Leichte Sprache als wichtige Voraussetzung für die Förderung des Gesundheitsbewusstseins kognitiv beeinträchtigter Menschen sowie deren Bedeutung für medizinische Ausbildungsberufe

In der vorliegenden Arbeit geht es darum, aufzuzeigen, dass es dringend erforderlich ist, die Leichte Sprache als Teil der Normalität des sozialen Verhaltens in unserer Gesellschaft zu etablieren, um somit kognitiv Beeinträchtigten eine Chance auf Gleichstellung zu geben. Des Weiteren wird auf die Notwendigkeit hingewiesen, die Thematik Leichte Sprache gezielter in den medizinischen Bereich zu integrieren. Dadurch könnte ein Beitrag zu einer barrierefreien Kommunikation mit dieser Personengruppe geleistet werden - ein aktuelles und brisantes Thema. Darüber hinaus gewinnt auch das Thema Digitalisierung im Gesundheitswesen zunehmend an Bedeutung. Informations- und Kommunikationstechnologien sowie Robotik sind inzwischen unverzichtbar. Deshalb werden in dieser Arbeit die Digitalisierung im medizinischen Bereich sowie insbesondere die Telemedizin näher betrachtet. Im Rahmen der Gesundheitsförderung kommt dieser Neuerung eine wichtige Bedeutung zu. Es stellt sich aber die Frage, ob und inwiefern kognitiv Beeinträchtigte von den unterschiedlichen gesundheitsunterstützenden Maßnahmen - die zunehmend auch digitalisiert sind - profitieren bzw. ob durch die fortschreitende Technisierung ggf. sogar weitere Hürden bzw. Barrieren für betroffene Menschen entstehen. Die vorliegende Arbeit ist in einen theoretischen und einen praktischen Teil gegliedert. Im theoretischen Teil werden sowohl die Gesundheitsförderung im Allgemeinen als auch in Bezug auf kognitiv Beeinträchtigte, die bereits angesprochene Digitalisierung in der Medizin und deren Auswirkungen auf kognitiv Beeinträchtigte erläutert. Die Experten-Laien-Kommunikation stellt ebenfalls einen Schwerpunkt dar. Deren genauere Beschreibung erfolgt am Beispiel der medizinischen Aufklärung. Ein weiteres Thema ist die Leichte Sprache - das Konzept, die Regeln aber auch ihre Grenzen. Gleichzeitig soll der Prozess der Erstellung eines Textes in Leichter Sprache dargestellt werden. Darüber hinaus ist es ein Ziel der Arbeit, die Notwendigkeit der Einbeziehung des Konzepts der Leichten Sprache in die medizinischen Ausbildungsberufe zu begründen. Zur Verdeutlichung dienen hierfür die Ausbildungen zur bzw. zum Medizinischen Fachangestellten sowie zur Medizinisch-technischen Assistentin bzw. zum Medizinisch-technischen Assistenten für den Operationsdienst. Der praktische Teil besteht aus dem Versuch zweier Übersetzungen in Leichte Sprache. Insbesondere in Arztpraxen sowie Krankenhäusern ist die Kommunikation mit kognitiv Beein-trächtigten von großer Bedeutung. Aufklärungsbroschüren sowie Flyer werden dort als Informationsmaterial ausgelegt. Ebenso erhalten die Patientinnen bzw. Patienten vor Untersuchungen und geplanten operativen Eingriffen spezielle Aufklärungsbögen. Diese sind jedoch nicht für jeden verständlich. Deshalb habe ich bereits zum zweiten Mal versucht, einen ausgewählten Aufklärungsbogen in Leichte Sprache zu übersetzen - zusätzlich den dazu passenden Abschnitt eines Früherkennungsfaltblattes. Es ist durchaus denkbar, eine solche Textübertragung an der Berufsschule im Rahmen eines Projekts mit zukünftigen Medizinischen Fachangestellten zu thematisieren und ggf. umzusetzen. Am Ende der Arbeit erfolgt eine kritische Auseinandersetzung mit der Methode des Übersetzens in Leichte Sprache, bevor ein Fazit gezogen wird.:Inhaltsverzeichnis I Einleitung 4 II Theoretischer Teil 6 1 Gesundheitsförderung im digitalen Zeitalter bei kognitiv beeinträchtigten Menschen 6 1.1 Die Gesundheitsförderung - ein gesetzlicher Anspruch auch für kognitiv beeinträchtigte Menschen 6 1.1.1 Die Gesundheitsförderung - eine Begriffserklärung 7 1.1.2 Die Auswirkungen der Gesundheitsförderung 7 1.1.3 Die Teilhabe kognitiv beeinträchtigter Menschen an der Gesundheitsförderung 10 1.2 Die Digitalisierung und deren Auswirkungen auf kognitiv beeinträchtigte Menschen 16 1.2.1 Ein Einblick in die Telemedizin 16 1.2.2 Die Digitalisierung in der Medizin 17 1.2.3 Die Auswirkungen der Digitalisierung auf kognitiv beeinträchtigte Menschen 19 2 Experten-Laien-Kommunikation im Gesundheitswesen unter besonderer Beachtung kognitiv beeinträchtigter Menschen 22 2.1 Das Expertensystem 22 2.2 Das Laiensystem 22 2.3 Die Medizin als Profession 23 2.4 Die Experten-Laien-Kommunikation sowie die Arzt-Patienten-Kommunikation 24 2.4.1 Das Aufklärungsgespräch als Form der Experten-Laien-Kommunikation 28 2.4.2 Die Inhalte eines Aufklärungsgesprächs 28 2.4.3 Die Aufklärung aus Sicht der Expertin bzw. des Experten 29 2.4.4 Die Aufklärung aus Sicht des Laien 32 3 Leichte Sprache und Inklusion 34 3.1 Das Konzept der Leichten Sprache 35 3.2 Die drei Funktionen der Leichten Sprache 38 3.3 Die Regeln der Leichten Sprache - ein Überblick 39 3.4 Einige Grenzen von Leichter Sprache 40 4 Die Methode des Übersetzens in Leichte Sprache 44 4.1 Die Texterstellung in Leichter Sprache - Schrittfolge der Übersetzung 44 4.2 Die Leichte Sprache und medizinische Ausbildungsberufe 49 4.2.1 Die Ausbildung zur bzw. zum medizinischen Fachangestellten 49 4.2.2 Die Ausbildung zur Medizinisch-technischen Assistentin bzw. zum Medizinisch-technischen Assistenten für den Operationsdienst 53 III Praktischer Teil 55 5 Versuch zweier Übersetzungen in Leichte Sprache 55 6 Methodenkritik 56 7 Fazit und Ausblick 64 Literaturverzeichnis 67 Anhangsverzeichnis 73 Selbstständigkeitserklärung 13

