of necrosis. Thus, we conclude that loss of peroxisomal function leads to a form of necrotic cell death.