[Informed consent for surgery: clearly regulated by the patient rights law-significant uncertainty among medical students : Legal analysis and inventory of over 2500 medical students in Berlin as part of the Progress Test Medicine]. / Chirurgische Aufklärung: Klar geregelt durch das Patientenrechtegesetz ­ deutliche Unsicherheit bei Medizinstudierenden : Rechtsanalyse und Bestandsaufnahme bei über 2500 Berliner Medizinstudierenden im Rahmen des Progress Test Medizin.

BACKGROUND: Obtaining informed consent is a challenging task and is part of the educational objectives in the German NKLM. Teaching formats are inconsistent and time-consuming, with little emphasis on legal aspects, although they have moved into the focus of attention since the implementation of patient rights laws and play an important role in legal proceedings. OBJECTIVES: The aim of this study was the evaluation of medical students' knowledge about the legal aspects of obtaining informed consent. A legal analysis was performed, and the patient rights laws were reviewed with reference to implications for undergraduate medical education. MATERIALS AND METHODS: After the analysis of laws and jurisdiction, multiple-choice questions regarding the legal aspects of obtaining informed consent were created and placed in the Progress Test Medicine (PTM). A statistical analysis of the results of Berlin medical students was performed descriptively. RESULTS: The answers of 2625 (winter semester 2018/19) and 2409 (summer semester 2019) medical students in Berlin were analyzed. The rate of students who answered the questions about the procedures requiring informed consent and adequate time for consideration increased over time but did not reach comparable values to all PTM questions. Questions about required content were answered correctly by 30 to 60% of the students, regardless of their level of training; we did not see an increase along with the time of study. CONCLUSION: In our study, we were able to show that medical students of all educational levels show tentativeness when it comes to the legal aspects of obtaining informed consent. Yet, the legal framework offers room for new teaching formats like "Co-Action", introduced in this paper for the first time, where students acquire informed consent while being supervised by the medical doctor in charge.

Effect of team sports and resistance training on physical function, quality of life, and motivation in older adults.

The aim of this study was to investigate the effect of team sports and resistance training on physical function, psychological health, quality of life, and motivation in older untrained adults. Twenty-five untrained men and forty-seven untrained women aged 80 (range: 67-93) years were recruited. Fifty-one were assigned to a training group (TRG) of which twenty-five performed team training (TG) and twenty-six resistance training (RG). The remaining twenty-one were allocated to a control group (CG). TRG trained for 1 hour twice a week for 12 weeks. Compared with CG, TRG improved the number of arm curls within 30 seconds (P<.05) and 30-seconds chair stand (P<.05) during the intervention. In TRG, participation in training led to higher (P<.05) scores in the subscales psychological well-being, general quality of life, and health-related quality of life, as well as decreased anxiety and depression levels. No differences between changes in TG and RG were found over the intervention period, neither in physical function tests nor psychological questionnaires. Both TG and RG were highly motivated for training, but TG expressed a higher degree of enjoyment and intrinsic motivation mainly due to social interaction during the activity, whereas RG was more motivated by extrinsic factors like health and fitness benefits. In conclusion, both team training and resistance training improved physical function, psychological well-being, and quality of life. However, team sport training motivated the participants more by intrinsic factors than resistance training.

Effect of floorball training on blood lipids, body composition, muscle strength, and functional capacity of elderly men.

Floorball training consists of intense repeated exercise and may offer a motivating and social stimulating team activity in elderly individuals. However, the effect of floorball training in elderly adults on physiological adaptations important for health is not known. Thus, this study examined the effect of floorball training on blood lipids, muscle strength, body composition, and functional capacity of men aged 65-76 years. Thirty-nine recreational active men were randomized into a floorball group (FG; n = 22) or petanque group (PG; n = 17), in which training was performed 1 h twice a week for 12 weeks. In FG and PG, average heart rate (HR) during training was 80% and 57%, respectively, of maximal HR. In FG, plasma low-density lipoprotein (LDL) cholesterol and triglycerides were 11% and 8% lower (P < 0.05), respectively. Insulin resistance determined by homeostatic model assessment (HOMA-IR) was reduced (P < 0.05) by 18%. HR during submaximal cycling was 5% lower (P < 0.05), and maximal voluntary contraction force was 8% higher (P < 0.05). Total and visceral fat content was lowered (P < 0.05) by 5% and 14%, respectively, HR at rest was 8% lower (P < 0.05) and performance in four different functional capacity tests were better (P < 0.05) after compared to before the training period. No changes were observed in PG. In conclusion, 12 weeks of floorball training resulted in a number of favorable effects important for health and functional capacity, suggesting that floorball training can be used as a health-promoting activity in elderly men.

Girls with generalized joint hypermobility display changed muscle activity and postural sway during static balance tasks.

