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Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management. Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected? A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety. A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice. There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.

Zusammenfassung Hintergrund Polypharmazie und daraus resultierende Probleme führen zu erheblichen Belastungen bei den Betroffenen. Darüber hinaus lassen sich erhebliche Probleme bei der Medikamentenversorgung feststellen. Fragestellung Welche Interventionen und Programme zur Optimierung der Medikamentenversorgung liegen für die stationäre Langzeitpflege vor, und mit welchen Umsetzungsproblemen ist zu rechnen? Material und Methode Literaturrecherche zu Interventionsstudien, die in stationären Pflegeeinrichtungen in Deutschland durchgeführt wurden, mit dem Fokus auf der Optimierung der Medikamentenversorgung. Ergebnisse Sechs Programme mit Evaluationsergebnissen konnten identifiziert werden. Obwohl der Ansatz meist multimodal ist und mehrere Interventionsbereiche umfasst, wie Medikamentenbewertungen, Fort- und Weiterbildung sowie die Entwicklung von Hilfsmitteln, sind die Ergebnisse größtenteils enttäuschend. Lediglich in einer Studie konnten signifikante Auswirkungen auf die Gesamtzahl der Verschreibungen, bestimmte Medikamentengruppen und Outcome-Parameter wie Krankenhauseinweisungen belegt werden, wobei hierfür ein Selektionsbias zumindest mitverantwortlich sein könnte. Die größten Schwierigkeiten bestehen in der Umsetzung interdisziplinärer Zusammenarbeit und der Anwendung der in Reviews formulierten Medikamentenempfehlungen durch die zuständigen Ärzt*innen. Gleichzeitig wird die zentrale Rolle der Pflegenden im Gesamtprozess zu wenig beachtet und aktiv gefördert, was ein weiterer Grund für die Schwierigkeiten bei der Umsetzung in der Praxis sein könnte. Schlussfolgerungen Es zeigen sich fast keine signifikanten Veränderungen als Folge der in den gesichteten Studien durchgeführten Interventionen. Vor allem die interprofessionelle Kooperation, speziell die Kompetenzen der Pflegenden und die Zurückhaltung aufseiten der Ärzt*innen, müssten hierbei vermutlich noch stärker in den Blick genommen werden.

HintergrundPolypharmazie und daraus resultierende Probleme führen zu erheblichen Belastungen bei den Betroffenen. Darüber hinaus lassen sich erhebliche Probleme bei der Medikamentenversorgung feststellen.FragestellungWelche Interventionen und Programme zur Optimierung der Medikamentenversorgung liegen für die stationäre Langzeitpflege vor, und mit welchen Umsetzungsproblemen ist zu rechnen?Material und MethodeLiteraturrecherche zu Interventionsstudien, die in stationären Pflegeeinrichtungen in Deutschland durchgeführt wurden, mit dem Fokus auf der Optimierung der Medikamentenversorgung.ErgebnisseSechs Programme mit Evaluationsergebnissen konnten identifiziert werden. Obwohl der Ansatz meist multimodal ist und mehrere Interventionsbereiche umfasst, wie Medikamentenbewertungen, Fort- und Weiterbildung sowie die Entwicklung von Hilfsmitteln, sind die Ergebnisse größtenteils enttäuschend. Lediglich in einer Studie konnten signifikante Auswirkungen auf die Gesamtzahl der Verschreibungen, bestimmte Medikamentengruppen und Outcome-Parameter wie Krankenhauseinweisungen belegt werden, wobei hierfür ein Selektionsbias zumindest mitverantwortlich sein könnte. Die größten Schwierigkeiten bestehen in der Umsetzung interdisziplinärer Zusammenarbeit und der Anwendung der in Reviews formulierten Medikamentenempfehlungen durch die zuständigen Ärzt*innen. Gleichzeitig wird die zentrale Rolle der Pflegenden im Gesamtprozess zu wenig beachtet und aktiv gefördert, was ein weiterer Grund für die Schwierigkeiten bei der Umsetzung in der Praxis sein könnte.SchlussfolgerungenEs zeigen sich fast keine signifikanten Veränderungen als Folge der in den gesichteten Studien durchgeführten Interventionen. Vor allem die interprofessionelle Kooperation, speziell die Kompetenzen der Pflegenden und die Zurückhaltung aufseiten der Ärzt*innen, müssten hierbei vermutlich noch stärker in den Blick genommen werden.

