Constructional infection prevention strategy - architectural analysis, evaluation and solution strategy to control infection transmission pathways in building systems

Bis zu einem Drittel aller Todesfälle sind weltweit auf Infektionen zurückzuführen (WHO 2015). Erreger können sich aufgrund der zunehmenden Globalisierung und der damit einhergehenden Mobilität von Menschen, Nutztieren und Gütern auf ganz neuen Ausbreitungswegen übertragen. Das vermehrte Auftreten multiresistenter Erreger stellt eine besondere Herausforderung dar. Um auf die infektiologischen Herausforderungen der Zukunft adäquat reagieren zu können, muss eine fächerübergreifende Zusammenarbeit im Sinne des „One-Health-Konzeptes“ (King 2008; Wieler 2014; King 2008) erfolgen. Ziel der vorgelegten Arbeit ist daher die Wechselwirkung von Infektionsketten und der gebauten Umwelt zu analysieren, zu bewerten und eine ganzheitliche Strategie zur baulichen Infektionsprävention abzuleiten. Zunächst werden die Infektionsübertragungswege auf Grundlage der Erkenntnisse der Epidemiologie dargestellt und relevante Faktoren im Zusammenspiel von Infektionsausbreitung und baulichen Aspekten analysiert. Die dabei identifizierten Baukomponenten werden anschließend auf ihre Möglichkeiten der baulichen Infektionsprävention beschrieben und bewertet sowie Optimierungspotential der bereits etablierten Baumethoden aufgezeigt. Um neue interdisziplinäre Ansätze zur Lösung des komplexen Themenfeldes der Infektionsunterbrechung zu identifizieren, werden Experten aus unterschiedlichsten Wissenschaftsdisziplinen befragt. Die daraus gewonnenen Erkenntnisse zu Themen wie z. B. dem Raumnutzungsverhalten, der Gruppendynamik, der Verhaltensökonomie oder kultureller Unterschiede in der Wahrnehmung werden über eine vertiefende Literaturrecherche aufgearbeitet und für die Entwicklung einer transsektoralen baulichen Infektionspräventionsstrategie zunutze gemacht. Zur Kontrolle der Infektionskette wird ein transsektoraler, aus mehreren Komponenten bestehender und skalenübergreifender Ansatz gewählt, die kombinierte Multi-Skalen-Barrieren-Strategie. Die bautechnisch-konstruktive Weiterentwicklung und die baufunktional-prozessuale Optimierung ausgesuchter Baukomponenten mithilfe der Entwicklung neuer interdisziplinärer Methoden stellen die Grundlage der Strategie dar. Die vorgelegte Arbeit stellt mit ihrer Strategie eine strukturierte Grundlage für die Entwicklung einer Vielzahl von neuen Forschungsstudien durch die Kombination der weiter zu optimierenden Baukomponenten mit den neuentwickelten transsektoralen Methoden für die bauliche Infektionsprävention zur Verfügung.Up to one third of all deaths worldwide can be attributed to infections. Due to the increasing globalization and the resulting mobility of people, livestock and goods, pathogens can be transmitted in completely new ways. The increased incidence of multi-resistant pathogens presents a special challenge. In order to be able to respond adequately to the infectious challenges of the future, cross-disciplinary cooperation in the sense of the "one-health concept" must take place. The aim of the presented work is therefore to analyse and evaluate the interaction of infection chains and the built environment and to develop a holistic strategy for structural infection prevention. Firstly, the transmission of infections is presented on the basis of epidemiological findings and relevant factors are analysed in the interaction of infection propagation and structural aspects. The identified building components will then be described and evaluated in terms of their possibilities for structural infection prevention and the optimisation potential of the already established construction methods will be demonstrated. In order to identify new inter-disciplinary approaches to solve the complex topic of infection interruption, experts from a wide variety of scientific disciplines are interviewed. The findings on topics such as spatial use behaviour, group dynamics, behavioural economics or cultural differences in perception, which are gained from these studies, will be investigated in more depth and used to develop a trans-sectoral structural infection prevention strategy. To control the infection chain, a trans-sectoral, multi-component and multi-scale-overlapping approach is chosen, the combined Multi-Scale-Barrier-Strategy. The strategy is based on the further development of technical and construction engineering and the functional and process-related optimization of selected building components by means of the development of new trans-sectoral methods. With its strategy, the presented work provides a structured basis for the development of a large number of new research studies by combining the components to be further optimized with the newly developed trans-sectoral methods for structural infection prevention

Design and usability testing of an in-house developed performance feedback tool for medical students

Background: Feedback is essential in a self-regulated learning environment such as medical education. When feedback channels are widely spread, the need arises for a system of integrating this information in a single platform. This article reports on the design and initial testing of a feedback tool for medical students at Charite-Universitatsmedizin, Berlin, a large teaching hospital. Following a needs analysis, we designed and programmed a feedback tool in a user-centered approach. The resulting interface was evaluated prior to release with usability testing and again post release using quantitative/qualitative questionnaires. Results: The tool we created is a browser application for use on desktop or mobile devices. Students log in to see a dashboard of "cards" featuring summaries of assessment results, a portal for the documentation of acquired practical skills, and an overview of their progress along their course. Users see their cohort's average for each format. Learning analytics rank students' strengths by subject. The interface is characterized by colourful and simple graphics. In its initial form, the tool has been rated positively overall by students. During testing, the high task completion rate (78%) and low overall number of non-critical errors indicated good usability, while the quantitative data (system usability scoring) also indicates high ease of use. The source code for the tool is open-source and can be adapted by other medical faculties. Conclusions: The results suggest that the implemented tool LevelUp is well-accepted by students. It therefore holds promise for improved, digitalized integrated feedback about students' learning progress. Our aim is that LevelUp will help medical students to keep track of their study progress and reflect on their skills. Further development will integrate users' recommendations for additional features as well as optimizing data flow

Clinically relevant depressive symptoms in young stroke patients - results of the sifap1 study

BACKGROUND Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. METHODS The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. RESULTS From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. CONCLUSION Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings