Is TNF-α a prognostic factor in patients with sepsis?

Objective: To determine tumor necrosis factor-α (TNF-α) levels in a prospective study in 58 hospitalized patients in a department of internal medicine (63 episodes, 29 in immunocompromised patients) during a 7-month period.Methods: Patients fulfilling the following criteria were included: clinical evidence of acute infection, temperature >38.2°C, tachycardia >90 beats/min, tachypnea >20 breaths/min. Samples were taken from day 1 up to day 13 after an infection was diagnosed, and TNF-α was determined by enzyme immunoassay.Results: In 29 episodes (46.0%) the infection was microbiologically documented. The median of the TNF-α levels in the Gram-negative episodes was significantly higher than that in the Gram-positive episodes (p = 0.002). Thirteen of 63 episodes (20.6%) had a fatal outcome. With respect to all measured values, the non-survivors had a significantly higher median of TNF-α levels than the survivors (p = 0.0001). There was, however, great interpatient and intrapatient variability in TNF-α levels; thus, no unequivocal correlation between TNF-α and outcome could be documented.Conclusions: Our data indicate that the influence of the infecting organism on TNF-α kinetics is less pronounced than that of the underlying disease

Non-Poissonian Bursts in the Arrival of Phenotypic Variation Can Strongly Affect the Dynamics of Adaptation

Modeling the rate at which adaptive phenotypes appear in a population is a key to predicting evolutionary processes. Given random mutations, should this rate be modeled by a simple Poisson process, or is a more complex dynamics needed? Here we use analytic calculations and simulations of evolving populations on explicit genotype–phenotype maps to show that the introduction of novel phenotypes can be “bursty” or overdispersed. In other words, a novel phenotype either appears multiple times in quick succession or not at all for many generations. These bursts are fundamentally caused by statistical fluctuations and other structure in the map from genotypes to phenotypes. Their strength depends on population parameters, being highest for “monomorphic” populations with low mutation rates. They can also be enhanced by additional inhomogeneities in the mapping from genotypes to phenotypes. We mainly investigate the effect of bursts using the well-studied genotype–phenotype map for RNA secondary structure, but find similar behavior in a lattice protein model and in Richard Dawkins’s biomorphs model of morphological development. Bursts can profoundly affect adaptive dynamics. Most notably, they imply that fitness differences play a smaller role in determining which phenotype fixes than would be the case for a Poisson process without bursts

Theology, News and Notes - Vol. 43, No. 02

Theology News & Notes was a theological journal published by Fuller Theological Seminary from 1954 through 2014.https://digitalcommons.fuller.edu/tnn/1125/thumbnail.jp

TcT: Tyrolean Complexity Tool

International audienceIn this paper we present TcT v3.0, the latest version of our fully automated complexity analyser.TcT implements our framework for automated complexity analysis and focuses on extensibility and automation. TcT is open with respect to the input problem under investigation and the resource metric in question.It is the most powerful tool in the realm of automated complexity analysis of term rewrite systems. Moreover it provides an expressive problem-independent strategy language that facilitates proof search.We give insights about design choices, the implementation of the framework and report different case studies where we have applied TcT successfully

Clinical skills of veterinary students - a cross-sectional study of the self-concept and exposure to skills training in Hannover, Germany

Background: Students of veterinary medicine should achieve basic professional competences required to practise their profession. A main focus of veterinary education is on developing clinical skills. The present study used the guidelines of the "Day-One Skills" list of European Association of Establishments for Veterinary Education (EAEVE) to create an online questionnaire for assessing the skills acquired by students at the University of Veterinary Medicine Hannover (TiHo). The theoretical and practical veterinary knowledge levels of the students and postgraduates are determined and compared. Results: In two batches, 607 people responded (response batch 1, 23.78%; response batch 2, 23.83%). From 49 defined skills, 28 are actually practised during training at the university and 21 activities are known only theoretically. Furthermore, the students showed great willingness to use simulators and models in a clinical skills lab. Conclusions: The results of this survey highlight that the opening of a clinical skills lab at the University of Veterinary Medicine Hannover and its incorporation into the study programme are ideal tools to promote practical competences and foster the motivation to learn

Teaching clinical hematology and leukocyte differentiation in veterinary medicine using virtual patients

Due to contact restrictions imposed because of the COVID-19 pandemic, we created a novel digital course on the Moodle learning platform for winter term in 2020. In the clinical pathology course (CPC) with hematological content, third-year students were able to work independently on 10 extra digital cases of internal medicine involving eight different animal species as a compensation for the reduction in traditional microscopy exercises. Each case presented was initiated using an anamnesis, also the participants to generate a differential blood count based on digitized leukocytes, previously been photographed using a microscope camera. The cases were successive and increased in complexity, for example through the increase in the number of different cell types to be differentiated. The participants had the opportunity to evaluate the course through a final module to rate user-friendliness and acceptance. The total results of the participants in 2021 were analyzed descriptively, focusing on success rates, time spent on the tasks, and number of attempts. A total of 237 (= 96%) of 247 students completed all cases, each assessing 1033 photographed blood cells in sum. The mean processing time was 22.48 min for a differentiation and the students spent an average of 1.48 attempts on it. A voluntary feedback form was completed by 192 (= 78%) students, with more than 95% rating the course positively in 12 evaluation questions, and 29 of 33 comments (= 87.88%) providing positive statements in a comment box. Suggestions for improvement primarily included more explanations on erythrocyte morphologies, followed by adjusting the difficulty level and improving the presentational set-up. Slight improvements in results, time spent on processing the tasks, and the number of attempts indicated an achievement of routine and confidence during the course and were associated with an increase of competency. The positive feedback showed a high acceptance of the digital format and students evaluated the course as improving the quality of teaching when combined with practical exercises

Dokumentation über die Erhebungsinstrumente in der Längsschnittstudie Learning to Practice, Learning to Reflect? (LtP) zur Nutzung und Wirkung des Praxissemesters in der Lehrer*innenbildung

Die vorliegende Skalendokumentation beinhaltet die Erhebungsinstrumente und die entsprechenden statistische Angaben des Verbundprojektes Learning to Practice, Learning to Reflect? (LtP), das unter der Leitung von Prof. Dr. Johannes König, Prof. Dr. Martin Rothland und Prof. Dr. Niclas Schaper an den Universitäten Köln, Siegen und Paderborn durchgeführt wurde. Ziel des standortübergreifenden Verbundprojektes war die empirische Untersuchung der Nutzung und Wirkung des Praxissemesters in Nordrhein-Westfalen. Im Rahmen des Projekts wurden die Studierenden der drei Standorte, die ihr Praxissemester im Sommersemester 2016 absolvierten, vor Antritt und nach Abschluss dieses Ausbildungsabschnittes umfassend befragt und getestet. So wurden im Längsschnitt 409 Studierende erreicht. Detaillierte Ergebnisdarstellungen finden sich in den einzelnen Kapiteln des Sammelbandes „Learning to Practice, Learning to Reflect?“ (König, Rothland & Schaper, 2018). Die vorliegende Darstellung der Erhebungsinstrumente gliedert sich anhand des zur Untersuchung des Praxissemesters herangezogenen Rahmenmodells in: demographische Angaben und Angaben zur Praxissemesterschule, individuelle Voraussetzungen, Angebot, Nutzung der Lerngelegenheiten, Lernprodukte und Output