Aufbruch - Veränderung - Positionierung: Erfahrungen aus 25 Jahren wissenschaftlicher Weiterbildung

Seit 1993 gibt es an der heutigen Otto-von-Guericke-Universität Magdeburg einen weiterbildenden Studiengang der Erwachsenenbildung. Im Beitrag wird der Blick auf 25 Jahre Entwicklungsgeschichte, Gelingensbedingungen und aktuelle Herausforderungen gerichtet. In einem moderierten Gespräch rekonstruieren und bewerten vier zu unterschiedlichen Zeiten verantwortliche Professoren die Geschichte und aktuelle Situation des Studiengangs. Dies sind Erich Schäfer als Akteur der ersten Stunde, Michael Dick für die Zeit der Umstellung vom Zertifikats- zum Masterstudium sowie Olaf Dörner und Johannes Fromme, die seit einigen Jahren den Studiengang unterstützt durch Olaf Freymark und Heike Schröder leiten. Das 2,5-stündige Gespräch führte Linda Vieback. Abgedruckt ist nicht die vollständige ursprüngliche Diskussion, sondern eine gekürzte und im Nachgang von den Herausgeber:innen in Abstimmung mit den Diskutanten redaktionell überarbeitete und in Details ergänzte Fassung

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

Recent insights in rheumatoid arthritis (RA) necessitated updating the European League Against Rheumatism (EULAR) RA management recommendations. A large international Task Force based decisions on evidence from 3 systematic literature reviews, developing 4 overarching principles and 12 recommendations (vs 3 and 14, respectively, in 2013). The recommendations address conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GC); biological (b) DMARDs (tumour necrosis factor (TNF)-inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, clazakizumab, sarilumab and sirukumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (Janus kinase (Jak) inhibitors tofacitinib, baricitinib). Monotherapy, combination therapy, treatment strategies (treat-to-target) and the targets of sustained clinical remission (as defined by the American College of Rheumatology-(ACR)-EULAR Boolean or index criteria) or low disease activity are discussed. Cost aspects were taken into consideration. As first strategy, the Task Force recommends MTX (rapid escalation to 25 mg/week) plus short-term GC, aiming at >50% improvement within 3 and target attainment within 6 months. If this fails stratification is recommended. Without unfavourable prognostic markers, switching to—or adding—another csDMARDs (plus short-term GC) is suggested. In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered. For each recommendation, levels of evidence and Task Force agreement are provided, both mostly very high. These recommendations intend informing rheumatologists, patients, national rheumatology societies, hospital officials, social security agencies and regulators about EULAR's most recent consensus on the management of RA, aimed at attaining best outcomes with current therapies

Nützlichkeit und Effektivität: Orientierungen von Studierenden im Umgang mit digitalen Medien in der wissenschaftlichen Weiterbildung. Forschungsbericht

  Der digitale Wandel von Wirtschaft und Gesellschaft wird derzeit breit diskutiert. Eines der Handlungsfelder, die im Rahmen politischer Debatten und Agenden zur Digitalisierung bundesweit identifiziert werden, ist die sog. digitale Bildung. Sie soll einerseits sicherstellen, dass die Menschen jene digitalen Kompetenzen erwerben, die für den Umgang mit den neuen Technologien und damit für die soziale Teilhabe in einer digitalen Welt erforderlich sind. Andererseits sollen digitale Medien und Lernumgebungen verstärkt zur Unterstützung von Lehr‐ und Lernprozessen eingesetzt werden. Sofern die Verwendung digitaler Medien nicht nur pauschal mit moderner oder zeitgemäßer Vermittlung bzw. (Fach‐)Didaktik assoziiert wird, werden damit vor allem drei Erwartungen verbunden: 1) dass digitale Medien eine zeit‐ und ortsunabhängige Auseinandersetzung mit Studieninhalten und somit ein flexibleres und selbstgesteuertes Lernen ermöglichen, 2) dass sie die Lernmotivation steigern, z.B. durch multimediale, interaktive und/oder kompetitive Formate, und 3) dass sie zu größerer Effizienz des Lernens beitragen, z.B. durch adaptive Lehr‐Lern‐Systeme und individualisierte Lernverläufe. Daher wird dem Einsatz digitaler Medien auch ein Potenzial im Kontext der Entwicklung von Studienformaten zugewiesen, die der besonderen Situation nicht traditioneller Zielgruppen von Hochschulen – beispielsweise in der wissenschaftlichen Weiterbildung – gerecht werden können und sollen.   &nbsp

The role of saline irrigation prior to wound closure in the reduction of surgical site infection: a systematic review and meta-analysis

Background!#!Surgical site infection (SSI) describes an infectious complication of surgical wounds. Although SSI is thought to be preventable, it still represents a major cause of morbidity and substantial economic burden on the health system. Wound irrigation (WI) might reduce the level of bacterial contamination, but current data on its role in reducing or preventing SSI is conflicting. Our aim was to investigate the effectiveness of WI with normal saline prior to wound closure for the reduction of SSI in patients undergoing abdominal surgery.!##!Methods!#!We conducted a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to present, and cross-checked the reference lists of all included primary studies and relevant systematic reviews. (Quasi-) randomized controlled trials (RCTs) investigating the rate of SSI when using normal saline vs. no irrigation prior to wound closure following abdominal surgery were included. Primary outcome was the rate of SSI, secondary outcome the mean length of hospital stay (LOS).!##!Results!#!Four RCTs including a total of 1194 patients were included for analysis. All studies compared wound irrigation with normal saline with no wound irrigation prior to wound closure. Their risk of bias was moderate. The relative risk of developing a SSI was lower when wound irrigation with normal saline was performed prior to wound closure although the effect was not statistically significant (risk ratio 0.73, 95%-confidence level: 0.37 to 1.43). Similarly, there was no difference in the LOS amongst both intervention arms.!##!Conclusion!#!This systematic review could not identify an advantage for routine irrigation of abdominal wounds with normal saline over no irrigation prior to wound closure in preventing or reducing the rate of SSI.!##!Systematic review registration!#!PROSPERO registry number CRD42018082287

