How Can Medical Students Be Prepared Effectively for Current Challenges in the Field of Expert-Guided Online-Counselling on Preventive Interventions? - A Randomised, Prospective Trial Exemplified by a Case Study of Mammography-Screening

Introduction The impact of the Internet on medical care leads to various medical information sources for patients and to an increasing demand for online-counselling. Thus new challenges for doctors arise. Aim of this project is to close the gap between these challenges and the current lack in options to prepare medical students for them. A training program in a blended-learning format with an online-platform as training instrument was designed and implemented into a gynaecology course during 9th semester of medical curriculum. It was analysed on basis of the following research question: How can medical students be prepared effectively for current challenges in the field of expert-guided online-counselling on preventive interventions? - A randomised, prospective trial exemplified by a case study of Mammography-Screening 1. How does an online-forum need to be designed, in order to provide an adequate training instrument simulating the arising challenges with a high level in closeness to reality? 2. Which didactical blended-learning approach (trainer-directed or self-directed) is most appropriate to prepare students effectively? Methods The online-forum’s development is shown as well as the establishment of the two course formats along Kern’s model. In a prospective, randomised, parallel group study the training outcome is evaluated by standardised and blinded pre/post analysis using a test, in which students counselled a simulated patient request through the forum. This was followed by an online-survey for students’ self-assessment regarding the learning objectives. The survey also collected data on students’ characteristics and course evaluation. Results The data shows a G*Power (1-β) > .8 and no significant differences between sociodemographic aspects (p > .05) of the two groups (G1, G2). Students’ evaluation (lowest: 1, best: 5) results as follows: external organisational circumstances (time, distances) (mean = 2.79; SD = .142), performance and moderation of the course (mean = 4.19; SD = .104), application of online-forum (mean = 3.90; SD = .103). The students of the self-directed group (G1) show a significant increase in their self-assessment (doctor-patient communication: Z = -2.036; p =.042; online-communication: Z = -2.058; p =.04), implemented independent online-research (p =.073) during independent training more often than G2 students and completed more training cases in any range. Discussion The data indicates great suitability of the online-forum for training and its high acceptance amongst the students. However, external organisational circumstances were criticised. The forum supports the effectiveness of training and since it is an instructional method in fields of simulation-based learning, it is shown to raise the effectiveness of medical education. Students of G1 (self-directed) arise to show a better learning outcome and their higher activity level correlates with their significantly raised self-assessment regarding the topical learning objectives. This is supported by scientific evidence describing the strengths of blended-learning and self-directed learning approaches in medical education. In particular, the limitation of self-assessment as a method for characterising the students’ learning outcome needs to be regarded, since it is shown to be highly vulnerable to rater biases. Thus aligning the results with the subsequent OSCE evaluation of the students’ texts from the pre/post test in the forum arises as relevant. In addition, the forum’s content and features’ high level in flexibility allows easy transfer to further disciplines and target groups. Conclusion The blended-learning course with the online-forum as training instrument provides a basis for an effective training of medical students in fields of expert-guided online-counselling regarding preventive interventions. Its transfer to other target groups in a self-directed approach arises as major perspective. The alignment of data from self-assessment with the subsequent OSCE evaluation arises as further relevant perspective, since its preliminary results appear to highly significantly confirm the tendency described throughout this study

Influence of material alterations and machine impairment on throughput related sensor-based sorting performance

Experiments with sensor-based sorting (SBS) machinery provide insight into the effect of throughput rate and input composition on the sorting performance. For this purpose, material mixtures with certain compositions and particle size distributions were created from waste fractions and sorted at various throughput rates. To evaluate the sorting performance of the SBS unit (using near infrared technology) in dependence of the applied load, four assessment factors concerning the output fractions were studied: yield, product purity, recovery/product quantity and incorrectly discharged share of reject particles. The influences on the assessment parameters of light twodimensional (2D) particles in the input of a sorting stage and failing air valves in an SBS unit were evaluated for various input compositions at different throughput rates. It was found that a share of approximately 5 wt% 2D particles in the input had a similar negative effect on the yield as the malfunction of 20% of all air valves in an SBS machine at high throughput rates. Additionally, the failure of the air valves reduced the product purity of the sorting stage at increased throughput rates. Furthermore, qualitative observations concerning systematic effects of prior studies could be confirmed. Resulting graphs for a specific input composition of an SBS unit at varying throughput rates could be used to adjust the throughput rate to meet the exact demands for a sorting stage

