Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey

Background: Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective: We aimed to assess European medical students' perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students' most pressing needs. Methods: The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results: The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions: This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties

RELATIVISTIC CORRECTIONS TO THE ELECTROMAGNETIC AND AXIAL MOMENTS OF NUCLEI AND OTHER COMPOSITE SYSTEMS

We calculate the electromagnetic and axial nuclear moments of the deuteron and triton as a function of their radius using a relativistic two-nucleon and three-nucleon model formulated on the light-cone. The results also provide an estimate of the nuclear binding corrections to helicity-dependent deep inelastic scattering sum rules. At large nucleon radius, the moments are given by the usual non-relativistic formulae modified by finite binding effects. At small radius, the moments take the canonical values given by the generalization of the Drell-Hearn-Gerasimov sum rule. In addition, as R-->0, the constituent helicities become completely disoriented, and the Gamow-Teller matrix element vanishes. Thus, in the pointlike limit MR-->0, the moments of a spin-one bound states coincide with the canonical couplings of elementary spin-one bosons of the Standard Model, mu=e/M, Q=-e/M^2, and g_A=0.Comment: 10 pages, uuencoded postscript file. To obtain a copy of this paper, send e-mail to [email protected] and ask for i

Mathematical Modeling of Protein Misfolding Mechanisms in Neurological Diseases: A Historical Overview

Protein misfolding refers to a process where proteins become structurally abnormal and lose their specific 3-dimensional spatial configuration. The histopathological presence of misfolded protein (MP) aggregates has been associated as the primary evidence of multiple neurological diseases, including Prion diseases, Alzheimer’s disease, Parkinson’s disease, and Creutzfeldt-Jacob disease. However, the exact mechanisms of MP aggregation and propagation, as well as their impact in the long-term patient’s clinical condition are still not well understood. With this aim, a variety of mathematical models has been proposed for a better insight into the kinetic rate laws that govern the microscopic processes of protein aggregation. Complementary, another class of large-scale models rely on modern molecular imaging techniques for describing the phenomenological effects of MP propagation over the whole brain. Unfortunately, those neuroimaging-based studies do not take full advantage of the tremendous capabilities offered by the chemical kinetics modeling approach. Actually, it has been barely acknowledged that the vast majority of large-scale models have foundations on previous mathematical approaches that describe the chemical kinetics of protein replication and propagation. The purpose of the current manuscript is to present a historical review about the development of mathematical models for describing both microscopic processes that occur during the MP aggregation and large-scale events that characterize the progression of neurodegenerative MP-mediated diseases

1997; 82-1

© F e r r a t a S t o r t i F o u n d a t i o n 65 that encompasses true biphenotypic leukemias as well as others which are ALL or AML with atypical expression of a single marker from another lineage. Cases described as phenotypic switch probably represent examples of biphenotypic acute leukemias originating from a primitive stem cell with the potential to differentiate along the lymphoid or myeloid lineage, with the pathway taken being determined by the therapy used. We have proposed a scoring system aimed at distinguishing cases of bona fide biphenotypic acute leukemia from those with aberrant expression of a marker from another lineage, eg. Ly+AML and My+ALL. This system is based on the number and degree of specificity of the markers (lymphoid and myeloid) expressed by the leukemic cells. 2 Morphology and cytochemistry In one third of the cases, the blasts resemble lymphoblasts (L1 or L2 morphology). Cytochemical staining with Sudan black B (SBB), MPO and ␣-naphthyl esterase (ANAE) are negative (< 3%+ blasts). The remaining cases can be classified as AML on the basis of standard morphology and cytochemistry because they show more than 3% blasts positive with SBB or MPO, or display a pattern of ANAE activity typical of monoblasts (diffuse, strong and sensitive to NaF). According to FAB criteria most of the latter cases are either M1 or M2 or, rarely, M4 and M5. We have not yet seen a case with biphenotypic features which corresponds to the M3, M6 or M7 subtypes. It is not unusual to identify two distinct blast populations in the same patient, one of small size with a high nucleus/cytoplasm ratio resembling lymphoblasts and the other larger with more abundant cytoplasm with or without granulation ( Immunological markers Diagnosis of biphenotypic acute leukemia is based on immunophenotyping. According to the lymphoid and myeloid markers expressed by the blasts, four groups can be distinguished. The most common are those in which the blasts coexpress myeloid and B-lymphoid, less often T-lymphoid antigens. Trilineage differentiation with expression of B, T and myeloid markers is rare and coexistence Acute biphenotypic leukemia of blasts expressing only B and T cell markers is very uncommon. Most cases are terminal deoxynucleotidyl transferase (TdT) positive and express early hemopoietic markers such as CD34 and class-II HLA-DR determinants. In cases of biphenotypic acute leukemia classified as ALL by light microscopy morphology and cytochemistry (SBB-, MPO-), MPO activity can be demonstrated using sensitive techniques on unfixed cells at the ultrastructural level 3 or with the anti-MPO monoclonal antibody. 5 These findings support the myeloid commitment of the blasts. The fact that MPO activity cannot be detected by light microscopy cytochemistry is related to the small amount of this enzyme, which is only seen by electron microscopy in very small granules and in cell membranes. Alternatively, it is possible that the blasts contain the enzyme as a proenzyme form, which nevertheless is detectable with the monoclonal antibody. In cases of biphenotypic acute leukemia presenting with morphological and cytochemical features of AML, there is a high incidence (c.50%) of rearrangement of the Ig-heavy chain gene and/or T cell receptor chain genes, further confirming the lymphoid commitment of the blasts at a genomic level (simultaneously with the myeloid features) 2 Cytogenetics There is no single chromosomal abnormality which is uniquely associated with biphenotypic acute leukemia. Our own data and those of others demonstrate that structural chromosome abnormalities are frequent and that there is a high incidence of the Philadelphia chromosome t(9;22), 7 Clinical features Biphenotypic acute leukemias may affect adults or children, particularly infants under 2 years old. They may present as de novo or, rarely, they become apparent during a relapse following anti-AML or ALL therapy. The WBC is often high and most cases have a varying proportion of circulating blasts. 8 There are no uniform criteria about whether to treat these cases as ALL or AML when they are diagnosed only by standard morphology and cytochemistry, or whether to use an approach which combines drugs that are effective for ALL and AML, 9 followed by bone marrow or mobilized peripheral stem cell transplantation in complete remission. 10 Extensive data on response to therapy and clinical outcome are not available; however, our impression based on cases treated at the RMH and from single cases reported in the literature is that of a poor outcome in both children and adults. This may be related to the underlying chromosome abnormality. Conclusions In summary, biphenotypic acute leukemia is an uncommon type of leukemia which probably arises in a multipotent progenitor cell with the capability of differentiating along both myeloid and lymphoid lineages. This is supported by: i) immunological, cytochemical and molecular involvement of genes and/or protein products present in lymphoid and myeloid cells; ii) cytogenetic findings such as the presence of the Philadelphia chromosome or the MLL gene at 11q23, and iii) the documented phenomenon of in vivo and in vitro phenotypic switch in some of the cases. Data are emerging that biphenotypic acute leukemia has a poor prognosis and thus is likely to require a more intensive treatment approach to achieve long-term complete remissions, probably obtainable only with high-dose therapy followed by an allo-or autograft, which may eradicate the disease permanently. © F e r r a t a S t o r t i F o u n d a t i o

Partial Correlation-Based Retinotopically Organized Resting-State Functional Connectivity Within and Between Areas of the Visual Cortex Reflects More Than Cortical Distance

Photograph of the exterior of the General Store and Café