OBJECTIVES: To study knee muscle activity and static postural sway in girls with generalized joint hypermobility (GJH). METHOD: Sixteen girls with GJH and 11 girls with non-GJH (NGJH) aged 14 years, randomly recruited among schoolchildren, participated in this study. GJH inclusion criteria were: Beighton score minimum 6/9 and one hypermobile knee; for NGJH: Beighton score maximum 5/9 and no knees with hypermobility. The participants performed a static two-legged balance test with eyes open (2EO) and eyes closed (2EC) and a one-legged stance test with eyes open (1EO). Postural sway (centre of pressure path length, COPL) was calculated, along with rambling and trembling components. Surface electromyography (sEMG) from the quadriceps (Q), hamstrings (H), and gastrocnemius (G) muscles was recorded, expressed as a percentage of the maximum voluntary EMG (%MVE), and the co-contraction index (CCI) of Q, H, and G muscle activity was calculated. Knee function was self-reported using the Knee Injury and Osteoarthritis Outcome Score for children (KOOS-Child). RESULTS: GJH had a significantly lower lateral HQ CCI and a higher medial/lateral HQ CCI ratio in all balance tasks. Group mean EMG varied from 1.3%MVE in Q (during 2EO) to 15.7%MVE in G (during 1EO). GJH had larger postural sway length than NGJH during 2EC (COPL 1.64 vs. 1.37 m/min, p < 0.001). Rambling and trembling components did not differ between groups. CONCLUSIONS: Girls with GJH and at least one hypermobile knee performed, compared with NGJH, static balance tasks with higher medial knee muscle activity relative to the lateral activity, and larger postural sway when vision was eliminated. The short- and long-term consequences should be studied further.

Hydraulic properties of individual xylem vessels of Fraxinus americana.

Studies of the hydraulic properties of xylem vessels have been limited to measurements of whole plant or whole stem segments. This approach allows the longitudinal transport properties of the ensemble of vessels within a stem to be determined, but provides little information on radial transport. Here the xylem of Fraxinus americana L. has been examined using a new method that allows the transport properties of individual vessels to be examined. One goal of this study was to quantify transport parameters relevant to embolism repair. The longitudinal conductivity of vessel segments open at both ends (i.e. no end walls) agreed with values predicted by the Poiseuille equation. Radial specific conductance (conductance per unit area) was approximately six orders of magnitude lower than the longitudinal conductance of the vessel segment normalized by the cross-sectional area of the vessel lumen. There was a step increase in the radial specific conductance of previously gas-filled vessels when the delivery pressure exceeded 0.4 MPa. This is consistent with the idea that positive pressure, required for embolism repair, can be compartmentalized within a vessel if the bordered pit chambers are gas-filled. The diffusion coefficient for the movement of gas from a pressurized air-filled vessel was of the same order of magnitude as that for air diffusing through water (1.95 e(-9) m(2) s(-1)). Estimates of the time needed to displace all of the gas from an air-filled vessel were in the order of 20 min, suggesting that gas removal may not be a major limitation in embolism repair.

Hydrogel control of xylem hydraulic resistance in plants.

Increasing concentrations of ions flowing through the xylem of plants produce rapid, substantial, and reversible decreases in hydraulic resistance. Changes in hydraulic resistance in response to solution ion concentration, pH, and nonpolar solvents are consistent with this process being mediated by hydrogels. The effect is localized to intervessel bordered pits, suggesting that microchannels in the pit membranes are altered by the swelling and deswelling of pectins, which are known hydrogels. The existence of an ion-mediated response breaks the long-held paradigm of the xylem as a system of inert pipes and suggests a mechanism by which plants may regulate their internal flow regime.

Use of nursing homes in Baccalaureate nursing education.

Although the use of nursing homes in nursing education has been described in the published research, no current report exists outlining guidelines for faculty if they desire to use nursing homes for their undergraduate nursing courses. Thus, the purpose of this paper is to identify courses that are best taught in nursing homes and the approaches faculty can implement when using nursing homes for student experience. The use of nursing homes for the courses in fundamentals, leadership and management, research and community health is discussed. A step-by-step approach for faculty to initiate the use of nursing homes for undergraduate teaching is also provided. The nature of the faculty, the characteristics of nursing home settings and the characteristics within the community will affect students' learning experiences and effectiveness. Thus, it is important to consider nursing homes as appropriate for certain types of learning needs.

Water relations of coastal and estuarine Rhizophora mangle: xylem pressure potential and dynamics of embolism formation and repair.

