Implementation of a digital health module for undergraduate medical students: A comparative study on knowledge and attitudes.

BACKGROUND: Digital competencies are more and more required in everyday work, and training future healthcare professionals in digital health is highly important. OBJECTIVE: Aim of this study was to assess medical students' gain of knowledge by participation in a teaching module "Digital Health", and to evaluate their attitudes towards digital health and its role in medical education. METHODS: Students of the module were asked to complete a questionnaire and a multiple-choice-test before and after completing the classes. Students of the same educational level in different modules served as reference group. RESULTS: 34 students took part (n= 17 "Digital Health group"; n= 17 "reference group"). There was no significant difference in pre-existing knowledge between the groups. After having completed the module, participants reached significantly higher scores, compared to their preexisting knowledge (p< 0.05) and the reference group (p< 0.05). Most students found that digital medicine is not sufficiently represented in undergraduate medical education, but will influence everyday work of physicians in the next five years. CONCLUSIONS: Students showed a high awareness for the impact of digital health on physicians' work. The results suggest that the format can sufficiently transfer knowledge about digital health. Teaching of digital knowledge and competencies should be firmly implemented into medical education to form digitally competent future doctors.

Universal distributions from non-Hermitian perturbation of zero modes.

Hermitian operators with exact zero modes subject to non-Hermitian perturbations are considered. Specific focus is on the distribution of the former zero eigenvalues of the Hermitian operators. The broadening of these zero modes is found to follow an elliptic Gaussian random matrix ensemble of fixed size, where the symmetry class of the perturbation determines the behavior of the modes. This distribution follows from a central limit theorem of matrices and is shown to be robust to deformations.

Universal broadening of zero modes: A general framework and identification.

We consider the smallest eigenvalues of perturbed Hermitian operators with zero modes, either topological or system specific. To leading order for small generic perturbation we show that the corresponding eigenvalues broaden to a Gaussian random matrix ensemble of size ν×ν, where ν is the number of zero modes. This observation unifies and extends a number of results within chiral random matrix theory and effective field theory and clarifies under which conditions they apply. The scaling of the former zero modes with the volume differs from the eigenvalues in the bulk, which we propose as an indicator to identify them in experiments. These results hold for all 10 symmetric spaces in the Altland-Zirnbauer classification and build on two facts. First, the broadened zero modes decouple from the bulk eigenvalues and, second, the mixing from eigenstates of the perturbation form a central limit theorem argument for matrices.

Social bonds facilitate cooperative resource sharing in wild chimpanzees.

Why share when access to benefits is uncertain is crucial to our understanding of the evolution of humans' extensive cooperation. Here, we investigated some of the different human sharing hypotheses and potential neuroendocrine mechanisms, in one of our closest living relatives, chimpanzees. The strongest predictor of sharing across food types was the presence of enduring and mutually preferred grooming partners, more than harassment, direct signalling, or trade. Moreover, urinary oxytocin levels were higher after the sharing of both individually and jointly acquired resources compared with controls. We conclude that the emotional connection inherent in social bonds was a key factor determining sharing patterns, with the oxytocinergic system potentially facilitating long-term cooperative exchanges. Testing for the role of social bonds in increasing predictability of sharing behaviour, a feature frequently overlooked, may help us to identify the evolutionary drivers of resource sharing and mechanisms that sustain delayed reciprocity between non-kin.

Urinary oxytocin levels in relation to post-conflict affiliations in wild male chimpanzees (Pan troglodytes verus).

Many animals living in social groups have evolved behaviors to resolve conflicts between group members, behaviors thought crucial for maintaining stable group life. Several hypotheses, based mainly on observational data, aim to explain how post-conflict (PC) affiliations, such as reconciliation and consolation, resolve conflicts by restoring relationships and/or alleviating anxiety. To examine a potential endocrinological mechanism of PC affiliations, we used an experimental-like procedure to investigate whether the oxytocinergic system is activated during naturally observed reconciliations, receiving bystander PC affiliations and aggressions not followed by PC affiliations in wild male chimpanzees. We compared urinary oxytocin (uOT) levels after reconciliations, receiving bystander PC affiliations or aggressions without affiliations with two control conditions: affiliations without previous aggression and after time periods without social interactions. We furthermore tested the 'valuable relationship' hypothesis of reconciliation, as well as the influence of relationship quality between individuals engaged in each of the three behavioral conditions involving aggression on uOT levels. We found that the probability to reconcile a conflict increased with increasing relationship quality between opponents, thus our results support the 'valuable relationship' hypothesis. However, relationship quality did not influence uOT levels, while behavioral condition had a significant effect on uOT levels. uOT levels after reconciliations, receiving bystander PC affiliations and affiliations not related to conflicts were higher than after aggressions alone and time periods without social interactions. Overall, our results indicate that the oxytocinergic system is activated during affiliative interactions, whether occurring as reconciliation, bystander PC affiliation or affiliation alone. We conclude that the oxytocinergic system, in addition to building and maintaining social relationships, also takes part in repairing them.