An extreme high temperature event in coastal East Antarctica associated with an atmospheric river and record summer downslope winds

High surface temperatures are important in Antarctica because of their role in ice melt and sea level rise. We investigate a high temperature event in December 1989 that gave record temperatures in coastal East Antarctica between 60º and 100º E. The high temperatures were associated with a pool of warm lower tropospheric air with December temperature anomalies of >14º C that developed in two stages over the Amery Ice Shelf. Firstly, there was near-record poleward warm advection within an atmospheric river. Secondly, synoptically-driven downslope flow from the interior reached unprecedented December strength over a large area, leading to strong descent and further warming in the coastal region. The coastal easterly winds were unusually deep and strong, and the warm pool was advected westwards, giving a short period of high temperatures at coastal locations, including a surface temperature of 9.3ºC at Mawson, the second highest in its 66-year record

New Tetrahedral Global Minimum for the 98-atom Lennard-Jones Cluster

A new atomic cluster structure corresponding to the global minimum of the 98-atom Lennard-Jones cluster has been found using a variant of the basin-hopping global optimization algorithm. The new structure has an unusual tetrahedral symmetry with an energy of -543.665361, which is 0.022404 lower than the previous putative global minimum. The new LJ_98 structure is of particular interest because its tetrahedral symmetry establishes it as one of only three types of exceptions to the general pattern of icosahedral structural motifs for optimal LJ microclusters. Similar to the other exceptions the global minimum is difficult to find because it is at the bottom of a narrow funnel which only becomes thermodynamically most stable at low temperature.Comment: 3 pages, 2 figures, revte

The dominant role of extreme precipitation events in Antarctic snowfall variability

