Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes

Abstract: Clinical reasoning for acute dyspnoea: Comparison of final-year medical students from discipline- andcompetency-based undergraduate programmes. Background: The global shift to competency-based medical education aims to improve the performance of itstrainees, including in the key competency domain of clinical reasoning. However, research on whether such educationactually improves clinical reasoning is sparse. The purpose of this study is to compare assessed clinical reasoningperformance in digitally presented cases of acute dyspnoea between final-year medical students from a traditional,discipline-based and those from an integrated, competency-based undergraduate programme. Methods: A total of 60 medical students in their final-year clerkships participated in the study; 30 were from adiscipline-based programme, and 30 were from a competency-based programme of the same faculty. The studentscompleted a knowledge test consisting of 22 single choice items and a computer-based test of clinical reasoning withsix video-based case scenarios with different underlying diseases leading to dyspnoea. The operationalized measures ofclinical reasoning were the number and relevance of the diagnostic tests chosen, time to diagnosis and diagnosticaccuracy. Results: The two groups did not differ in their knowledge of the acute dyspnoea content domain. With regard toclinical reasoning, the selection of relevant tests, time required to make a diagnosis and accuracy of the diagnosisvaried across the six case scenarios in both groups. However, the results from the measures of the clinical reasoningprocess did not differ between the students from the two types of undergraduate medical programmes. No significantdifferences were found with regard to the selection of relevant diagnostic tests (M = 63.8% vs. M = 62.8%), the time toa diagnosis (M = 128.7 s vs. M = 136.4 s) or the accuracy of diagnosis (M = 82.2% vs. M = 77.0%). Conclusions: Key indicators of the clinical reasoning process, when assessed with objectively measured parameters,did not differ between final-year medical students from a traditional, discipline-based and those from an integrated,competency-based undergraduate programme in the domain of acute dyspnoea. The results substantiate and expandthose of previous studies based on subjective assessor ratings that showed limited change in the clinical reasoningperformance of medical students with competency-based undergraduate education

Plastid DNA sequences and oospore characters of some European taxa of Tolypella section Tolypella (Characeae) identify five clusters, including one new cryptic Tolypella taxon from Sardinia, but they do not coincide with current morphological descriptions

In Europe, the genus Tolypella (Characeae) comprises four to eight Tolypella taxa in sections Rothia and Tolypella that have been distinguished by vegetative morphology and gametangial characters such as antheridial size and oospore wall ornamentation. However, morphological differentiation is difficult in some cases due to overlapping and variable vegetative features, which in many cases are difficult to observe clearly. To clarify the taxonomic status of the five European taxa of Tolypella in section Tolypella, sequence data of the plastid genes atpB, rbcL and psbC for Tolypella glomerata (Desv.) Leonh., Tolypella hispanica Allen, Tolypella nidifica (O.F. Müll.) A. Braun, Tolypella normaniana (Nordst.) Nordst. and Tolypella salina Cor. were combined with data on oospore morphology, including oospore wall ornamentation. Gene sequence data identified five distinct clusters, but they were not consistent with the morphologically identified five taxa. T. glomerata consisted of some of the samples morphologically identified as T. glomerata and seven samples of T. normaniana, while the remaining T. glomerata samples clustered with specimens of unclear affiliation (Tolypella sp.). We identified two clusters of T. hispanica within the European material: cluster T. hispanica I consisted of samples from various locations, whereas the second cluster (T. hispanica II) consisted of samples of T. hispanica from Sardinia Island. The remaining cluster consisted of all the specimens that had been determined as T. salina or T. nidifica in addition to two specimens of T. normaniana. Oospore morphology was most clearly distinguishable for T. glomerata. Oospore characteristics for all other taxa were not as informative but showed some geographical and/or environmentally influenced differences, especially for T. nidifica and T. salina. Our results suggest the need to further check the different taxonomy of Tolypella sect. Tolypella in which specimens normally identified as T. glomerata might be two different taxa, T. glomerata and an unidentified taxon; T. nidifica and T. salina are not separate taxa; T. normaniana is a diminutive variant of two different Tolypella taxa; and T. hispanica comprises two different taxa, one from the Mediterranean island Sardinia.publishedVersio

Resilience of aquatic ecosystems - vitality of seed banks

Die Eutrophierung aquatischer Systeme steigt durch erhöhte anthropogene Einflussnahme. Restaurierungsprozesse beziehen das Element der Makrophyten, v.a. das der Characeen, aktiv mit ein. Eine Abschätzung des Potentials (Ausnutzung systemeigener Diasporen) setzt jedoch eine Bestimmung der Diasporenbankzusammensetzung und der Vitalität voraus. Multivariater Analysen konnten zur Artidentifizierung ausgenutzt werden. Die Bestimmung der Vitalität von Oosporen kann über den Nachweis von Dehydrogenasen mittels 2,3,5 – Triphenyltetrazoliumchlorid erfolgen.The eutrophication of aquatic systems rises by an increased anthropogenic influence. Restoration processes incorporates the element of macrophytes, especially that of Characeae, actively. However, the estimate of the potential of the exploitation of native diaspores requires the determination of seed bank composition and vitality of oospores. Multidimensional analyses were used for species identification. The determination of the vitality of oospores can be effected by means of the detection of dehydrogenases by 2,3,5-Triphenyltetrazoliumchloride

Morphological adaptations of <i>Chara baltica</i> and <i>Chara liljebladii</i> (Characeae) under different light conditions

