Voluntary undergraduate technical skills training course to prepare students for clerkship assignment: tutees’ and tutors’ perspectives

BACKGROUND: Skills lab training has become a widespread tool in medical education, and nowadays, skills labs are ubiquitous among medical faculties across the world. An increasingly prevalent didactic approach in skills lab teaching is peer-assisted learning (PAL), which has been shown to be not only effective, but can be considered to be on a par with faculty staff-led training. The aim of the study is to determine whether voluntary preclinical skills teaching by peer tutors is a feasible method for preparing medical students for effective workplace learning in clerkships and to investigate both tutees’ and tutors’ attitudes towards such an intervention. METHODS: A voluntary clerkship preparation skills course was designed and delivered. N = 135 pre-clinical medical students visited the training sessions. N = 10 tutors were trained as skills-lab peer tutors. Voluntary clerkship preparation skills courses as well as tutor training were evaluated by acceptance ratings and pre-post self-assessment ratings. Furthermore, qualitative analyses of skills lab tutors’ attitudes towards the course were conducted following principles of grounded theory. RESULTS: Results show that a voluntary clerkship preparation skills course is in high demand, is highly accepted and leads to significant changes in self-assessment ratings. Regarding qualitative analysis of tutor statements, clerkship preparation skills courses were considered to be a helpful and necessary asset to preclinical medical education, which benefits from the tutors’ own clerkship experiences and a high standardization of training. Tutor training is also highly accepted and regarded as an indispensable tool for peer tutors. CONCLUSIONS: Our study shows that the demand for voluntary competence-oriented clerkship preparation is high, and a peer tutor-led skills course as well as tutor training is well accepted. The focused didactic approach for tutor training is perceived to be effective in preparing tutors for their teaching activity in this context. A prospective study design would be needed to substantiate the results objectively and confirm the effectiveness

Performance of international medical students in psychosocial medicine

Background: Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. Methods: All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. Results: International medical students scored significantly poorer than their local peers (p < .001; η2 = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η2 = .053). No differences emerged within the multiple-choice examination (p = .127). Conclusion: International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship

Ciliary dyslexia candidate genes DYX1C1 and DCDC2 are regulated by Regulatory Factor X (RFX) transcription factors through X-box promoter motifs

DYX1C1, DCDC2, and KIAA0319 are three of the most replicated dyslexia candidate genes (DCGs). Recently, these DCGs were implicated in functions at the cilium. Here, we investigate the regulation of these DCGs by Regulatory Factor X transcription factors (RFX TFs), a gene family known for transcriptionally regulating ciliary genes. We identify conserved X-box motifs in the promoter regions of DYX1C1, DCDC2, and KIAA0319 and demonstrate their functionality, as well as the ability to recruit RFX TFs using reporter gene and electrophoretic mobility shift assays. Furthermore, we uncover a complex regulation pattern between RFX1, RFX2, and RFX3 and their significant effect on modifying the endogenous expression of DYX1C1 and DCDC2 in a human retinal pigmented epithelial cell line immortalized with hTERT (hTERT-RPE1). In addition, induction of ciliogenesis increases the expression of RFX TFs and DCGs. At the protein level, we show that endogenous DYX1C1 localizes to the base of the cilium, whereas DCDC2 localizes along the entire axoneme of the cilium, thereby validating earlier localization studies using overexpression models. Our results corroborate the emerging role of DCGs in ciliary function and characterize functional noncoding elements, X-box promoter motifs, in DCG promoter regions, which thus can be targeted for mutation screening in dyslexia and ciliopathies associated with these genes.Peer reviewe

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Ehrenamtliche Helfer*innen in der Versorgung von Geflüchteten: Situation, Motivation, Barrieren und Koordination