Antarctic snowfall consists of frequent clear‐sky precipitation and heavier falls from intrusions of maritime airmasses associated with amplified planetary waves. We investigate the importance of different precipitation events using the output of the RACMO2 model. Extreme precipitation events consisting of the largest 10% of daily totals are shown to contribute more than 40% of the total annual precipitation across much of the continent, with some areas receiving in excess of 60% of the total from these events. The greatest contribution of extreme precipitation events to the annual total is in the coastal areas and especially on the ice shelves, with the Amery Ice Shelf receiving 50% of its annual precipitation in less than the 10 days of heaviest precipitation. For the continent as a whole, 70% of the variance of the annual precipitation is explained by variability in precipitation from extreme precipitation events, with this figure rising to over 90% in some areas

Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant

RATIONALE: Primary graft dysfunction (PGD) is a form of acute lung injury that occurs after lung transplantation. The definition of PGD was standardized in 2005. Since that time, clinical practice has evolved, and this definition is increasingly used as a primary endpoint for clinical trials; therefore, validation is warranted. OBJECTIVES: We sought to determine whether refinements to the 2005 consensus definition could further improve construct validity. METHODS: Data from the Lung Transplant Outcomes Group multicenter cohort were used to compare variations on the PGD definition, including alternate oxygenation thresholds, inclusion of additional severity groups, and effects of procedure type and mechanical ventilation. Convergent and divergent validity were compared for mortality prediction and concurrent lung injury biomarker discrimination. MEASUREMENTS AND MAIN RESULTS: A total of 1,179 subjects from 10 centers were enrolled from 2007 to 2012. Median length of follow-up was 4 years (interquartile range = 2.4-5.9). No mortality differences were noted between no PGD (grade 0) and mild PGD (grade 1). Significantly better mortality discrimination was evident for all definitions using later time points (48, 72, or 48-72 hours; P < 0.001). Biomarker divergent discrimination was superior when collapsing grades 0 and 1. Additional severity grades, use of mechanical ventilation, and transplant procedure type had minimal or no effect on mortality or biomarker discrimination. CONCLUSIONS: The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination

The relationship between plasma lipid peroxidation products and primary graft dysfunction after lung transplantation is modified by donor smoking and reperfusion hyperoxia

BACKGROUND: Donor smoking history and higher fraction of inspired oxygen (FIO2) at reperfusion are associated with primary graft dysfunction (PGD) after lung transplantation. We hypothesized that oxidative injury biomarkers would be elevated in PGD, with higher levels associated with donor exposure to cigarette smoke and recipient hyperoxia at reperfusion. METHODS: We performed a nested case-control study of 72 lung transplant recipients from the Lung Transplant Outcomes Group cohort. Using mass spectroscopy, F2-isoprostanes and isofurans were measured in plasma collected after transplantation. Cases were defined in 2 ways: grade 3 PGD present at day 2 or day 3 after reperfusion (severe PGD) or any grade 3 PGD (any PGD). RESULTS: There were 31 severe PGD cases with 41 controls and 35 any PGD cases with 37 controls. Plasma F2-isoprostane levels were higher in severe PGD cases compared with controls (28.6 pg/ml vs 19.8 pg/ml, p = 0.03). Plasma F2-isoprostane levels were higher in severe PGD cases compared with controls (29.6 pg/ml vs 19.0 pg/ml, p = 0.03) among patients reperfused with FIO2 >40%. Among recipients of lungs from donors with smoke exposure, plasma F2-isoprostane (38.2 pg/ml vs 22.5 pg/ml, p = 0.046) and isofuran (66.9 pg/ml vs 34.6 pg/ml, p = 0.046) levels were higher in severe PGD compared with control subjects. CONCLUSIONS: Plasma levels of lipid peroxidation products are higher in patients with severe PGD, in recipients of lungs from donors with smoke exposure, and in recipients exposed to higher Fio2 at reperfusion. Oxidative injury is an important mechanism of PGD and may be magnified by donor exposure to cigarette smoke and hyperoxia at reperfusion

Winter Targeted Observing Periods during the Year of Polar Prediction in the Southern Hemisphere (YOPP-SH)