Percutaneous Anorectoplasty (PARP)-An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair

Background: Anorectal malformations comprise a broad spectrum of disease. We developed a percutaneous anorectoplasty (PARP) technique as a minimal-invasive option for repair of amenable types of lesions. Methods: Patients who underwent PARP at five institutions from 2008 through 2021 were retrospectively analyzed. Demographic information, details of the operative procedure, and perioperative complications and outcomes were collected. Results: A total of 10 patients underwent the PARP procedure during the study interval. Patients either had low perineal malformations or no appreciable fistula. Most procedures were guided by ultrasound, fluoroscopy, or endoscopy. Median age at PARP was 3 days (range 1 to 311) days;eight patients were male. Only one intraoperative complication occurred, prompting conversion to posterior sagittal anorectoplasty. Functional outcomes in most children were highly satisfactory in terms of continence and functionality. Conclusions: The PARP technique is an excellent minimal-invasive alternative for boys born with perineal fistulae, as well as patients of both sexes without fistulae. The optimal type of guidance (ultrasound, fluoroscopy, or endoscopy) depends on the anatomy of the lesion and the presence of a colostomy at the time of repair

Expression of the IRTA1 receptor identifies intraepithelial and subepithelial marginal zone B cells of the mucosa-associated lymphoid tissue (MALT)

AbstractIRTA1 (immunoglobulin superfamily receptor translocation-associated 1) is a novel surface B-cell receptor related to Fc receptors, inhibitory receptor superfamily (IRS), and cell adhesion molecule (CAM) family members and we mapped for the first time its distribution in human lymphoid tissues, using newly generated specific antibodies. IRTA1 was selectively and consistently expressed by a B-cell population located underneath and within the tonsil epithelium and dome epithelium of Peyer patches (regarded as the anatomic equivalents of marginal zone). Similarly, in mucosa-associated lymphoid tissue (MALT) lymphomas IRTA1 was mainly expressed by tumor cells involved in lympho-epithelial lesions. In contrast, no or a low number of IRTA1+ cells was usually observed in the marginal zone of mesenteric lymph nodes and spleen. Interestingly, monocytoid B cells in reactive lymph nodes were strongly IRTA1+. Tonsil IRTA1+ cells expressed the memory B-cell marker CD27 but not mantle cell-, germinal center-, and plasma cell-associated molecules. Polymerase chain reaction (PCR) analysis of single tonsil IRTA1+ cells showed they represent a mixed B-cell population carrying mostly mutated, but also unmutated, IgV genes. The immunohistochemical finding in the tonsil epithelial areas of aggregates of IRTA1+ B cells closely adjacent to plasma cells surrounding small vessels suggests antigen-triggered in situ proliferation/differentiation of memory IRTA1+ cells into plasma cells. Collectively, these results suggest a role of IRTA1 in the immune function of B cells within epithelia. (Blood. 2003;102: 3684-3692

A comprehensive microarray-based DNA methylation study of 367 hematological neoplasms

Background: Alterations in the DNA methylation pattern are a hallmark of leukemias and lymphomas. However, most epigenetic studies in hematologic neoplasms (HNs) have focused either on the analysis of few candidate genes or many genes and few HN entities, and comprehensive studies are required. Methodology/Principal Findings: Here, we report for the first time a microarray-based DNA methylation study of 767 genes in 367 HNs diagnosed with 16 of the most representative B-cell (n = 203), T-cell (n = 30), and myeloid (n = 134) neoplasias, as well as 37 samples from different cell types of the hematopoietic system. Using appropriate controls of B-, T-, or myeloid cellular origin, we identified a total of 220 genes hypermethylated in at least one HN entity. In general, promoter hypermethylation was more frequent in lymphoid malignancies than in myeloid malignancies, being germinal center mature B-cell lymphomas as well as B and T precursor lymphoid neoplasias those entities with highest frequency of gene-associated DNA hypermethylation. We also observed a significant correlation between the number of hypermethylated and hypomethylated genes in several mature B-cell neoplasias, but not in precursor B- and T-cell leukemias. Most of the genes becoming hypermethylated contained promoters with high CpG content, and a significant fraction of them are targets of the polycomb repressor complex. Interestingly, T-cell prolymphocytic leukemias show low levels of DNA hypermethylation and a comparatively large number of hypomethylated genes, many of them showing an increased gene expression. Conclusions/Significance: We have characterized the DNA methylation profile of a wide range of different HNs entities. As well as identifying genes showing aberrant DNA methylation in certain HN subtypes, we also detected six genes—DBC1, DIO3, FZD9, HS3ST2, MOS, and MYOD1—that were significantly hypermethylated in B-cell, T-cell, and myeloid malignancies. These might therefore play an important role in the development of different HNs