Seit dem Jahr 2015, als eine große Zahl an geflüchteten Menschen nach Deutschland kam, ist die Bedeutung des Ehrenamts bei der Unterstützung für Geflüchtete zunehmend gestiegen. In vielen Bereichen ist die ehrenamtliche Tätigkeit zu einem zentralen Bestandteil bei der Versorgung, Betreuung und Integration geworden. Das Ehrenamt hat weder eine zentrale Organisationsstruktur noch eine feste Bindung an öffentliche Stellen, und dennoch ist die Vernetzung von Ehrenamt und Öffentlichen Strukturen ein zentraler Knotenpunkt für eine gelingende Versorgung der Geflüchteten einerseits sowie der Resilienz und psychischen Gesundheit der Ehrenamtlichen anderseits. Der Notwendigkeit funktionierender Netzwerkstrukturen mit ihren sozialen Faktoren wie Kommunikation, Transparenz und Vertrauen stehen Gefahren, die die Netzwerkstrukturen gefährden, im Sinne von psychischer Belastung und sekundärer Traumatisierung bei der Arbeit mit Geflüchteten entgegen. Nicht zuletzt hat die Corona-Pandemie und die damit verbundenen Beschränkungen die Arbeit der Ehrenamtlichen zusätzlich erschwert. Bislang unbekannt sind die Besonderheiten bei der Koordination und Zusammenarbeit von Haupt- und Ehrenamt im Bereich der Hilfe für Geflüchtete und der damit in Verbindung stehenden Belastungen durch die ehrenamtliche Arbeit mit Geflüchteten. Ziel dieser Untersuchung war es daher, Faktoren für eine gelingende Koordination und Kooperation zwischen hauptamtlich und ehrenamtlich Tätigen herauszuarbeiten. In einem ersten Teilprojekt wurde anhand einer Datenrecherche zur Gründung von Vereinen, die sich für der Hilfe für Geflüchteten in Deutschland einsetzen, ein Indikator untersucht, der den Zuwachs ehrenamtlicher Hilfe für Geflüchtete belegt und in einer bundeweiten Landkarte aufzeigt, wo ehrenamtliche Hilfe besteht und welche Form von Hilfe geleistet wird. Bundesweit konnten N = 909 Vereine ausfindig gemacht werden, die sich in der Flüchtlingshilfe engagieren. 35 % dieser Vereine wurden seit Beginn des Bürgerkriegs in Syrien (2011) geründet. Gemessen am Anteil der Bevölkerung, gibt es in den Stadtstaaten Berlin, Hamburg und Bremen die meisten Vereine mit dem Fokus auf akute Hilfe für geflüchtete Menschen. In den westdeutschen Bundesländern liegt die Dichte der Vereine höher als der Bundesdurchschnitt, in den ostdeutschen Ländern sowie Bayern deutlich niedriger. Etwa jeder fünfte Verein bietet konkrete praktische Hilfe wie „Behördengänge“ oder „Sprachkurse“ an, ebenfalls 22,2% leisten indirekte Hilfe wie z.B. „Spendensammeln“ oder „Hilfe vermitteln“ und 11,7% bieten soziale Kontakte im Sinne von „Integration durch Begegnung“ an. Konkrete medizinische oder psychosoziale Hilfe – etwa für traumatisierte Flüchtlingen – wird nur von 5,9% der Vereine zur Verfügung gestellt. Durch das zweite Teilprojekt wurde untersucht, wie sich die Sicht von hauptamtlich Tätigen auf die