Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States

Background: Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations. Methods: Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference. Results: In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and gender-related content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences. Conclusions: The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine

Induktion der Eicosanoide bei Gesunden und Patienten mit Sepsis

Ziel der vorliegenden Promotionsarbeit war die Untersuchung von Sepsis-assoziierten Veränderungen des Arachidonsäure (AA)-Metabolismus und die Identifikation differentiell regulierter AA-Metabolite mit Prüfung ihres diagnostischen Potentials bei Patienten mit Sepsis unter Anwendung eines in-vitro Lipopolysaccharid (LPS) Vollblutaktivierungs-Modells. In Zellüberständen von nicht-aktiviertem und LPS-aktiviertem Heparinblut (25 Sepsis- Patienten, 15 Gesunde) wurden AA-Metabolite mittels Flüssigkeitschromatographie-Tandem- Massenspektrometrie analysiert. In einer unabhängigen Kohorte (10 Sepsis-Patienten, 3 Gesunde) wurden nach RNA-Isolation aus Zellmaterial zusätzlich Target-Gene des AAMetabolismus (Cyclooxygenase (COX)-2 und mikrosomale Prostaglandin-E-Synthase (mPGES)-1 mittels quantitativer Reverse Transkriptase-Polymerase Kettenreaktion (RT-PCR) untersucht. Es konnte eine differentielle Freisetzung von AA, AA-Analoga und der COX-assoziierten Metabolite Prostaglandin (PG) E2, 11-Hydroxyeicosatetraensäure (HETE) und Thromboxan (TX) B2 zwischen Patienten und gesunden Kontrollpersonen gezeigt werden. Sepsis-Patienten wiesen dabei gegenüber Gesunden eine deutlich reduzierte Freisetzung von AA und den COXassoziierten Metaboliten 11-HETE und PGE2 auf. Das Ausmaß der reduzierten Mediatorenfreisetzung bei Sepsis-Patienten war mit der Schwere der Erkrankungssymptomatik und dem klinischen Outcome assoziiert. Auf Genexpressionsebene zeigte sich eine reduzierte Induzierbarkeit der COX-2 mRNA-Expression bei Sepsis-Patienten gegenüber Gesunden, jedoch eine erhaltene Induzierbarkeit auf der Ebene der mPGES-1.:I Bibliographische Beschreibung………………………………………………………2 II Abkürzungen……………………………..……………………………………………4 III Einleitung 1. Epidemiologie und Definition der Sepsis……………………………………………..…6 2. Pathophysiologie der Sepsis……………………………………………………………..7 3. Stellenwert und Limitationen labordiagnostischer Marker bei Sepsis…………………..8 4. Eicosanoide und Sepsis…………………………………………………………………10 5. In-vitro LPS Vollblutaktivierungs-Modell für die Prüfung der Eicosanoidantwort auf Genexpressions- und Mediatorenebene……………..................12 6. Bestimmung von Eicosanoiden mittels LC-MS/MS........................................................16 7. Zielstellung der Arbeit……………………………………………………………….....18 IV Publikation…………………………………………………………….......................19 V Zusammenfassung der Arbeit………………………………………………………29 VI Literatur……………………………………………………………………………...32 VII Erklärung über die eigenständige Abfassung der Arbeit.………..…………….....35 VIII Lebenslauf………………………………………………………………………........36 IX Spezifizierung des wissenschaftlichen Beitrages zur Publikation...........................38 X Danksagung………………………………………………………………………......3

One Step Closer to Preschool-aged Children's Self-Regulation: Conceptualization and Investigation of its Correlates during Everyday Life

The ability to self-regulate one's own attention, behavior, and emotions is essential for healthy trajectories. The present thesis complements previous research by providing first evidence that preschoolers' self-regulation should be considered as a multi-faceted construct, with intra-individual variability (i.e., daily fluctuations) in addition to inter-individual differences and divergent relations. There is first evidence that daily variability in preschoolers' succesful self-regulation seems to be directly explained by their daily positive affective states and indirectly by habitual physical activity through positive affect, indicating that these child-level variables may constitute promising psychological resources for children's successful self-regulation, occurring in their everyday life. In addition, different parenting behaviors and facets of the home context seem to be differently related according to preschoolers' self-regulation facet. By investigating preschoolers' multi-faceted self-regulation skills and their correlates during everyday lives, the present thesis gets one step closer and contributes to the mosaic of the rising field of self-regulation research

Fully guided implant surgery using Magnetic Resonance Imaging – An in vitro study on accuracy in human mandibles

