The consequences of growth hormone deficiency in adulthood, and the effects of growth hormone replacement

The availability of recombinant human growth hormone (GH) has resulted in investigation of the role of GH in adulthood and the effects of GH replacement in the GH-deficient adult. These studies have led to the recognition of a specific syndrome of GH-deficiency, characterized by symptoms, signs and investigative findings. Adults with long-standing growth hormone deficiency are often overweight, have altered body composition, with reduced lean body mass (LBM), increased fat mass (FM), reduced total body water and reduced bone mass. In addition, there is reduced physical and cardiac performance, altered substrate metabolism and an abnormal lipid profile predisposing to the development of cardiovascular disease. Adults with GH deficiency report reduced psychological well-being and quality of life. These changes may contribute to the morbidity and premature mortality observed in hypopituitary adults on conventional replacement therapy. GH treatment restores LBM, reduces FM, increases total body water and increases bone mass. Following GH therapy, increases are recorded in exercise capacity and protein synthesis, and "favourable" alterations occur in plasma lipids. In addition, psychological well-being and quality of life improve with replacement therapy. GH is well tolerated; adverse effects are largely related to fluid retention and respond to dose adjustment. It is likely that GH replacement will become standard therapy for the hypopituitary adult in the near future. The benefits of GH replacement in the GH-deficient adult have been unequivocally demonstrated in studies lasting up to 3 years. The results of longer term studies are awaited to determine whether these benefits are sustained over a lifetime.

Changing Europe and The Relevance of Care and The Caring Professions

The aim of the paper is to introduce the challenges of the international care debate of the last ten years in order to grasp basic social needs, to analyse their treatment in the public and private sphere and to look at the orientation of professional answers by the care-professions. The concept of care enhances the societal dealing with - or ignoring of - different forms of dependency on informal and formal personal and social services throughout the life-cycle (child-care, nursing sick or handicapped persons, supporting the elderly) and in special life situations (from help to lone mothers and their children, via help to drug-addicts to help for homeless people). All societies have different approaches to deal with these life-situations, they do so by employ-ing various mixtures of: familial support, mostly provided by women, social politics, organized by the state, public and/or private social services. This welfare-mix shows different combinations of private and public obligations, paid and und unpaid work, professional and laymen's tasks based on a specific understanding of mo-rality and justice embedded in the gender structure and intergenerational relationships. The importance of social work as a profession in this context differs according to the historical developments and cultural traditions. Characteristic for the profile of social work is the rele-vance of a care ethics and the existence of social rights, the tension of mothering and profes-sional methods, the relationship between help, denial and punishment and the ways of institu-tionalisation. The actuality of this debate is closely intertwined with the restructuring of societal bonds in the face of globalisation, the political reorganisation of states, the changes in the living to-gether of different generations and both sexes and the consequences for the organisation and contents of welfare. Looking at Germany and Eastern Europe two new phenomena of social relevance for the dis-cussion of care work and care needs can be taken as an example: the extent of cheap illegal women laborers travelling between east and west, especially Polish women working intermit-tendly in private care for old people and the highly organized traffiking of women from Russia to Germany to work in the sex business. The care debate entails a reframing of welfare issues in the light of social justice between classes, ethnicities and gender groups.

Differences in Internet Usage - Social Inequality and Informal Education

In the public debate the internet is regarded as a central resource for knowledge and information. Associated with this is the idea that everyone is able and even expected to serve himself or herself according to his or her own needs via this medium. Since more and more services are also delivered online the internet seems to allow its users to enjoy specific advantages in dealing with their everyday life. However, using the internet is based on a range of preconditions. New results of empirical and theoretical research indicate the rise of a social divide in this context. Within the internet, different ways of use can be identified alongside social inequalities. Boundaries of the "real life" are mirrored in the virtual space e.g. in terms of forms of communification and spaces for appropriation. These are not only shaped by invidual preferences but particularly by social structures and processes. In the context of the broader debate on education it is stated that formal educational structures are to be completed by arrangements which are structured in informal respectively nonformal ways. Particularly the internet is suggested to play an important role in this respect. However, the phenomenon of digital inequality points to limitations consolidated by effects of economic, social, and cultural ressources: Economical resources affect opportunities of access, priorities of everyday life shape respective intentions of internet use, social relationships have an impact on the support structures available and ways of appropriation reproduce a specific understanding of informal education ("informelle Bildung"). This produces an early stratification of opportunities especially for the subsequent generation and may lead to extensive inequalities regarding the distribution of advantages in terms of education. Thus the capacity of the virtual space in terms of participatory opportunities and democratic potentials raises concerns of major relevance with respect to social and educational policy. From the perspective of different disciplines involved in these issues it is essential to clarify this question in an empirical as well as in a theoretical way and to make it utilizable for a future-orientied practice. This article discusses central questions regarding young people's internet use and its implications for informal education and social service delivery on the basis of empirical findings. It introduces a methodological approach for this particular perspective and illustrates that the phenomena of digital divide and digital inequality are as much created by social processes as by technical issues.