[The influence of visual rehabilitation on secondary depressive disorders due to age-related macular degeneration. A randomized controlled pilot study]. / Einfluss visueller Rehabilitation auf sekundäre depressive Störungen bei altersabhängiger Makuladegeneration. Eine randomisierte kontrollierte Pilotstudie.

BACKGROUND: Age-related macular degeneration (AMD) often leads to visual impairment, loss of reading ability, reduced quality of life and secondary depression. The present study examined if visual rehabilitation has a preventive effect on secondary depression in these patients. MATERIAL AND METHODS: In a controlled pilot study 20 patients were randomized into 2 groups whereby 9 underwent visual rehabilitation at first examination and 11 received magnifying visual aids only after 3 months. Psychosocial status was assessed by the geriatric depression scale (GDS) and the German version of the Centre for Epidemiologic Studies depression (CES-D) scale (main outcome parameter), cognitive status by the dementia detection test (DemTecT), minimental status (MMS) and quality of life by the National Eye Institute visual function questionnaire (NEI-VFQ 25). Ophthalmological examination included reading speed measurement by standardized texts (International Reading Speed Texts; IReST). RESULTS: Parameters of the CES-D scale, DemTect and the subitem exercise of social roles of the NEI-VFQ 25 emerged in a divergent manner. Patients of the rehabilitation group became less depressive and improved in cognitive and social abilities and in the control group vice versa. The interactive effect of group and time was statistically significant for all three tests. CONCLUSIONS: Visual rehabilitation has a positive impact on depression as well as cognitive status and quality of life in patients with AMD. The effects have to be confirmed in future studies with more patients and a longer observation period.

[Use of the film Keep on the open road in palliative care education of undergraduate medical students : Proof-of-concept study]. / Verwendung des Kinofilms Halt auf freier Strecke in der palliativmedizinischen Pflichtlehre von Medizinstudenten. "Proof-of-concept"-Studie.

OBJECTIVE: Recently palliative care has become an integral and compulsory part of undergraduate medical training in Germany. From 2014 onwards every German medical faculty must have developed and implemented undergraduate teaching in this cross-disciplinary medical field and to conduct examinations. At Witten/Herdecke University (Germany) this new cross-sectional course in palliative care was taught for the first time in 2011. The film "Keep on the open road" was incorporated and the use of this film as part of compulsory palliative care education was evaluated from the student perspective. METHOD: In two teaching units (1.5 h each) the film was watched with the students and discussed in the context of the palliative care setting with a special focus on psychosocial aspects. A semi-quantitative evaluation was performed after the debriefing. RESULTS: A total of 23 students participated in the course, 87 % (n = 20) evaluated the use of the film as unrestricted useful and 14 indicated a benefit from the film in terms of their medical attitude. Most of the students (n = 19, 83%) did not consider bed-side teaching to be more useful than the film unit. The free text answers underlined that primarily the multidisciplinary aspects of a palliative treatment situation and the meaning of a social environment were highlighted by the film. CONCLUSIONS: According to the evaluation of the students and the judgement of the participating teachers the use of the film is a suitable method to clarify complex medical, social and psychological aspects in palliative care. Especially at faculties with much larger numbers of students the film unit is thought to be a helpful method to teach psychosocial aspects and to promote development of attitude in palliative care. In future semesters further experience with the unit and the use of films in palliative care teaching will be collected.

First experiences with a new device for mechanical thrombectomy in acute basilar artery occlusion.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate our first results using a new device for mechanical thrombectomy in patients with acute basilar artery occlusion. METHODS: Between May 2009 and September 2010 a new device for aspiration thrombectomy (The Penumbra System™; Penumbra Inc., Alameda, Calif., USA) was used in 12 patients with acute basilar artery occlusion. We performed a retrospective review of these patients' medical records. RESULTS: One patient received endovascular treatment without intravenous (IV) thrombolysis because of infarction on the initial CT scan. Eleven of 12 patients received IV thrombolysis with rtPA followed by endovascular thrombectomy according to a bridging concept. After thrombolysis, the basilar artery was patent in 1 patient (9%), partially recanalized in 3 (27%) and still occluded in 7 (64%). The endovascular device could not access in 2 patients (17%). Among the remaining 10 patients, the patency rate after thrombectomy was 100%. The overall patency rate after treatment was 9 of 12 (75%) at the time of discharge. National Institute of Health Stroke Scale improved from a median of 27 to a median of 18 after treatment. Four patients died (33%). The survivors had a mean modified Rankin Scale before discharge of 2.3 (range 0-4). CONCLUSIONS: A bridging therapy with the combination of IV thrombolysis with recombinant tissue plasminogen activator and continuous aspiration thrombectomy seems to be a promising therapy strategy for acute basilar artery occlusion. Furthermore, our results confirm the advantage of the additional use of this new thrombectomy device, working with thrombus aspiration, with a satisfactory patency rate and a good clinical outcome.