The Year of Polar Prediction in the Southern Hemisphere (YOPP-SH) held seven targeted observing periods (TOPs) during the 2022 austral winter to enhance atmospheric predictability over the Southern Ocean and Antarctica. The TOPs of 5–10-day duration each featured the release of additional radiosonde balloons, more than doubling the routine sounding program at the 24 participating stations run by 14 nations, together with process-oriented observations at selected sites. These extra sounding data are evaluated for their impact on forecast skill via data denial experiments with the goal of refining the observing system to improve numerical weather prediction for winter conditions. Extensive observations focusing on clouds and precipitation primarily during atmospheric river (AR) events are being applied to refine model microphysical parameterizations for the ubiquitous mixed-phase clouds that frequently impact coastal Antarctica. Process studies are being facilitated by high-time-resolution series of observations and forecast model output via the YOPP Model Intercomparison and Improvement Project (YOPPsiteMIIP). Parallel investigations are broadening the scope and impact of the YOPP-SH winter TOPs. Studies of the Antarctic tourist industry’s use of weather services show the scope for much greater awareness of the availability of forecast products and the skill they exhibit. The Sea Ice Prediction Network South (SIPN South) analysis of predictions of the sea ice growth period reveals that the forecast skill is superior to the sea ice retreat phase

Developing a utility index for the Aberrant Behavior Checklist (ABC-C) for fragile X syndrome

Purpose This study aimed to develop a utility index (the ABC-UI) from the Aberrant Behavior Checklist-Community (ABC-C), for use in quantifying the benefit of emerging treatments for fragile X syndrome (FXS). Methods The ABC-C is a proxy-completed assessment of behaviour and is a widely used measure in FXS. A subset of ABC-C items across seven dimensions was identified to include in health state descriptions. This item reduction process was based on item performance, factor analysis and Rasch analysis performed on an observational study dataset, and consultation with five clinical experts and a methodological expert. Dimensions were combined into health states using an orthogonal design and valued using time trade-off (TTO), with lead-time TTO methods used where TTO indicated a state valued as worse than dead. Preference weights were estimated using mean, individual level, ordinary least squares and random-effects maximum likelihood estimation [RE (MLE)] regression models. Results A representative sample of the UK general public (n = 349; mean age 35.8 years, 58.2 % female) each valued 12 health states. Mean observed values ranged from 0.92 to 0.16 for best to worst health states. The RE (MLE) model performed best based on number of significant coefficients and mean absolute error of 0.018. Mean utilities predicted by the model covered a similar range to that observed. Conclusions The ABC-UI estimates a wide range of utilities from patient-level FXS ABC-C data, allowing estimation of FXS health-related quality of life impact for economic evaluation from an established FXS clinical trial instrument

Sterile Protection against Plasmodium knowlesi in Rhesus Monkeys from a Malaria Vaccine: Comparison of Heterologous Prime Boost Strategies

Using newer vaccine platforms which have been effective against malaria in rodent models, we tested five immunization regimens against Plasmodium knowlesi in rhesus monkeys. All vaccines included the same four P. knowlesi antigens: the pre-erythrocytic antigens CSP, SSP2, and erythrocytic antigens AMA1, MSP1. We used four vaccine platforms for prime or boost vaccinations: plasmids (DNA), alphavirus replicons (VRP), attenuated adenovirus serotype 5 (Ad), or attenuated poxvirus (Pox). These four platforms combined to produce five different prime/boost vaccine regimens: Pox alone, VRP/Pox, VRP/Ad, Ad/Pox, and DNA/Pox. Five rhesus monkeys were immunized with each regimen, and five Control monkeys received a mock vaccination. The time to complete vaccinations was 420 days. All monkeys were challenged twice with 100 P. knowlesi sporozoites given IV. The first challenge was given 12 days after the last vaccination, and the monkeys receiving the DNA/Pox vaccine were the best protected, with 3/5 monkeys sterilely protected and 1/5 monkeys that self-cured its parasitemia. There was no protection in monkeys that received Pox malaria vaccine alone without previous priming. The second sporozoite challenge was given 4 months after the first. All 4 monkeys that were protected in the first challenge developed malaria in the second challenge. DNA, VRP and Ad5 vaccines all primed monkeys for strong immune responses after the Pox boost. We discuss the high level but short duration of protection in this experiment and the possible benefits of the long interval between prime and boost