Physiological traits related to water transport were studied in Rhizophora mangle (red mangrove) growing in coastal and estuarine sites in Hawaii. The magnitude of xylem pressure potential (P x), the vulnerability of xylem to cavitation, the frequency of embolized vessels in situ, and the capacity of R. mangle to repair embolized vessels were evaluated with conventional and recently developed techniques. The osmotic potential of the interstitial soil water (πsw) surrounding the roots of R. mangle was c. -2.6±5.52×10-3 and -0.4±6.13×10-3 MPa in the coastal and estuarine sites, respectively. Midday covered (non-transpiring) leaf water potentials (ΨL) determined with a pressure chamber were 0.6-0.8 MPa more positive than those of exposed, freely-transpiring leaves, and osmotic potential of the xylem sap (πx) ranged from -0.1 to -0.3 MPa. Consequently, estimated midday values of P x (calculated by subtracting πx from covered ΨL) were about 1 MPa more positive than ΨL determined on freely transpiring leaves. The differences in ΨL between covered and transpiring leaves were linearly related to the transpiration rates. The slope of this relationship was steeper for the coastal site, suggesting that the hydraulic resistance was larger in leaves of coastal R. mangle plants. This was confirmed by both hydraulic conductivity measurements on stem segments and high-pressure flowmeter studies made on excised leafy twigs. Based on two independent criteria, loss of hydraulic conductivity and proportions of gas- and liquid-filled vessels in cryo-scanning electron microscope (cryo-SEM) images, the xylem of R. mangle plants growing at the estuarine site was found to be more vulnerable to cavitation than that of plants growing at the coastal site. However, the cryo-SEM analyses suggested that cavitation occurred more readily in intact plants than in excised branches that were air-dried in the laboratory. Cryo-SEM analyses also revealed that, in both sites, the proportion of gas-filled vessels was 20-30% greater at midday than at dawn or during the late afternoon. Refilling of cavitated vessels thus occurred during the late afternoon when considerable tension was present in neighboring vessels. These results and results from pressure-volume relationships suggest that R. mangle adjusts hydraulic properties of the water-transport system, as well as the leaf osmotic potential, in concert with the environmental growing conditions.

Photosynthetic gas exchange and temperature-induced damage in seedlings of the tropical alpine species Argyroxiphium sandwicense.

The capacity of Argyroxiphium sandwicense (silverword) seedlings to acclimate photosynthetic processes to different growing temperatures, as well as the tolerance of A. sandwicense to temperatures ranging from -15 to 60° C, were analyzed in a combination of field and laboratory studies. Altitudinal changes in temperature were also analyzed in order to explain the observed spatial distribution of A. sandwicense. A. sandwicense (Asteraceae) is a giant rosette plant that grows at high elevation on two Hawaiian volcanoes, where nocturnal subzero temperatures frequently occur. In addition, the soil temperatures at midday in the open alpine vegetation can exceed 60° C. In marked contrast to this large diurnal temperature variation, the seasonal variation in temperature is very small due to the tropical maritime location of the Hawaiian archipelago. Diurnal changes of soil and air temperature as well as photosynthetic photon flux density were measured on Haleakala volcano during four months. Seedlings were grown in the laboratory, from seeds collected in ten different A. sandwicense populations on Haleakala volcano, and maintained in growth chambers at 15/5, 25/15, and 30/25° C day/night temperatures. Irreversible tissue damage was determined by measuring electrolyte leakage of leaf samples. For seedlings maintained at each of the three different day/night temperatures, tissue damage occurred at -10° C due to freezing and at about 50° C due to high temperatures. Tissue damage occurred immediately after ice nucleation suggesting that A. sandwicense seedlings tend to avoid ice formation by permanent supercooling. Seedlings maintained at different day/night temperatures had similar maximum photosynthetic rates (5 µmol m-2 s-1) and similar optimum temperatures for photosynthesis (about 16° C). Leaf dark respiration rates compared at identical temperatures, however, were substantially higher for seedlings maintained at low temperatures, but almost perfect homeostasis is observed when compared at their respective growing conditions. The lack of acclimation in terms of frost resistance and tolerance to high temperatures, as well as in terms of the optimum temperature for photosynthesis, may contribute to the restricted altitudinal range of A. sandwicense. The small seasonal temperature variations in the tropical environment where this species grows may have prevented the development of mechanisms for acclimation to longterm temperature changes.

Determinants of thermal balance in the Hawaiian giant rosette plant, Argyroxiphium sandwicense.

The effects of leaf pubescence and rosette geometry on thermal balance were studied in a subspecies of a Hawaiian giant rosette plant, Argyroxiphium sandwicense. This species, a member of the silversword alliance, grows above 2000 m elevation in the alpine zone of two Hawaiian volcanoes. Its highly pubescent leaves are very reflective (absorptance in the 400-700 nm waveband=0.44). Temperature of the expanded leaves was very similar to, or even lower than, air temperature during clear days, which was somewhat surprising given that solar radiation at the high elevation sites where this species grows can exceed 1100 W m-2. However, the temperature of the apical bud, which is located in the center of the parabolic rosette, was usually 25°C higher than air temperature at midday. Experimental manipulations in the field indicated that incoming solar radiation being focussed towards the center of the rosette resulted in higher temperatures of the apical bud. Attenuation of wind speed inside the rosette, which increased the thickness of the boundary layer surrounding the apical bud, also contributed to higher temperatures. The heating effect on the apical bud of the large parabolic rosette, which apparently enhances the rates of physiological processes in the developing leaves, may exclude the species from lower elevations by producing lethal tissue temperatures. Model simulations of apical bud temperatures at different elevations and laboratory estimates of the temperature threshold for permanent heat injury predicted that the lower altitude limit should be approximately 1900 m, which is reasonably close to the lower limit of distribution of A. sandwicense on Haleakala volcano.