The importance of scientific competencies in German medical curricula - the student perspective

Background: Scientific competencies are of great importance for physicians; not only for conducting reliable research, but also for patient care. However, there is growing concern that a lack of scientific competencies among physicians may lead to a deterioration in the quality on biomedical research. This study aims at assessing medical students’ perspectives on the implementation of scientific competency training in German medical curricula. Methods: An online survey was conducted in order to collect German medical students’ opinions on the importance of acquiring scientific competencies during their medical studies and to provide us with an assessment of their current levels of basic scientific competencies by having them conduct a self-evaluation. Moreover, we wanted to understand their perceptions of current curricular content and to receive suggestions for improving scientific competency training. Participants were reached via the mailing lists of the German Medical Students’ Association, as well as of local medical student committees, and the German Medical Students’ Associations social media channel on Facebook. Results: In total, 2380 medical students from across all 37 German medical faculties participated in the survey. The majority of students agreed that the ability to critically evaluate the relevant literature is an important competency for physicians, and that every student should conduct a research project during their medical studies. However, the students evaluated their scientific competencies as unsatisfactory, especially with regard to statistics and scientific writing. They were strongly in favor of receiving extended research training. Conclusion: Our study provides insight into German medical students’ self-perception in relation to both patient care and biomedical research, and makes recommendations for potential improvements in scientific training. The study demonstrates that scientific competencies are of great importance to medical students in Germany. Students are not lacking motivation for scientific practice and have numerous ideas for enhancing scientific teaching opportunities. Scientific training should follow a holistic approach based on three pillars: (i) a scientific core curriculum, (ii) intracurricular research projects, and (iii) special research programs for students strongly interested in medical research

Representation of social determinants of health in German medical education: protocol of a content analysis study

Introduction: Action on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO's Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health. Methods and analysis: We will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO's Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content. Ethics and dissemination: This study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal

A stochastic model for the evolution of the web allowing link deletion

Recently several authors have proposed stochastic evolutionary models for the growth of the web graph and other networks that give rise to power-law distributions. These models are based on the notion of preferential attachment leading to the ``rich get richer'' phenomenon. We present a generalisation of the basic model by allowing deletion of individual links and show that it also gives rise to a power-law distribution. We derive the mean-field equations for this stochastic model and show that by examining a snapshot of the distribution at the steady state of the model, we are able to tell whether any link deletion has taken place and estimate the link deletion probability. Our model enables us to gain some insight into the distribution of inlinks in the web graph, in particular it suggests a power-law exponent of approximately 2.15 rather than the widely published exponent of 2.1

Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review

Objectives: To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. Design: Rapid systematic review. Participants: Humans with viral respiratory infections, exposed to systemic NSAIDs. Primary outcomes: Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. Results: We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution

A Retrospective Study of Clinical and Histopathological Features of 81 Cases of Canine Apocrine Gland Adenocarcinoma of the Anal Sac: Independent Clinical and Histopathological Risk Factors Associated with Outcome.

Canine apocrine gland anal sac adenocarcinoma (AGASAC) is a malignant tumour with variable clinical progression. The objective of this study was to use robust multivariate models, based on models employed in human medical oncology, to establish clinical and histopathological risk factors of poor survival. Clinical data and imaging of 81 cases with AGASAC were reviewed. Tissue was available for histological review and immunohistochemistry in 49 cases. Tumour and lymph node size were determined using the response evaluation criteria in the solid tumours system (RECIST). Modelling revealed tumour size over 2 cm, lymph node size grouped in three tiers by the two thresholds 1.6 cm and 5 cm, surgical management, and radiotherapy were independent clinical variables associated with survival, irrespective of tumour stage. Tumour size over 1.3 cm and presence of distant metastasis were independent clinical variables associated with the first progression-free interval. The presence of the histopathological variables of tumour necrosis, a solid histological pattern, and vascular invasion in the primary tumour were independent risk factors of poor survival. Based upon these independent risk factors, scoring algorithms to predict survival in AGASAC patients are presented

Forward-Secure 0-RTT Goes Live: Implementation and Performance Analysis in QUIC

Modern cryptographic protocols, such as TLS 1.3 and QUIC, can send cryptographically protected data in zero round-trip times (0-RTT) , that is, without the need for a prior interactive handshake. Such protocols meet the demand for communication with minimal latency, but those currently deployed in practice achieve only rather weak security properties, as they may not achieve forward security for the first transmitted payload message and require additional countermeasures against replay attacks. Recently, 0-RTT protocols with full forward security and replay resilience have been proposed in the academic literature. These are based on puncturable encryption, which uses rather heavy building blocks, such as cryptographic pairings. Some constructions were claimed to have practical efficiency, but it is unclear how they compare concretely to protocols deployed in practice, and we currently do not have any benchmark results that new protocols can be compared with. We provide the first concrete performance analysis of a modern 0-RTT protocol with full forward security, by integrating the Bloom Filter Encryption scheme of Derler et al. (EUROCRYPT 2018) in the Chromium QUIC implementation and comparing it to Google\u27s original QUIC protocol. We find that for reasonable deployment parameters, the server CPU load increases approximately by a factor of eight and the memory consumption on the server increases significantly, but stays below 400 MB even for medium-scale deployments that handle up to 50K connections per day. The difference of the size of handshake messages is small enough that transmission time on the network is identical, and therefore not significant. We conclude that while current 0-RTT protocols with full forward security come with significant computational overhead, their use in practice is not infeasible, and may be used in applications where the increased CPU and memory load can be tolerated in exchange for full forward security and replay resilience on the cryptographic protocol level. Our results also serve as a first benchmark that can be used to assess the efficiency of 0-RTT protocols potentially developed in the future