<p>Individuals within wild populations differ substantially in their fitness as a result of either genetic differences or acclimation. Within the Charophyte algae, the two taxa <i>Chara baltica</i> and <i>C</i>. <i>liljebladii</i> predominate at different water depths of the same habitat. The two taxa are mainly distinguished by quantitative characteristics, pointing to light acclimation. In particular, they differ by a length of the internode and the bract cells, as well as the cortication type. Genetic analyses revealed that individuals of both morphotypes are genetically identical, and hence may belong to the same species. In the present paper, we tested a hypothesis that <i>C</i>. <i>liljebladii</i> is a low-light phenotype of <i>C</i>. <i>baltica</i>. Can a <i>C</i>. <i>baltica</i> phenotype be transferred into a <i>C</i>. <i>liljebladii</i> (and vice versa) by manipulation of the environmental conditions such as irradiance? We observed significant changes in the morphology of <i>C</i>. <i>baltica</i>: decreasing the irradiance significantly increased the growth of the branchlets and internodal cells. Consequently, the plants grew larger, changing their morphology in the direction of the <i>C</i>. <i>liljebladii</i> morphotype. In the reverse experiment, subjecting <i>C</i>. <i>liljebladii</i> to increasing irradiances, the individuals had slightly better growth, but none of the analysed morphological characteristics changed significantly. Both taxa have thus shown different adaptations to light limitation. Their morphologies cannot be transferred into each other by environmental factors. Thus, the presence of the different morphologies reflects the ecological characteristics of their habitats, such as light availability or turbidity.</p

Diaspore bank analysis of Baltic coastal waters

<p>The coastal waters are important transition zones for terrestrial nutrient and pollutant runoff and the open Sea. During the last decades, eutrophication has negatively influenced macrophyte communities of the coastal ecosystems, making restoration activities inevitable. This study analysed recent macrophyte vegetation and the reproductive potential through the sediment diaspore reservoir along the German Baltic Sea coastline. Salinity was identified to be the responsible factor for shifts in the macrophyte community with most commonly found species like <i>Stuckenia pectinata</i> or <i>Myriophyllum spicatum</i>. In contrast, the oospores of small charophytes (e.g. <i>Tolypella nidifica</i>) clearly dominated the sediment diaspore bank. The germination rates differed in the recent vegetation composition and the diaspore bank composition with <i>Zannichellia palustris</i> as the dominant species. However, several species not visually detected at the respective sites were represented in the diaspore bank and germinated at a low rate (e.g. <i>Chara contraria</i> and <i>Lamprothamnium papulosum</i>). The maximal germination frequency corresponded to the sediment layer in which diaspore density was the highest (5–15 cm). In conclusion, the germinable diaspores were observed at all sites. Considering the differences between the diaspore composition, recent vegetation and germination success, we have illustrated the potential of the diaspore banks for the restoration of the macrophyte communities after at least mid-term periods of disturbance.</p

Overview about the localization of nanoparticles in tissue and cellular context by different imaging techniques

The increasing interest and recent developments in nanotechnology pose previously unparalleled challenges in understanding the effects of nanoparticles on living tissues. Despite significant progress in in vitro cell and tissue culture technologies, observations on particle distribution and tissue responses in whole organisms are still indispensable. In addition to a thorough understanding of complex tissue responses which is the domain of expert pathologists, the localization of particles at their sites of interaction with living structures is essential to complete the picture. In this review we will describe and compare different imaging techniques for localizing inorganic as well as organic nanoparticles in tissues, cells and subcellular compartments. The visualization techniques include well-established methods, such as standard light, fluorescence, transmission electron and scanning electron microscopy as well as more recent developments, such as light and electron microscopic autoradiography, fluorescence lifetime imaging, spectral imaging and linear unmixing, superresolution structured illumination, Raman microspectroscopy and X-ray microscopy. Importantly, all methodologies described allow for the simultaneous visualization of nanoparticles and evaluation of cell and tissue changes that are of prime interest for toxicopathologic studies. However, the different approaches vary in terms of applicability for specific particles, sensitivity, optical resolution, technical requirements and thus availability, and effects of labeling on particle properties. Specific bottle necks of each technology are discussed in detail. Interpretation of particle localization data from any of these techniques should therefore respect their specific merits and limitations as no single approach combines all desired properties

Shallow hypersaline lakes as paleoclimate archives: A case study from the Laguna Salada, Malaga province, southern Spain

Although numerous studies concerning the Holocene climate of the southern Iberian Peninsula were accomplished within the last few decades, the climate history of this region is still poorly understood. Various studies deal with a combination of proxies, which are neither easy to compare nor is their connection easy to explain, e.g., due to spatial patterns and time transgression. Within this study, the suitability of the lacustrine sediments from the Laguna Salada (Andalucia region, southern Spain) as a paleoclimate archive is investigated. The lake sediments were evaluated using a multi-proxy approach including sedimentological, mineralogical, geochemical and biological analyses. The sediments reflect the evolution of the lake from pre-Medieval times onwards and Characeae as well as Ostracod analyses give an indication of paleosalinity. Moreover does the geochemical composition provide profound information concerning changes of elemental and mineralogical composition. Nevertheless, a robust, high-resolution chronology could not be achieved owed to the scarcity of material available for radiocarbon dating and contamination problems. Furthermore, poor preservation of pollen restricted the reconstruction of vegetation history, which could have complemented important information concerning climatic changes and human activity. (C) 2017 Elsevier Ltd and INQUA. All rights reserved