Landscapes of Education and the New Role of Social Work International Models of How to Combine Formal, Non-formal and Informal Education

Landscapes of education are a new topic within the debate about adequate and just education and human development for everybody. In particular, children and youths from social classes affected by poverty, a lack of prospects or minimal schooling are a focal group that should be offered new approaches and opportunities of cognitive and social development by way of these landscapes of education. It has become apparent that the traditional school alone does not suffice to meet this need. There is no doubt that competency-based orientation and employability are core areas with the help of which the generation now growing up will manage the start of its professional career. In addition and by no means less important, the development involves individual, social, cultural and societal perspectives that can be combined under the term of human development. In this context, the Capability Approach elaborated by Amartya Sen and Martha Nussbaum has developed a more extensive concept of human development and related it to empirical instruments. Using the analytic concept of individual capabilities and societal opportunities they shaped a socio-political formula that should be adapted in particular to modern social work. Moreover, the Capability Approach offers a critical foil with regard to further development and revision of institutionalised approaches in education and human development.

Digital Systems for Open Access to Formal and Informal Learning

Today, Digital Systems and Services for Technology Supported Learning and Education are recognized as the key drivers to transform the way that individuals, groups and organizations “learn” and the way to “assess learning” in 21st Century. These transformations influence: Objectives - moving from acquiring new “knowledge” to developing new and relevant “competences”; Methods – moving from “classroom” based teaching to “context-aware” personalized learning; and Assessment – moving from “life-long” degrees and certifications to “on-demand” and “in-context” accreditation of qualifications. Within this context, promoting Open Access to Formal and Informal Learning, is currently a key issue in the public discourse and the global dialogue on Education, including Massive Open Online Courses (MOOCs) and Flipped School Classrooms. This volume on Digital Systems for Open Access to Formal and Informal Learning contributes to the international dialogue between researchers, technologists, practitioners and policy makers in Technology Supported Education and Learning. It addresses emerging issues related with both theory and practice, as well as, methods and technologies that can support Open Access to Formal and Informal Learning. In the twenty chapters contributed by international experts who are actively shaping the future of Educational Technology around the world, topics such as: - The evolution of University Open Courses in Transforming Learning - Supporting Open Access to Teaching and Learning of People with Disabilities - Assessing Student Learning in Online Courses - Digital Game-based Learning for School Education - Open Access to Virtual and Remote Labs for STEM Education - Teachers’ and Schools’ ICT Competence Profiling - Web-Based Education and Innovative Leadership in a K-12 International School Setting are presented. An in-depth blueprint of the promise, potential, and imminent future of the field, Digital Systems for Open Access to Formal and Informal Learning is necessary reading for researchers and practitioners, as well as, undergraduate and postgraduate students, in educational technology.

Consequences of the combined loss of BOK and BAK or BOK and BAX

The multi-BCL-2 homology domain pro-apoptotic BCL-2 family members BAK and BAX have critical roles in apoptosis. They are essential for mitochondrial outer-membrane permeabilization, leading to the release of apoptogenic factors such as cytochrome-c, which promote activation of the caspase cascade and cellular demolition. The BOK protein has extensive amino-acid sequence similarity to BAK and BAX and is expressed in diverse cell types, particularly those of the female reproductive tissues. The BOK-deficient mice have no readily discernible abnormalities, and its function therefore remains unresolved. We hypothesized that BOK may exert functions that overlap with those of BAK and/or BAX and examined this by generating Bok−/−Bak−/− and Bok−/−Bax−/− mice. Combined loss of BOK and BAK did not elicit any noticeable defects, although it remains possible that BOK and BAK have critical roles in developmental cell death that overlap with those of BAX. In most tissues examined, loss of BOK did not exacerbate the abnormalities caused by loss of BAX, such as defects in spermatogenesis or the increase in neuronal populations in the brain and retina. Notably, however, old Bok−/−Bax−/− females had abnormally increased numbers of oocytes from different stages of development, indicating that BOK may have a pro-apoptotic function overlapping with that of BAX in age-related follicular atresia.

The ecological consequences of megafaunal loss: giant tortoises and wetland biodiversity

The giant tortoises of the Galapagos have become greatly depleted since European discovery of the islands in the 16th Century, with populations declining from an estimated 250000 to between 8000 and 14000 in the 1970s. Successful tortoise conservation efforts have focused on species recovery, but ecosystem conservation and restoration requires a better understanding of the wider ecological consequences of this drastic reduction in the archipelago's only large native herbivore. We report the first evidence from palaeoecological records of coprophilous fungal spores of the formerly more extensive geographical range of giant tortoises in the highlands of Santa Cruz Island. Upland tortoise populations on Santa Cruz declined 500-700years ago, likely the result of human impact or possible climatic change. Former freshwater wetlands, a now limited habitat-type, were found to have converted to Sphagnum bogs concomitant with tortoise loss, subsequently leading to the decline of several now-rare or extinct plant species.