Koordination und Kooperation mit ehrenamtlichen Helfer*innen darstellt. Die Untersuchung umfasst eine qualitative Querschnittstudie mittels halb-strukturierter Interviews unter n=18 Integrationsbeauftragten und Integrationsmanager*innen aus einem deutschen Regionalkreis, welche qualitativ ausgewertet wurden. Die Ergebnisse zeigen auf, dass einige ehrenamtlichen Helfer*innen bei der Arbeit mit Geflüchteten an ihre emotionale und zeitliche Belastungsgrenze kommen. Motivation der Ehrenamtlichen, klare Aufgabenteilung und eine Entlastung bei behördlichen Aufgaben könnten die Ehrenamtlichen in ihrer Hilfstätigkeit bestärken. Zwischen den Behörden und den ehrenamtlichen Helfern? werden ein funktionierender Informationsfluss, Aufgabenteilung und das Vermeiden von Doppelstrukturen als Kernelemente für einen gelingenden und reibungsfreien Arbeitsablauf benannt. Die Sicht von n=116 ehrenamtlichen Helfer*innen aus den Gemeinden desselben Regionalkreises wurde in einem dritten Teilprojekt mittels eines eigens erstellten Fragebogens zu Motivation, Tätigkeit, Belastungen und Koordination erhoben. Die n=121 befragten Ehrenamtlichen übernehmen vorwiegend Patenschaften und unterstützen Geflüchtete bei behördlichen Angelegenheiten. Die Motivation, sich ehrenamtlich zu engagieren, lässt sich durch persönliche Einstellungen zu gesellschaftspolitischen Fragen, religiösen Anschauungen oder besondere Lebenserfahrungen erklären. Die Befragten geben an, dass die ehrenamtliche Tätigkeit ihr Wohlbefinden steigert und dass sie überwiegend Bestätigung, Zuspruch und Dankbarkeit erfahren. Etwa ein Drittel der Befragten fühlt sich emotional belastet, wobei sich Frustration und Ärger über Geflüchtete und bürokratischen Hürden sowie eine mangelhafte Organisation als belastende Faktoren identifizieren lassen. Demgegenüber wirken Lob, Wertschätzung und eine konstruktive Zusammenarbeit mit hauptamtlichen Personen Belastungen entgegen. Das vierten Teilprojekt spiegelt die besondere Situation der ehrenamtlichen Hilfe während der Corona-Pandemie wieder. Hierfür wurde eine prospektive Querschnittsuntersuchung unter den Ehrenamtlichen in denselben Gemeinden mittels einer Online-Fragebogenerhebung durchgeführt. Die Ergebnisse zeigen, dass es eine deutliche Reduktion der Unterstützung für Geflüchteten von Seiten ehrenamtlicher Helfer*innen gegeben hat, wenngleich ein hohes Maß an Motivation und Eigeninitiative zur Aufrechterhaltung der Hilfeleistungen beigetragen haben. Schließlich verdeutlichen die Ergebnisse der vier Studien, dass Ehrenamtliche Hilfe einen wichtigen Anteil an der Versorgung für Flüchtlingen ausmacht. Anerkennung der ehrenamtlichen Tätigkeit, entlastende Aufgabenteilung, und konstruktive unterstützende Zusammenarbeit sind wichtige Faktoren um die Motivation ehramtlich Tätiger zu erhöhen und psychischer Belastung eben jener entgegen zu wirken