Identification and characterization of the tungsten-containing class of benzoyl-coenzyme A reductases

Aromatic compounds are widely distributed in nature and can only be biomineralized by microorganisms. In anaerobic bacteria, benzoyl-CoA (BCoA) is a central intermediate of aromatic degradation, and serves as substrate for dearomatizing BCoA reductases (BCRs). In facultative anaerobes, the mechanistically difficult reduction of BCoA to cyclohexa-1,5-dienoyl-1-carboxyl-CoA (dienoyl-CoA) is driven by a stoichiometric ATP hydrolysis, catalyzed by a soluble, three [4Fe-4S] cluster-containing BCR. In this work, an in vitro assay for BCR from the obligately anaerobic Geobacter metallireducens was established. It followed the reverse reaction, the formation of BCoA from dienoyl-CoA in the presence of various electron acceptors. The benzoate-induced activity was highly specific for dienoyl-CoA (Km = 24 ± 4 μM). The corresponding oxygen-sensitive enzyme was purified by several chromatographic steps with a 115-fold enrichment and a yield of 18%. The 185-kDa enzyme comprised 73- and 20-kDa subunits, suggesting an α2β2-composition. MS analysis revealed the subunits as products of the benzoate-induced bamBC genes. The αβ unit contained 0.9 W, 15 Fe, and 12.5 acid-labile sulfur. Results from EPR spectroscopy suggest the presence of one [3Fe-4S]0/+1 and three [4Fe-4S]+1/+2 clusters per αβ unit; oxidized BamBC exhibited an EPR signal typical for a W(V) species. The FeS clusters and the W- cofactor could only be fully reduced by dienoyl-CoA. BamBC represents the prototype of a previously undescribed class of dearomatizing BCRs that differ completely from the ATP-dependent enzymes from facultative anaerobes

Non-canonical two-step biosynthesis of anti-oomycete indole alkaloids in Kickxellales

Abstract Background Fungi are prolific producers of bioactive small molecules of pharmaceutical or agricultural interest. The secondary metabolism of higher fungi (Dikarya) has been well-investigated which led to > 39,000 described compounds. However, natural product researchers scarcely drew attention to early-diverging fungi (Mucoro- and Zoopagomycota) as they are considered to rarely produce secondary metabolites. Indeed, only 15 compounds have as yet been isolated from the entire phylum of the Zoopagomycota. Results Here, we showcase eight species of the order Kickxellales (phylum Zoopagomycota) as potent producers of the indole-3-acetic acid (IAA)-derived compounds lindolins A and B. The compounds are produced both under laboratory conditions and in the natural soil habitat suggesting a specialized ecological function. Indeed, lindolin A is a selective agent against plant-pathogenic oomycetes such as Phytophthora sp. Lindolin biosynthesis was reconstituted in vitro and relies on the activity of two enzymes of dissimilar evolutionary origin: Whilst the IAA–CoA ligase LinA has evolved from fungal 4-coumaryl-CoA synthetases, the subsequently acting IAA-CoA:anthranilate N-indole-3-acetyltransferase LinB is a unique enzyme across all kingdoms of life. Conclusions This is the first report on bioactive secondary metabolites in the subphylum Kickxellomycotina and the first evidence for a non-clustered, two-step biosynthetic route of secondary metabolites in early-diverging fungi. Thus, the generally accepted “gene cluster hypothesis” for natural products needs to be reconsidered for early diverging fungi

Generating Virtual Short Tau Inversion Recovery (STIR) Images from T1- and T2-Weighted Images Using a Conditional Generative Adversarial Network in Spine Imaging

Short tau inversion recovery (STIR) sequences are frequently used in magnetic resonance imaging (MRI) of the spine. However, STIR sequences require a significant amount of scanning time. The purpose of the present study was to generate virtual STIR (vSTIR) images from non-contrast, non-fat-suppressed T1- and T2-weighted images using a conditional generative adversarial network (cGAN). The training dataset comprised 612 studies from 514 patients, and the validation dataset comprised 141 studies from 133 patients. For validation, 100 original STIR and respective vSTIR series were presented to six senior radiologists (blinded for the STIR type) in independent A/B-testing sessions. Additionally, for 141 real or vSTIR sequences, the testers were required to produce a structured report of 15 different findings. In the A/B-test, most testers could not reliably identify the real STIR (mean error of tester 1–6: 41%; 44%; 58%; 48%; 39%; 45%). In the evaluation of the structured reports, vSTIR was equivalent to real STIR in 13 of 15 categories. In the category of the number of STIR hyperintense vertebral bodies (p = 0.08) and in the diagnosis of bone metastases (p = 0.055), the vSTIR was only slightly insignificantly equivalent. By virtually generating STIR images of diagnostic quality from T1- and T2-weighted images using a cGAN, one can shorten examination times and increase throughput