Umsetzung der deutschen Approbationsordnung 2002 im modularen Reformstudiengang Heidelberger Curriculum Medicinale (HeiCuMed)

Am 1.10.2003 trat die neue deutsche Approbationsordnung für Ärzte (ÄAppO) in Kraft. Das klinische Lehrangebot sollte dabei in 22 Fächern, 12 Querschnittsbereichen und 5 Blockpraktika angeboten werden. Bereits 1998 begann die medizinische Fakultät der Universität Heidelberg das medizinische Curriculum stärker praktisch und interdisziplinär auszurichten. Dieses neue Curriculum erhielt den Namen HeiCuMed (Heidelberger Curriculum Medicinale). Planung und Organisation von HeiCuMed erfolgte in Kooperation mit verschiedenen universitären und auswärtigen Partnern. Dieser Artikel befasst sich mit der Umsetzung der neuen ÄAppO in HeiCuMed. Dabei wird auch dargestellt, inwiefern in der Literatur beschriebene Prinzipien erfolgreicher Curriculumsreform im Reformprozess beachtet wurden. 09.12.2008 | Sören Huwendiek, M. Kadmon, J. Jünger, M. Kirschfink, H.M. Bosse & F. Resc

Environmental drivers of distribution and reef development of the Mediterranean coral Cladocora caespitosa

Cladocora caespitosa is the only Mediterranean scleractinian similar to tropical reef-building corals. While this species is part of the recent fossil history of the Mediterranean Sea, it is currently considered endangered due to its decline during the last decades. Environmental factors affecting the distribution and persistence of extensive bank reefs of this endemic species across its whole geographic range are poorly understood. In this study, we examined the environmental response of C. caespitosa and its main types of assemblages using ecological niche modeling and ordination analysis. We also predicted other suitable areas for the occurrence of the species and assessed the conservation effectiveness of Mediterranean marine protected areas (MPAs) for this coral. We found that phosphate concentration and wave height were factors affecting both the occurrence of this versatile species and the distribution of its extensive bioconstructions in the Mediterranean Sea. A set of factors (diffuse attenuation coefficient, calcite and nitrate concentrations, mean wave height, sea surface temperature, and shape of the coast) likely act as environmental barriers preventing the species from expansion to the Atlantic Ocean and the Black Sea. Uncertainties in our large-scale statistical results and departures from previous physiological and ecological studies are also discussed under an integrative perspective. This study reveals that Mediterranean MPAs encompass eight of the ten banks and 16 of the 21 beds of C. caespitosa. Preservation of water clarity by avoiding phosphate discharges may improve the protection of this emblematic species.Spanish Ministry of Economy and Competitiveness [CTM2014-57949-R]info:eu-repo/semantics/publishedVersio

Descriptions, truth value intuitions, and questions

International audienceSince the famous debate between Russell (Mind 14: 479–493, 1905, Mind 66: 385–389, 1957) and Strawson (Mind 59: 320–344, 1950; Introduction to logical theory, 1952; Theoria, 30: 96–118, 1964) linguistic intuitions about truth values have been considered notoriously unreliable as a guide to the semantics of definite descriptions. As a result, most existing semantic analyses of definites leave a large number of intuitions unexplained. In this paper, I explore the nature of the relationship between truth value intuitions and non-referring definites. Inspired by comments in Strawson (Introduction to logical theory, 1964), I argue that given certain systematic considerations, one can provide a structured explanation of conflicting intuitions. I show that the intuitions of falsity, which proponents of a Russellian analysis often appeal to, result from evaluating sentences in relation to specific questions in context. This is shown by developing a method for predicting when sentences containing non-referring definites elicit intuitions of falsity. My proposed analysis draws importantly on Roberts (in: Yoon & Kathol (eds.) OSU working papers in Linguistics: vol. 49: Papers in Semantics 1998; in: Horn & Ward (eds.) Handbook of pragmatics, 2004) and recent research in the semantics and pragmatics of focus

Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps

Background: Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Ca

Progression of duodenal adenomatosis in familial adenomatous polyposis: due to ageing of subjects and advances in technology

Familial adenomatous polyposis patients are at risk of duodenal cancer. Surveillance is indicated and the extent of duodenal polyposis is quantified by the Spigelman staging system. We noticed an impressive increase in high Spigelman stages over the years and therefore decided to investigate whether this increase might be due to the time-lapse since the inception of surveillance or related to improvements in endoscopic imaging and/or changes in dysplasia-reporting. Patients who were investigated by the same endoscopist since 1980 in at least 2 different episodes of technical improvements were eligible. The period 1980–2009 was divided into 4 episodes using the following landmarks: replacement of fibre-endoscopes by video-endoscopes in 1987, change in processors in 1995, change in image resolution in 2000, and change in dysplasia-reporting in 2006. An increase in Spigelman stages from low stages (0–II 100%) to high stages (III 28.1%, IV 43.8%) was seen (median follow-up: 19.5 years). In patients who progressed, a median of 4 years elapsed before progression by one stage occurred and 7 years to progress by two stages. In a mixed-model analysis, both time-lapse and technical improvements were determinant factors for duodenal disease progression. When both factors were introduced in the model, the time-lapse as well as the change in image resolution and dysplasia-ranking contributed consistently in increasing Spigelman scores and stages. The impressive increase in severity of duodenal polyposis is determined by time-lapse, technological advances and change in dysplasia-reporting. These results might call for a revised Spigelman classification

Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model

<p>Abstract</p> <p>Background</p> <p>It is well known that the information requirements necessary to safely treat children with therapeutic medications cannot be met with the same approaches used in adults. Over a 1-year period, Duke University Hospital engaged in the challenging task of enhancing an established computerized provider order entry (CPOE) system to address the unique medication dosing needs of pediatric patients.</p> <p>Methods</p> <p>An advanced dosing model (ADM) was designed to interact with our existing CPOE application to provide decision support enabling complex pediatric dose calculations based on chronological age, gestational age, weight, care area in the hospital, indication, and level of renal impairment. Given that weight is a critical component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information.</p> <p>Results</p> <p>Pediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period. Safeguards to prevent miskeyed values became important in allowing providers the flexibility to override the ADM logic if desired. Methods to guard against over- and under-dosing were added. The modular nature of our model allows us to easily add new dosing scenarios for specialized populations as the pediatric population and formulary change over time.</p> <p>Conclusions</p> <p>The medical needs of pediatric patients vary greatly from those of adults, and the information systems that support those needs require tailored approaches to design and implementation. When a single CPOE system is used for both adults and pediatrics, safeguards such as redirection and suppression must be used to protect children from inappropriate adult medication dosing content. Unlike other pediatric dosing systems, our model provides active dosing assistance and dosing process management, not just static dosing advice.</p