Jacobaea vulgaris Gaertn

&lt;i&gt;2.1. PA profile of J. vulgaris&lt;/i&gt; &lt;p&gt; We coupled chromatography with high resolution mass spectrometry (LC-HR-MS) in order to detect low PAs contents and different structures of PAs. A total of 98 different PA structures were determined in 367 &lt;i&gt;J. vulgaris&lt;/i&gt; plant samples of which 347 were located in Schleswig-Holstein and 20, respectively 2 populations, in Hesse (Fig. 1, Table.1). At the time of the study, 13 of these 98 PAs were available as reference standards and could therefore be unambiguously determined. The most abundant PA in &lt;i&gt;J. vulgaris&lt;/i&gt; individuals was erucifoline- &lt;i&gt;N&lt;/i&gt; -oxide (16.33%) followed by senecionine- &lt;i&gt;N&lt;/i&gt; -oxide_senecivernine- &lt;i&gt;N&lt;/i&gt; -oxide (13.75%) and jacobine- &lt;i&gt;N&lt;/i&gt; -oxide (10.84%) (Table 2). Fig. 2 shows the structural formula of the most abundant PAs and a comprehensive list of all identified PAs is shown in Table 5.&lt;/p&gt; &lt;p&gt;The average total PA content of an individual was 1032 &plusmn; 365 mg / kg corresponding to 0.1% of dry weight. The mean amount of PA between populations differed from the lowest 777 &plusmn; 237 mg /kg of dry weight (Heiligenhafen) to the highest 1666 &plusmn; 476 mg /kg of dry weight (Breklum) (Fig. 3A). Both locations in Hesse show similar sums of PAs when compared to the locations in Schleswig-Holstein. Population 17 (Breklum) has a higher PA content, than the remaining populations (Kruskal-Wallis, p &lt;0.0001). However, given our hypothesis, this content might not be relevant for selection by big herbivores, as all found concentrations do not reach the level of harmfulness for big grazing mammals like cattle. For insect herbivores it is known that the effect of the concentration of PAs depends on both PA and insect species (Macel et al., 2005). Nonetheless compared to other investigations in Germany, we found lower overall PA contents in dry weight (These et al., 2013).&lt;/p&gt; &lt;p&gt;Explanations for different contents of PAs are rare. A possible influence might be soil composition and nutrient availability. This was shown by Kirk et al. (2010) who found higher PA concentrations in plants growing in soils with limited nutrients. Kirk et al. (2010) also suggested that there is no selective pressure on PA content by different herbivores. However, other studies did not point towards relevant effects of locational factors including soil composition or herbivory insects on PA content (Joosten et al., 2009; Van der Meijden et al., 1989; Vrieling and Wijk, 1994), indicating the need for further research in this field.&lt;/p&gt; &lt;p&gt;PA diversity was investigated by counting the different PAs that are produced by individuals and subsequently averaged within populations (Fig. 3B). Individuals from population 5 (70 &plusmn; 2), 6 (71 &plusmn; 3), 15 (73 &plusmn; 3), 16 (74 &plusmn; 3), and 19 (71 &plusmn; 3) produced a greater range of different PAs than the average of all individuals hence are chemically more diverse. Population 2 (49 &plusmn; 2), 3 (51 &plusmn; 2), 12 (57 &plusmn; 3), 23 (49 &plusmn; 3), 24 (50 &plusmn; 2), 25 (51 &plusmn; 5) and 27 (57 &plusmn; 2) in contrast produced a lower range of different PAs (ANOVA, F (27, 706) = 18.86, P &lt;0.0001). Population 15 was genetically investigated, too and shows one of the highest genetic diversity values (Table 4).&lt;/p&gt; &lt;p&gt; Previous studies have specified three (Macel et al., 2004) respectively four chemotypes of &lt;i&gt;J. vulgaris&lt;/i&gt; (Witte et al., 1992). According to the dominant PAs, a jacobine type, an erucifoline type, a senecionine type and a mixed type were assigned. We found mainly individuals with both PA jacobine as well as erucifoline. However, ANOVA revealed that averaged trough all populations, 11 populations contained a significantly higher relative share of jacobine. In contrast, 5 populations produced more erucifoline (Fig. 3C), confirming Marcel at al. (2004) who postulated that erucifoline chemotypes are not only restricted to South-East Europe. Moreover, one population (10) contained no erucifoline and 5 populations contained no jacobine at all (2, 5, 7, 15, and 17) or less than 2% (Fig. 4). Remarkably individuals from Population 3 (Stodhagen) produced neither much of jacobine nor erucifoline but plenty seneciphylline and its &lt;i&gt;N&lt;/i&gt; -oxide. However, our data regarding PA composition widely spread so that individuals from the same population produce considerably different amounts of different PAs. As we cannot figure out any consistency or dominant PA profile we suggest that there might not be a direct evolutionary constraint as a selective pressure on PA composition in &lt;i&gt;J. vulgaris&lt;/i&gt; at all. At least for specialist herbivores other studies confirm that they do not put any selective pressure on PA composition (Macel et al., 2002; Macel and Vrieling, 2003; Vrieling and Boer, 1999). In contrast, the same authors showed that different PAs had different effects on generalist and specialist herbivores and thus hypothesized that herbivores could play a role in the evolution of PA diversity (Macel et al., 2005; Macel and Klinkhamer, 2010). Furthermore, soil constitution and its content of microorganisms can affect PA composition (Joosten et al., 2009). Although diversity within populations does exist, averaged values of our data do not support any directed evolution, therefore we interpret the overall diversity of PAs in &lt;i&gt;J. vulgaris&lt;/i&gt;, lacking specific chemotypes to be the result of a panmictic metapopulation with no directing selection on the geographic range of our study.&lt;/p&gt;Published as part of &lt;i&gt;Jung, Stefanie, Lauter, Jan, Hartung, Nicole M., These, Anja, Hamscher, Gerd &amp; Wissemann, Volker, 2020, Genetic and chemical diversity of the toxic herb Jacobaea vulgaris Gaertn. (syn. Senecio jacobaea L.) in Northern Germany, pp. 1-9 in Phytochemistry (112235) (112235) 172&lt;/i&gt; on pages 2-3, DOI: 10.1016/j.phytochem.2019.112235, &lt;a href="http://zenodo.org/record/8294291"&gt;http://zenodo.org/record/8294291&lt;/a&gt

Jacobaea vulgaris Gaertn.

