Objektiv strukturierte Bewertung einer Hautnaht am Modell : ist die direkte Beobachtung der video-basierten Beobachtung überlegen? ; Poster

Poster Einleitung: OSCEs werden immer häufiger in der Ausbildung von Studierenden eingesetzt. Die Einführung eines OSCEs im fach Chirurgie ist in Planung. Durch die große Anzahl von Studierenden pro Semester oder Studienjahr (400 Studierende in Frankfurt) ist die Durchführung einer OSCE Prüfung mit großem personellen Aufwand verbunden. Vor allem während der Prüfung müssen eine Vielzahl von Chirurgen simultan zu Prüfungszwecken zur Verfügung stehen. Ziel der Studie war es, zu überprüfen, ob eine video-basierte Bewertung einer „Nahtstation“ zu einem späteren Zeitpunkt zu gleichen Ergebnissen in der Bewertung der Leistung der Studierenden führt. Methode: 33 Studierende führten unter standardisierten Bedingungen eine Hautnaht an einem Modell durchzuführen. Die Studierenden wurden während der Prozedur von zwei prüfenden Chirurgen und zwei Studierenden im PJ (praktischen Jahr) beobachtet und anhand einer objektiv strukturierten Checkliste bewertet (Prozessevaluation). Die Prozedur wurde gleichzeitig auf Video aufgezeichnet und zu einem späteren Zeitpunkt zwei weiteren Chirurgen und zwei weiteren Studierenden im PJ zur Bewertung gezeigt. Ergebnisse: Der Vergleich zwischen "live“-prüfenden und "video“-prüfenden Chirurgen zeigt eine signifikant hohe Korrelation (r=0,87; p<0,01) und eine hohe Übereinstimmung (88,2%) in der Bewertung. Ebenso zeigen die prüfenden PJler eine signifikant hohe Korrelation (r=0,84; p<0,01). Die Übereinstimmung ist bei den PJlern mit (82.4%) etwas niedriger als bei den beteiligten Chirurgen. Zusammenfassung: Mit dieser Studie konnte zeigt werden, daß es bei der Beurteilung der Performance von Studierenden bei einer Hautnaht am Modell unter Anwendung von objektiv strukturierten Checklisten möglich ist, eine direkte Beobachtung der Studierenden durch eine video-basierte Beobachtung zu ersetzen. Eine "Nahtstation“ in einem OSCE kann somit während der Prüfungszeit ohne Prüfer auskommen und im Anschluß bewertet werden

Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review

BACKGROUND: In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. METHODS: Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. RESULTS: Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. CONCLUSIONS: While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous

A guide to the deep-water sponges of the Aleutian Island Archipelago

The first dedicated collections of deep-water (>80 m) sponges from the central Aleutian Islands revealed a rich fauna including 28 novel species and geographical range extensions for 53 others. Based on these collections and the published literature, we now confirm the presence of 125 species (or subspecies)of deep-water sponges in the Aleutian Islands. Clearly the deep-water sponge fauna of the Aleutian Islands is extraordinarily rich and largely understudied. Submersible observations revealed that sponges, rather than deep-water corals, are the dominant feature shaping benthic habitats in the region and that they provide important refuge habitat for many species of fish and invertebrates including juvenile rockfish (Sebastes spp.) and king crabs (Lithodes sp). Examination of video footage collected along 127 km of the seafloor further indicate that there are likely hundreds of species still uncollected from the region, and many unknown to science. Furthermore, sponges are extremely fragile and easily damaged by contact with fishing gear. High rates of fishery bycatch clearly indicate a strong interaction between existing fisheries and sponge habitat. Bycatch in fisheries and fisheries-independent surveys can be a major source of information on the location of the sponge fauna, but current monitoring programs are greatly hampered by the inability of deck personnel to identify bycatch. This guide contains detailed species descriptions for 112 sponges collected in Alaska, principally in the central Aleutian Islands. It addresses bycatch identification challenges by providing fisheries observers and scientists with the information necessary to adequately identify sponge fauna. Using that identification data, areas of high abundance can be mapped and the locations of indicator species of vulnerable marine ecosystems can be determined. The guide is also designed for use by scientists making observations of the fauna in situ with submersibles, including remotely operated vehicles and autonomous underwater vehicles

ALMA finds dew drops in the dusty spider’s web

We present 0.̋5 resolution ALMA detections of the observed 246 GHz continuum, [CI] 3P2→3P1 fine structure line ([CI]2–1), CO(7–6), and H2O lines in the z = 2.161 radio galaxy MRC1138-262, the so-called Spiderweb galaxy. We detect strong [CI]2–1 emission both at the position of the radio core, and in a second component ~4 kpc away from it. The 1100 km s-1 broad [CI]2–1 line in this latter component, combined with its H2 mass of 1.6 × 1010 M⊙, implies that this emission must come from a compact region <60 pc, possibly containing a second active galactic nucleus (AGN). The combined H2 mass derived for both objects, using the [CI]2–1 emission, is 3.3 × 1010 M⊙. The total CO(7–6)/[CI]2–1 line flux ratio of 0.2 suggests a low excitation molecular gas reservoir and/or enhanced atomic carbon in cosmic ray dominated regions. We detect spatially-resolved H2O 211−202 emission – for the first time in a high-z unlensed galaxy – near the outer radio lobe to the east, and near the bend of the radio jet to the west of the radio galaxy. No underlying 246 GHz continuum emission is seen at either position. We suggest that the H2O emission is excited in the cooling region behind slow (10–40 km s-1) shocks in dense molecular gas (103−5 cm-3). The extended water emission is likely evidence of the radio jet’s impact on cooling and forming molecules in the post-shocked gas in the halo and inter-cluster gas, similar to what is seen in low-z clusters and other high-z radio galaxies. These observations imply that the passage of the radio jet in the interstellar and inter-cluster medium not only heats gas to high temperatures, as is commonly assumed or found in simulations, but also induces cooling and dissipation, which can lead to substantial amounts of cold dense molecular gas. The formation of molecules and strong dissipation in the halo gas of MRC1138-262 may explain both the extended diffuse molecular gas and the young stars observed around MRC1138-262