[Negative-pressure pulmonary edema after general anaesthesia. Imaging diagnostic procedure]. / Unterdrucklungenödem nach Allgemeinanästhesie. Bildgebende Diagnostik im Verlauf.

Negative-pressure pulmonary edema is not a rare complication, e.g. in general anaesthesia and the diagnosis is made predominantly by clinical findings. When clinical findings are not clear radiology is necessary. This case report with detailed radiologic diagnostics, including follow-up, shows which radiologic signs are important for the clinical assessment to obtain a precise diagnosis and to start an adequate therapy.

Malonyl coenzyme A affects insulin-stimulated glucose transport in myotubes.

There seems to be an association between increased concentrations of malonyl coenzyme A (malonyl CoA) in skeletal muscle and diabetes and/or insulin resistance. The purpose of the current study was to test the hypothesis that treatments designed to manipulate malonyl CoA concentrations would affect insulin-stimulated glucose transport in cultured C2C12 myotubes. We assessed glucose transport after polyamine-mediated delivery of malonyl CoA to myotubes, after incubation with dichloroacetate (which reportedly increases malonyl CoA levels), or after exposure of myotubes to 2-bromopalmitate, a carnitine palmitoyl transferase I inhibitor. All three of these treatments prevented stimulation of glucose transport by insulin. We also assayed glucose transport after 30 min of inhibition of acetyl coenzyme A carboxylase (ACC), the enzyme which catalyzes the production of malonyl CoA. Three unrelated ACC inhibitors (diclofop, clethodim, and Pfizer CP-640186) all enhanced insulin-stimulated glucose transport. However, none of the treatments designed to manipulate malonyl CoA concentrations altered markers of proximal insulin signaling through Akt. The findings support the hypothesis that acute changes in malonyl CoA concentrations affect insulin action in muscle cells but suggest that the effects do not involve alterations in proximal insulin signaling.

Polyclonal expansion of T cells with the TCR V beta type of the tumour cell in lesions of cutaneous T-cell lymphoma: evidence for possible superantigen involvement.

The involvement of superantigens in the pathology of cutaneous T-cell lymphomas (CTCL) has been suggested before, but without unequivocal evidence for superantigen activity in the patients. Seeking evidence for superantigen activity we analysed clones and microdissected single cells isolated from the epidermis of early-stage lesions of a CTCL patient for their T-cell receptor (TCR) V beta expression and TCR V gamma gene rearrangements. The vast majority of these T cells expressed the TCR V beta family type of the tumour. From their TCR gamma gene rearrangements, however, these cells were polyclonal. The tumour cell clone accounted for about 60% of these cells, about 40% were of heterogeneous origin. This dominance of a single V beta family in the polyclonally expanded dermal T-cell populations implies superantigen activity in the CTCL lesions.

Probabilities of the sum of n ranks assigned to one of K objects by N independent judges.

Each of N judges independently assigns K distinct ranks to K objects. A method is described which provides the exact point probability, exact one-sided P value, and exact two-sided P value of the observed sum of N ranks for a specified object.

Effective rate equations for the overdamped motion in fluctuating potentials.

We discuss physical and mathematical aspects of the overdamped motion of a Brownian particle in fluctuating potentials. It is shown that such a system can be described quantitatively by fluctuating rates if the potential fluctuations are slow compared to relaxation within the minima of the potential, and if the position of the minima does not fluctuate. Effective rates can be calculated; they describe the long-time dynamics of the system. Furthermore, we show the existence of a stationary solution of the Fokker-Planck equation that describes the motion within the fluctuating potential under some general conditions. We also show that a stationary solution of the rate equations with fluctuating rates exists.

Noise-induced transport of two coupled particles.

We study the motion of two harmonically coupled particles in a sawtooth potential. The particles are subject to temporally correlated multiplicative noise. The stationary current is calculated in an expansion about the limit of rigid coupling. For two coupled particles a driving mechanism occurs which is different from the one occurring in the case of a single particle. In particular this mechanism does not need diffusion. Depending on the equilibrium distance of the particles and the coupling constant, a current reversal occurs. Possible relevance as a model for motor proteins is discussed.

Noise induced stability in fluctuating, bistable potentials

The overdamped motion of a Brownian particle in an asymmetric, bistable, fluctuating potential shows noise induced stability: For intermediate fluctuation rates the mean occupancy of minima with an energy above the absolute minimum is enhanced. The model works as a detector for potential fluctuations being not too fast and not too slow. This effect occurs due to the different time scales in the problem. We present a detailed analysis of this effect using the exact solution of the Fokker-Planck equation for a simple model. Further we show that for not too fast fluctuations the system can be well described by effective rate equations. The results of the rate equations agree quantitatively with the exact results.