B-cell receptor reactivity against Rothia mucilaginosa in nodular lymphocyte-predominant Hodgkin lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a Hodgkin lymphoma expressing functional B-cell receptors (BCR). Recently, we described a dual stimulation model of IgD+ lymphocyte-predominant cells by Moraxella catarrhalis antigen RpoC and its superantigen MID/hag, associated with extralong CDR3 and HLA-DRB1*04 or HLADRB1*07 haplotype. The aim of the present study was to extend the antigen screening to further bacteria and viruses. The fragment antibody-binding (Fab) regions of seven new and 15 previously reported cases were analyzed. The reactivity of non-Moraxella spp.-reactive Fab regions against lysates of Rothia mucilaginosa was observed in 5/22 (22.7%) cases. Galactofuranosyl transferase (Gltf) and 2,3-butanediol dehydrogenase (Bdh) of R. mucilaginosa were identified by comparative silver- and immuno-staining in two-dimensional gels, with subsequent mass spectrometry and validation by western blots and enzyme-linked immunosorbent assay. Both R. mucilaginosa Gltf and Bdh induced BCR pathway activation and proliferation in vitro. Apoptosis was induced by recombinant Gltf/ETA’-immunotoxin conjugates in DEV cells expressing recombinant R. mucilaginosa-reactive BCR. Reactivity against M. catarrhalis RpoC was confirmed in 3/7 newly expressed BCR (total 10/22 reactive to Moraxella spp.), resulting in 15/22 (68.2%) cases with BCR reactivity against defined bacterial antigens. These findings strengthen the hypothesis of bacterial trigger contributing to subsets of NLPHL

Genomic and transcriptomic changes complement each other in the pathogenesis of sporadic Burkitt lymphoma

Burkitt lymphoma (BL) is the most common B-cell lymphoma in children. Within the International Cancer Genome Consortium (ICGC), we performed whole genome and transcriptome sequencing of 39 sporadic BL. Here, we unravel interaction of structural, mutational, and transcriptional changes, which contribute to MYC oncogene dysregulation together with the pathognomonic IG-MYC translocation. Moreover, by mapping IGH translocation breakpoints, we provide evidence that the precursor of at least a subset of BL is a B-cell poised to express IGHA. We describe the landscape of mutations, structural variants, and mutational processes, and identified a series of driver genes in the pathogenesis of BL, which can be targeted by various mechanisms, including IG-non MYC translocations, germline and somatic mutations, fusion transcripts, and alternative splicing

Genomic basis of a social polymorphism in a halictid bee

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The genomic and transcriptional landscape of primary central nervous system lymphoma

Primary lymphomas of the central nervous system (PCNSL) are mainly diffuse large B-cell lymphomas (DLBCLs) confined to the central nervous system (CNS). Molecular drivers of PCNSL have not been fully elucidated. Here, we profile and compare the whole-genome and transcriptome landscape of 51 CNS lymphomas (CNSL) to 39 follicular lymphoma and 36 DLBCL cases outside the CNS. We find recurrent mutations in JAK-STAT, NFkB, and B-cell receptor signaling pathways, including hallmark mutations in MYD88 L265P (67%) and CD79B (63%), and CDKN2A deletions (83%). PCNSLs exhibit significantly more focal deletions of HLA-D (6p21) locus as a potential mechanism of immune evasion. Mutational signatures correlating with DNA replication and mitosis are significantly enriched in PCNSL. TERT gene expression is significantly higher in PCNSL compared to activated B-cell (ABC)-DLBCL. Transcriptome analysis clearly distinguishes PCNSL and systemic DLBCL into distinct molecular subtypes. Epstein-Barr virus (EBV)+ CNSL cases lack recurrent mutational hotspots apart from IG and HLA-DRB loci. We show that PCNSL can be clearly distinguished from DLBCL, having distinct expression profiles, IG expression and translocation patterns, as well as specific combinations of genetic alterations