In eukaryotes, DNA is packed inside the cell nucleus in the form of chromatin, which consists of DNA, proteins such as histones, and RNA. Euchromatin, which is permissive for transcription, is spatially organized into transcriptionally inactive domains interspersed with pockets of transcriptional activity. While transcription and RNA have been implicated in euchromatin organization, it remains unclear how their interplay forms and maintains transcription pockets. Here we combine theory and experiment to analyze the dynamics of euchromatin organization as pluripotent zebrafish cells exit mitosis and begin transcription. We show that accumulation of RNA induces formation of transcription pockets which displace transcriptionally inactive chromatin. We propose that the accumulating RNA recruits RNA-binding proteins that together tend to separate from transcriptionally inactive euchromatin. Full phase separation is prevented because RNA remains tethered to transcribed euchromatin through RNA polymerases. Instead, smaller scale microphases emerge that do not grow further and form the typical pattern of euchromatin organization. How euchromatin organisation and transcription are related is unclear. Here, the authors observe the dynamics of euchromatin organization showing that accumulating RNA recruits RNA-binding proteins that together with transcribed euchromatin separate from non-transcribed euchromatin, forming microphases.

Marine spatial planning (MSP) is often considered as a pragmatic approach to implement an ecosystem based management in order to manage marine space in a sustainable way. This requires the involvement of multiple actors and stakeholders at various governmental and societal levels. Several factors affect how well the integrated management of marine waters will be achieved, such as different governance settings (division of power between central and local governments), economic activities (and related priorities), external drivers, spatial scales, incentives and objectives, varying approaches to legislation and political will. We compared MSP in Belgium, Norway and the US to illustrate how the integration of stakeholders and governmental levels differs among these countries along the factors mentioned above. Horizontal integration (between sectors) is successful in all three countries, achieved through the use of neutral ‘round-table’ meeting places for all actors. Vertical integration between government levels varies, with Belgium and Norway having achieved full integration while the US lacks integration of the legislature due to sharp disagreements among stakeholders and unsuccessful partisan leadership. Success factors include political will and leadership, process transparency and stakeholder participation, and should be considered in all MSP development processes.

Biomolecular condensates enable cell compartmentalization by acting as membraneless organelles 1 . How cells control the interactions of condensates with other cellular structures such as membranes to drive morphological transitions remains poorly understood. We discovered that formation of a tight-junction belt, which is essential for sealing epithelial tissues, is driven by a wetting phenomenon that promotes the growth of a condensed ZO-1 layer 2 around the apical membrane interface. Using temporal proximity proteomics in combination with imaging and thermodynamic theory, we found that the polarity protein PATJ mediates a transition of ZO-1 into a condensed surface layer that elongates around the apical interface. In line with the experimental observations, our theory of condensate growth shows that the speed of elongation depends on the binding affinity of ZO-1 to the apical interface and is constant. Here, using PATJ mutations, we show that ZO-1 interface binding is necessary and sufficient for tight-junction belt formation. Our results demonstrate how cells exploit the collective biophysical properties of protein condensates at membrane interfaces to shape mesoscale structures. Experimental and theoretical results demonstrate that tight-junction formation depends on the growth of a condensed layer of ZO-1 proteins at the interface of the apical and lateral membrane, providing insight into self-assembly of complex mesoscale structures in cells.

In living cells, protein-rich condensates can wet the cell membrane and surfaces of membrane-bound organelles. Interestingly, many phase-separating proteins also bind to membranes leading to a molecular layer of bound molecules. Here we investigate how binding to membranes affects wetting, prewetting and surface phase transitions. We derive a thermodynamic theory for a three-dimensional bulk in the presence of a two-dimensional, flat membrane. At phase coexistence, we find that membrane binding facilitates complete wetting and thus lowers the wetting angle. Moreover, below the saturation concentration, binding facilitates the formation of a thick layer at the membrane and thereby shifts the prewetting phase transition far below the saturation concentration. The distinction between bound and unbound molecules near the surface leads to a large variety of surface states and complex surface phase diagrams with a rich topology of phase transitions. Our work suggests that surface phase transitions combined with molecular binding represent a versatile mechanism to control the formation of protein-rich domains at intra-cellular surfaces.

Biomolecules, such as proteins and nucleic acids, can phase separate in the cytoplasm of cells to form biomolecular condensates. Such condensates are often liquid-like droplets that can wet biological surfaces such as membranes. Many molecules that participate in phase separation can also reversibly bind to membrane surfaces. When a droplet wets a surface, molecules can diffuse inside and outside of the droplet or in the bound state on the surface. How the interplay between surface binding, diffusion in surface and bulk affects the wetting kinetics is not well understood. Here, we derive the governing equations using non-equilibrium thermodynamics by relating the thermodynamic fluxes and forces at the surface coupled to the bulk. We study the spreading dynamics in the presence of surface binding and find that binding speeds up wetting by nucleating a droplet inside the surface. Our results suggest that the wetting dynamics of droplets can be regulated by two-dimensional surface droplets in the surface-bound layer through changing the binding affinity to the surfaces. These findings are relevant both to engineering life-like systems with condensates and vesicles, and biomolecular condensates in living cells.