&lt;i&gt;2.2. Genetic profile of J. vulgaris&lt;/i&gt; &lt;p&gt;Our results generated with AFLP markers draw the same picture as our former results using ISSR markers (Jung et al., 2017). In total, three primer combinations produced 243 loci for 75 individuals of which 241 (99.2%) were polymorphic, hence show differences between individuals. AMOVA shows that the main part of the total genetic differentiation (96%) is located within populations while 4% of the genetic differentiation is among populations (Table 3).&lt;/p&gt; &lt;p&gt;The principal co-ordinate analysis (PCoA) was performed to visualize genetic similarities. It shows scattered individuals along with any clustering (Fig. 5). Coordinate 1 explains 29% of the variability and coordinate 2 explains 10%. As we do not see any grouping of individuals belonging to one population, PCoA results confirm AMOVA results and show that there is not too much differentiation among populations.&lt;/p&gt; &lt;p&gt; Genetic structure of &lt;i&gt;J. vulgaris&lt;/i&gt; populations in its native and invasive region has been investigated before (Doorduin et al., 2010). This study shows higher differentiation between populations (13.26%) in its native region which might be explained by the much greater distances between the different populations used in that study. The low differentiation we found in our study indicates that the &lt;i&gt;J. vulgaris&lt;/i&gt; populations are somehow cross-linked to each other, leading to the conclusion that &lt;i&gt;J. vulgaris&lt;/i&gt; forms a panmictic metapopulation in Northern Germany. This could be explained by long distance achene dispersion (e.g. via wind or hay transport) and a connection between populations via pollinators. At least 36 species are known to pollinate &lt;i&gt;J. vulgaris&lt;/i&gt;, mainly Diptera like Syrphidae and Hymenoptera (Vanparys et al., 2008). Therefore, the distances pollinating insects are able to overcome are very various. In human modified landscape for example insects can spread pollen up to 400 m (Rader et al., 2011). In addition, &lt;i&gt;J. vulgaris&lt;/i&gt; seeds are dispersed by wind, water and human activity (Harper and Wood, 1957). Especially rail- and motorways seem to be good propagation vectors for seeds from &lt;i&gt;J. vulgaris&lt;/i&gt; (Harper and Wood, 1957). For the related species &lt;i&gt;Senecio inaequidens&lt;/i&gt; DC. studies have already shown the importance of rail- and motorways as dispersion way (Blanchet et al., 2015; Griese, 1996). In addition, the comparison between the genetic distance and the geographical distance (Mantel test) showed a small positive correlation which was not significant (r = 0.083, p = 0.08), hence we could not detect any isolation by distance, confirming the conclusion that &lt;i&gt;J. vulgaris&lt;/i&gt; forms a metapopulation in Northern Germany.&lt;/p&gt; &lt;p&gt; Genetic diversity values range between 0.31 &plusmn; 0.01 (Neustadt) and 0.4 &plusmn; 0.07 (Rauischholzhausen). The average assumption is 0.35 (Table 4). This is a high to moderate genetic diversity on average and fits to the results of other common Asteraceae with similar life traits. Mand&aacute;k et al. (2009) investigated &lt;i&gt;Carduus acanthoides&lt;/i&gt; L. in its native range using allozymes. &lt;i&gt;C. acanthoides&lt;/i&gt; also shows high levels of genetic diversity and small genetic differentiation. Both species, &lt;i&gt;J. vulgaris&lt;/i&gt; and &lt;i&gt;C. acanthoides&lt;/i&gt;, are invasive in several parts of the world (Desrochers et al., 1988; Doorduin et al., 2010). This also applies to &lt;i&gt;Centaurea scabiosa&lt;/i&gt; L. in Denmark (Ehlers, 1999). In this case a connection between genetic variation and population reproductive success could be detected. According to the same probability to disperse seeds via wind and the general positive correlation between genetic variation and fitness (Leimu et al., 2006) we believe that this is also true for &lt;i&gt;J. vulgaris.&lt;/i&gt; This would mean, that &lt;i&gt;J. vulgaris&lt;/i&gt; has a great potential of spreading further und thus would aggravate the problem of toxic herbs on grazing fields of livestock. We interpret the overall genetic diversity in &lt;i&gt;J. vulgaris&lt;/i&gt;, lacking specific differentiated genotypes to be the result of a panmictic metapopulation with no directing selection on the geographic range of our study.&lt;/p&gt;Published as part of &lt;i&gt;Jung, Stefanie, Lauter, Jan, Hartung, Nicole M., These, Anja, Hamscher, Gerd &amp; Wissemann, Volker, 2020, Genetic and chemical diversity of the toxic herb Jacobaea vulgaris Gaertn. (syn. Senecio jacobaea L.) in Northern Germany, pp. 1-9 in Phytochemistry (112235) (112235) 172&lt;/i&gt; on page 4, DOI: 10.1016/j.phytochem.2019.112235, &lt;a href="http://zenodo.org/record/8294291"&gt;http://zenodo.org/record/8294291&lt;/a&gt