Nothing in (sponge) biology makes sense - except when based on holotypes

Sponge species are infamously difficult to identify for non-experts due to their high morphological plasticity and the paucity of informative morphological characters. The use of molecular techniques certainly helps with species identification, but unfortunately it requires prior reference sequences. Holotypes constitute the best reference material for species identification, however their usage in molecular systematics and taxonomy is scarce and frequently not even attempted, mostly due to their antiquity and preservation history. Here we provide case studies in which we demonstrate the importance of using holo-type material to answer phylogenetic and taxonomic questions. We also demonstrate the possibility of sequencing DNA fragments out of century-old holotypes. Furthermore we propose the deposition of DNA sequences in conjunction with new species descriptions

Health status of the advanced elderly in six european countries: results from a representative survey using EQ-5D and SF-12

<p>Abstract</p> <p>Background</p> <p>Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort.</p> <p>Aims of the study</p> <p>To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health.</p> <p>Methods</p> <p>In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health.</p> <p>Results</p> <p>68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean.</p> <p>Conclusions</p> <p>More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.</p

AluY-mediated germline deletion, duplication and somatic stem cell reversion in <i>UBE2T</i> defines a new subtype of Fanconi anemia

Fanconi anemia (FA) is a rare inherited disorder clinically characterized by congenital malformations, progressive bone marrow failure and cancer susceptibility. At the cellular level, FA is associated with hypersensitivity to DNA-crosslinking genotoxins. Eight of 17 known FA genes assemble the FA E3 ligase complex, which catalyzes monoubiquitination of FANCD2 and is essential for replicative DNA crosslink repair. Here, we identify the first FA patient with biallelic germline mutations in the ubiquitin E2 conjugase UBE2T. Both mutations were aluY-mediated: a paternal deletion and maternal duplication of exons 2-6. These loss-of-function mutations in UBE2T induced a cellular phenotype similar to biallelic defects in early FA genes with the absence of FANCD2 monoubiquitination. The maternal duplication produced a mutant mRNA that could encode a functional protein but was degraded by nonsense-mediated mRNA decay. In the patient's hematopoietic stem cells, the maternal allele with the duplication of exons 2-6 spontaneously reverted to a wild-type allele by monoallelic recombination at the duplicated aluY repeat, thereby preventing bone marrow failure. Analysis of germline DNA of 814 normal individuals and 850 breast cancer patients for deletion or duplication of UBE2T exons 2-6 identified the deletion in only two controls, suggesting aluY-mediated recombinations within the UBE2T locus are rare and not associated with an increased breast cancer risk. Finally, a loss-of-function germline mutation in UBE2T was detected in a high-risk breast cancer patient with wild-type BRCA1/2. Cumulatively, we identified UBE2T as a bona fide FA gene (FANCT) that also may be a rare cancer susceptibility gene.</p

Characterisation of Herschel-selected strong lens candidates through HST and sub-mm/mm observations

We have carried out HST snapshot observations at 1.1 $\mu$m of 281 candidate strongly lensed galaxies identified in the wide-area extragalactic surveys conducted with the Herschel space observatory. Our candidates comprise systems with flux densities at $500\,\mu$m$S_{500}\geq 80$ mJy. We model and subtract the surface brightness distribution for 130 systems, where we identify a candidate for the foreground lens candidate. After combining visual inspection, archival high-resolution observations, and lens subtraction, we divide the systems into different classes according to their lensing likelihood. We confirm 65 systems to be lensed. Of these, 30 are new discoveries. We successfully perform lens modelling and source reconstruction on 23 systems, where the foreground lenses are isolated galaxies and the background sources are detected in the HST images. All the systems are successfully modelled as a singular isothermal ellipsoid. The Einstein radii of the lenses and the magnifications of the background sources are consistent with previous studies. However, the background source circularised radii (between 0.34 kpc and 1.30 kpc) are $\sim$3 times smaller than the ones measured in the sub-mm/mm for a similarly selected and partially overlapping sample. We compare our lenses with those in the SLACS survey, confirming that our lens-independent selection is more effective at picking up fainter and diffuse galaxies and group lenses. This sample represents the first step towards characterising the near-IR properties and stellar masses of the gravitationally lensed dusty star-forming galaxies.Comment: 57 pages, 18 figures, 11 tables. Accepted for publication in MNRA

Health status of the advanced elderly in six european countries: results from a representative survey using EQ-5D and SF-12

<p>Abstract</p> <p>Background</p> <p>Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort.</p> <p>Aims of the study</p> <p>To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health.</p> <p>Methods</p> <p>In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health.</p> <p>Results</p> <p>68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean.</p> <p>Conclusions</p> <p>More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.</p