Adenosine receptor 2B activity promotes autonomous growth, migration as well as vascularization of head and neck squamous cell carcinoma cells

Adenosine is a signaling molecule that exerts dual effects on tumor growth: while it inhibits immune cell function and thereby prevents surveillance by the immune system, it influences tumorigenesis directly via activation of adenosine receptors on tumor cells at the same time. However, the adenosine-mediated mechanisms affecting oncogenic processes particularly in head and neck squamous cell carcinomas (HNSCC) are not fully understood. Here, we investigated the role of adenosine receptor activity on HNSCC-derived cell lines. Targeting the adenosine receptor A2B (ADORA2B) on these cells with the inverse agonist/antagonist PSB-603 leads to inhibition of cell proliferation, transmigration as well as VEGFA secretion in vitro. At the molecular level, these effects were associated with cell cycle arrest as well as the induction of the apoptotic pathway. In addition, shRNA-mediated downmodulation of ADORA2B expression caused decreased proliferation. Moreover, in in vivo xenograft experiments, chemical and genetic abrogation of ADORA2B activity impaired tumor growth associated with decreased tumor vascularization. Together, our findings characterize ADORA2B as a crucial player in the maintenance of HNSCC and, therefore, as a potential therapeutic target for HNSCC treatment

Proteins Interacting With Caenorhabditis elegans Gα Subunits

To identify novel components in heterotrimeric G-protein signalling, we performed an extensive screen for proteins interacting with Caenorhabditis elegans Gα subunits. The genome of C. elegans contains homologues of each of the four mammalian classes of Gα subunits (Gs, Gi/o, Gq and G12), and 17 other Gα subunits. We tested 19 of the GGα subunits and four constitutively activated Gα subunits in a largescale yeast two-hybrid experiment. This resulted in the identification of 24 clones, representing 11 different proteins that interact with four different Gα subunits. This set includes C. elegans orthologues of known interactors of Gα subunits, such as AGS3 (LGN/PINS), CalNuc and Rap1Gap, but also novel proteins, including two members of the nuclear receptor super family and a homologue of human haspin (germ cell-specific kinase). All interactions were found to be unique for a specific Gα subunit but variable for the activation status of the Gα subunit. We used expression pattern and RNA interference analysis of the G-protein interactors in an attempt to substantiate the biological relevance of the observed interactions. Furthermore, by means of a membrane recruitment assay, we found evidence that GPA-7 and the nuclear receptor NHR-22 can interact in the animal

Annihilation vs. Decay: Constraining dark matter properties from a gamma-ray detection

Most proposed dark matter candidates are stable and are produced thermally in the early Universe. However, there is also the possibility of unstable (but long-lived) dark matter, produced thermally or otherwise. We propose a strategy to distinguish between dark matter annihilation and/or decay in the case that a clear signal is detected in gamma-ray observations of Milky Way dwarf spheroidal galaxies with gamma-ray experiments. The sole measurement of the energy spectrum of an indirect signal would render the discrimination between these cases impossible. We show that by examining the dependence of the intensity and energy spectrum on the angular distribution of the emission, the origin could be identified as decay, annihilation, or both. In addition, once the type of signal is established, we show how these measurements could help to extract information about the dark matter properties, including mass, annihilation cross section, lifetime, dominant annihilation and decay channels, and the presence of substructure. Although an application of the approach presented here would likely be feasible with current experiments only for very optimistic dark matter scenarios, the improved sensitivity of upcoming experiments could enable this technique to be used to study a wider range of dark matter models.Comment: 29 pp, 8 figs; replaced to match published version (minor changes and some new references

Further investigation of a relic neutralino as a possible origin of an annual-modulation effect in WIMP direct search

We analyze the annual-modulation effect, measured by the DAMA Collaboration with the new implementation of a further two-years running, in the context of a possible interpretation in terms of relic neutralinos. We impose over the set of supersymmetric configurations, selected by the annual-modulation data, the constraints derived from WIMP indirect measurements, and discuss the features of the ensuing relic neutralinos. We critically discuss the sources of the main theoretical uncertainties in the analysis of event rates for direct and indirect WIMP searches.Comment: 29 pages, 12 figures, typeset with ReVTeX. In order to reduce size, the version on the archive has low resolution figures. A full version of the paper can be found at http://www.to.infn.it/~fornengo/papers