Objectives: The objective of this in vitro study was to assess the accuracy of fully guided implant placement following virtual implant planning based on MRI. Material and methods: Sixteen human cadaver hemimandibles with single missing teeth (n = 3), partially edentulous (n = 6) and edentulous situations (n = 7) were imaged using MRI. MRI and optical scans obtained with an intraoral scanner, were imported into an implant planning software. Virtual prosthetic and implant planning were performed regarding hard- and soft-tissue anatomy. Drill guides were manufactured, and fully guided implant placement was performed. Buccal and lingual bone and implant nerve distance were measured by three examiners in preoperative MRI and postoperative CBCT. The implant position was assessed using a software for deviation of implant positions displayed in CBCT and optical scans, respectively. Results: MRI displayed relevant structures for implant planning such as cortical and cancellous bone, inferior alveolar nerve and neighboring teeth. Implant planning, CAD/CAM of drill guides and guided implant placement were performed. Deviations between planned and actual implant positions in postoperative CBCT and optical scans were 1.34 mm (SD 0.84 mm) and 1.03 mm (SD 0.46 mm) at implant shoulder; 1.41 mm (SD 0.88 mm) and 1.28 mm (SD 0.52 mm) at implant apex, and 4.84° (SD 3.18°) and 4.21° (SD 2.01°). Measurements in preoperative MRI and postoperative CBCT confirmed the compliance with minimum distances of implants to anatomical structures. Conclusions: Relevant anatomical structures for imaging diagnostics in implant dentistry are displayed with MRI. The accuracy of MRI-based fully guided implant placement in vitro is comparable to the workflow using CBCT

"Krise, welche Krise?" Umfrage- und Fallstudienergebnisse zur betrieblichen Wirkung der Wirtschafts- und Finanzkrise

In den Jahren 2008 bzw. 2009 hat eine Wirtschaftskrise einen plötzlichen Abriss des Wirtschaftswachstums bewirkt. Es stellt sich die Frage, welche Effekte die Krise auf betrieblicher Ebene entfaltet hat und welche langfristigen Folgen sich daraus ergeben. Zur Beantwortung nutzen wir (1) Ergebnisse einer Betriebsbefragung (N=988 Betriebe), die in der zweiten Jahreshälfte 2010 erhoben wurde, sowie (2) vier Fallstudien von Maschinenbaubetrieben. Unsere quantitativen Analysen zeigen, dass nur in bestimmten Branchen ein starker Einbruch der wirtschaftlichen Lage zu verzeichnen ist, der wiederum 2010 fast bis auf Vorkrisenniveau ausgeglichen werden konnte. In den untersuchten Fallstudienbetrieben bestätigen sich diese Ergebnisse und unterstreichen die Erfahrung einer hoch volatilen Krisendynamik. Nach der Krise deutet sich jedoch kein umfassender organisatorischer Wandel an. Vielmehr wird die Krisenerfahrung als Bestätigung der eingeschlagenen Flexibilisierungsstrategien gewertet.In 2008 and 2009 an economic crisis caused a sudden decline of economic growth. This paper explores the immediate effects of the crisis at the establishment level as well as it asks about the long term effects of the crisis. Our study is based on (1) the results of an establishment survey (N=988 firms), conducted in the second half of 2010, alongside with (2) four case studies of manufacturing firms. Based upon our quantitative results we argue that a strong economic decline occurred only in certain industries. The affected establishments have almost recovered to a pre-crisis level by the end of 2010. Our case studies confirm these results and emphasize the common experience of a highly volatile crisis dynamic. None of the investigated cases did display attempts of substantial organizational changes as a reaction to the crisis. On the contrary the experience of the crisis was interpreted as a reassurance of already established strategies for flexibilization

Wie viel Heterogenität gibt es im "Modell Deutschland"? Zur Verbindung von betrieblichen Beschäftigungssystemen und Profilen der Innovationsfähigkeit

