. 2012 Updated stomatal flux and flux-effect models for wheat for quantifying effects of ozone on grain yield, grain mass and protein yield. Environmental Pollution, 165. 147-157. 10.1016Pollution, 165. 147-157. 10. /j.envpol.2012 Contact CEH NORA team at noraceh@ceh.ac.ukThe NERC and CEH trademarks and logos ('the Trademarks') are registered trademarks of NERC in the UK and other countries, and may not be used without the prior written consent of the Trademark owner. Field measurements and open-top chamber experiments using nine current European winter wheat 2 cultivars provided a data set that was used to revise and improve the parameterisation of a stomatal 3 conductance model for wheat, including a revised value for maximum stomatal conductance and 4 new functions for phenology and soil moisture. For the calculation of stomatal conductance for 5 ozone a diffusivity ratio between O 3 and H 2 O in air of 0.663 was applied, based on a critical review 6 of the literature. By applying the improved parameterisation for stomatal conductance, new flux-7 effect relationships for grain yield, grain mass and protein yield were developed for use in ozone 8 risk assessments including effects on food security. An example of application of the flux model at 9the local scale in Germany shows that negative effects of ozone on wheat grain yield were likely 10 each year and on protein yield in most years since the mid 1980s. 11 12 Keywords: Ozone, diffusivity ratio, stomatal flux, flux-effect models, wheat, food security 13 14Capsule 15Improved parameterizations of ozone stomatal conductance model for wheat and new ozone flux-16 effect relationships for risk assessments.

More attention will have to be paid to research and development needs regarding the provision of care to severely chronically ill and technology-dependent patients beyond the scope of individual health care sectors, organizations or professions.

The results improve the basis of the current debate in Germany about the development and reorganisation of the profiles of health professions and their qualification in a European context.

Zusammenfassung Einleitung In Deutschland gibt es zunehmend mehr beatmete und vergleichbar technikabhängige Patienten, die in der eigenen Häuslichkeit oder in Wohngemeinschaften versorgt werden. Fragen der Patientensicherheit wurden in diesem Kontext noch kaum wissenschaftlich beleuchtet. Anknüpfend an eine Befragung von Patienten und Angehörigen wurde die Perspektive professioneller Akteure auf das Thema Sicherheit in der häuslichen Intensivversorgung erkundet. Methodik Im Rahmen einer qualitativen Versorgungsforschungsstudie wurden professionelle Akteure in 6 heterogenen, nicht-natürlichen Focus Groups mit Erfahrungen und Sichtweisen von beatmeten Patienten und deren Angehörigen konfrontiert und nach ihren Perspektiven auf das Thema Patientensicherheit in der häuslichen Intensivversorgung befragt. Die erhobenen Daten wurden diskurs- sowie inhaltsanalytisch ausgewertet. Ergebnisse Die von den Patienten und deren Angehörigen angesprochenen subjektiven Sicherheitsdimensionen werden in vielerlei Hinsicht auch von den professionellen Akteuren als wichtig erachtet. Forderungen von Angehörigen nach mehr Partizipation werden aber eher skeptisch betrachtet. Die Sicherheit in der häuslichen Intensivversorgung sehen sie durch Kooperations- und Koordinationsmängel, Fachkräftemangel und Qualifikationsdefizite gefährdet. Insbesondere auf Seiten der Pflegenden, die zentrale Aufgaben der Versorgung übernehmen und denen damit besondere Verantwortung für die Patientensicherheit zugeschrieben wird, werden entsprechende Herausforderungen gesehen. Schlussfolgerungen Die Ergebnisse bieten Anknüpfungspunkte für die Sicherheitsarbeit in der häuslichen Intensivversorgung. Sie unterstreichen u. a. die Notwendigkeit zur Entwicklung nutzerzentrierter Sicherheitskonzepte, einer Sicherheitskultur auf Organisationsebene sowie einer flankierenden rechtlichen Regulierung.

Background: The number of home mechanically ventilated (HMV) patients has been growing for years. However, little is known about requirements, processes and effects of advanced home care, provided in distance from clinics and doctors. To date, safety related aspects of the above mentioned issues have scarcely been examined. Aim: Users of advanced home care were asked about their experiences and about situations in which they felt safe or unsafe. The aim was to gain insights into the daily care provision, explore safety risks from the users’ point of view, and to develop new approaches to enhance patient safety in home care for the severely ill. Method: A qualitative explorative study has been carried out, based on semi-structured interviews (ventilated patients N = 21; relatives N = 15). Sampling, data collecting and data analysis were guided by principles of Grounded Theory. Results: Risk situations occur when (non-)verbal communication offers of HMV patients are overseen or misunderstood, patient- or technology related monitoring tasks are neglected, if coordination and collaboration requirements are undervalued and if negotiation processes as well as education and supervision needs are disregarded. Furthermore, nurses’ lack of competence, self-confidence and professionalism may produce risk situations. Conclusion: Listen carefully to patients and relatives can help to identify quality shortcomings in advanced home care, to prevent risk situations and to develop patient-centered safety concepts for this particular setting.

Intensive home care for ventilated patients is resource-intensive and cost-intensive and has received little attention also from a health economics perspective. Valid information and transparency about the cost structures are required for an effective and economic design and management of the long-term care of this patient group.

BackgroundThe number of patients depending on long-term invasive mechanical ventilation (IMV) has been increasing for several years. Anecdotal reports indicate heterogeneous health structures, opaque patient pathways, nontransparent and sometimes questionable practices in individual areas of care, inadequate quality standards and control mechanisms in Germany. However, there is hardly any empirical data on this topic.AimTo report findings from a qualitative study conducted as part of a complex research project to assess the appropriateness of care provided to IMV patients in Germany.MethodsThirteen semi-structured expert interviews were conducted with 22 health professionals providing care for IMV patients. The data analysis was conducted with MAXQDA according to the framework by Meuser and Nagel.ResultsInterviewees emphasized similar healthcare deficits. They considered health providers to be nontransparent and influenced by secondary interests. Quality of care is reported to be jeopardized by shortage of trained staff. Warranty of self-determination and participatory decision-making is not a matter of fact. Clarifying issues of sustaining life, quality of life and shaping the end of life is often ignored. The professionals are familiar with the patient pathways, allocation processes and responsibilities described in existing guidelines, but criticize the fact that they are not sufficiently binding. Accordingly, patient pathways are frequently individual results of experience-based, informal networking, and often left to chance.ConclusionsThe results point to a considerable need for action to reach an appropriate, integrated, patient-centered level of care for long-term IMV patients and ensure its quality.

Wandel der (pflegerischen) Langzeitversorgung -168 13.2 Situation in Deutschland -169 13.3 Situation im Ausland -171 13.4 Effekte hochschulisch qualifizierter Pflege (in der Langzeitversorgung) -173 13.5 Schlussfolgerungen -174 Literatur -175