"Das spezifische Beschäftigungssystem Deutschlands wurde in der Vergangenheit als Voraussetzung für die Herstellung qualitativ hochwertiger Produkte und eine typische Innovationsstärke im Bereich inkrementeller Innovationen gewertet. Der Beitrag wird diesem Zusammenhang auf der Ebene betrieblicher Beschäftigungssysteme und Profilen der Innovationsfähigkeit nachgehen, indem die Daten einer repräsentativen telefonischen Betriebsbefragung ausgewertet werden, die im Herbst 2010 durchgeführt wurde (N = 988). Mit Hilfe einer latenten Klassenanalyse werden fünf verschiedene Profile der betrieblichen Innovationsfähigkeit identifiziert, die jeweils in deutlicher Weise mit den Merkmalen des betrieblichen Beschäftigungssystems in Zusammenhang stehen. Die Profile unterscheiden sich entlang der Orientierung an langfristiger Personalentwicklung sowie nach dezentralen Organisationspraktiken. Die Ergebnisse zeigen, dass innerhalb eines nationalen institutionellen Rahmens eine große Vielfalt betrieblicher Strategien verfolgt wird. Zudem deuten die Befunde darauf hin, dass die Betriebe nicht allein auf die Realisierung von inkrementellen Innovationen ausgerichtet sind. Vielmehr finden sich Hinweise auf eine komplementäre Verbindung zwischen inkrementellen und radikalen Innovationsaktivitäten." (Autorenreferat)"In the past, the German employment system has been considered a precondition for the manufacturing of high-quality products and the typically strong capacity for incremental innovation. This article investigates the relationship between establishment employment systems and innovative capability profiles using data from a representative establishment telephone survey conducted in the fall of 2010 (N = 988). Employing latent class analysis, five different innovative capability profiles are identified. All five profiles show significant association with the included aspects of establishment employment systems. The profiles differ with respect to long-term personnel development as well as decentralized organizational practices. The results reveal the variety of strategies being pursued within one national institutional framework. In addition, the findings indicate that establishments in the German economic model do not focus exclusively on incremental innovation. Instead the authors find evidence for complementary combination of radical and incremental innovation activities." (author's abstract

a web-based interactive knowledge-sharing platform for sex- and gender- specific medical education

Background Sex and Gender Medicine is a novel discipline that provides equitable medical care for society and improves outcomes for both male and female patients. The integration of sex- and gender-specific knowledge into medical curricula is limited due to adequate learning material, systematic teacher training and an innovative communication strategy. We aimed at initiating an e-learning and knowledge-sharing platform for Sex and Gender Medicine, the eGender platform (http://egender.charite.de), to ensure that future doctors and health professionals will have adequate knowledge and communication skills on sex and gender differences in order to make informed decisions for their patients. Methods The web-based eGender knowledge-sharing platform was designed to support the blended learning pedagogical teaching concept and follows the didactic concept of constructivism. Learning materials developed by Sex and Gender Medicine experts of seven universities have been used as the basis for the new learning tools. The content of these tools is patient-centered and provides add-on information on gender-sensitive aspects of diseases. The structural part of eGender was designed and developed using the open source e-learning platform Moodle. The eGender platform comprises an English and a German version of e-learning modules: one focusing on basic knowledge and seven on specific medical disciplines. Each module consists of several courses corresponding to a disease or symptom complex. Self-organized learning has to be managed by using different learning tools, e.g., texts and audiovisual material, tools for online communication and collaborative work. Results More than 90 users from Europe registered for the eGender Medicine learning modules. The most frequently accessed module was “Gender Medicine—Basics” and the users favored discussion forums. These e-learning modules fulfill the quality criteria for higher education and are used within the elective Master Module “Gender Medicine—Basics” implemented into the accredited Master of Public Health at Charité—Berlin. Conclusions The eGender platform is a flexible and user-friendly electronical knowledge-sharing platform providing evidence-based high-quality learning material used by a growing number of registered users. The eGender Medicine learning modules could be key in the reform of medical curricula to integrate Sex and Gender Medicine into the education of health professionals

A Pharmacokinetic and Metabolism Study of the TRPC6 Inhibitor SH045 in Mice by LC-MS/MS

TRPC6, the sixth member of the family of canonical transient receptor potential (TRP) channels, contributes to a variety of physiological processes and human pathologies. This study extends the knowledge on the newly developed TRPC6 blocker SH045 with respect to its main target organs beyond the description of plasma kinetics. According to the plasma concentration-time course in mice, SH045 is measurable up to 24 h after administration of 20 mg/kg BW (i.v.) and up to 6 h orally. The short plasma half-life and rather low oral bioavailability are contrasted by its reported high potency. Dosage limits were not worked out, but absence of safety concerns for 20 mg/kg BW supports further dose exploration. The disposition of SH045 is described. In particular, a high extravascular distribution, most prominent in lung, and a considerable renal elimination of SH045 were observed. SH045 is a substrate of CYP3A4 and CYP2A6. Hydroxylated and glucuronidated metabolites were identified under optimized LC-MS/MS conditions. The results guide a reasonable selection of dose and application route of SH045 for target-directed preclinical studies in vivo with one of the rare high potent and subtype-selective TRPC6 inhibitors availabl

Simulation of the furnace of the boiler P-49 in the package of applied programs fire 3D

The combustion of solid low-grade fuel in LTV-boiler furnaces is a pressing research questions currently. The aim of this work is the creation of a computational grid model LTV-furnace to calculate the package of applied programs FIRE 3D. The study created a model LTV-furnace. The model tested on brown coal from the Nazarovo Deposit. The resulting distribution of temperatures and velocities has proved the performance of the model