Self-monitoring accuracy does not increase throughout undergraduate medical education

Context: Accurate self-assessment of one's performace on a moment-by-moment basis (ie, accurate self-monitoring) is vital for the self-regulation of practising physicians and indeed for the effective regulation of self-directed learning during medical education. However, little is currently known about the functioning of self-monitoring and its co-development with medical knowledge across medical education. This study is the first to simultaneously investigate a number of relevant aspects and measures that have so far been studied separately: different measures of self-monitoring for a broad area of medical knowledge across 10 different performance levels. Methods: This study assessed the self-monitoring accuracy of medical students (n = 3145) across 10 semesters. Data collected during the administration of the formative Berlin Progress Test Medicine (PTM) were analysed. The PTM comprises 200 multiple-choice questions covering all major medical disciplines and organ systems. A self-report indicator (ie, confidence) and two behavioural indicators of self-monitoring accuracy (ie, response time and the likelihood of changing an initial answer to a correct rather than an incorrect item) were examined for their development over semesters. Results: Analyses of more than 390 000 observations (of approximately 250 students per semester) showed that confidence was higher for correctly than for incorrectly answered items and that 86% of items answered with high confidence were indeed correct. Response time and the likelihood of the initial answer being changed were higher when the initial answer was incorrect than when it was correct. Contrary to expectations, no differences in self-monitoring accuracy were observed across semesters. Conclusions: Convergent evidence from different measures of self-monitoring suggests that medical students self-monitor their knowledge on a question-by-question basis well, although not perfectly, and to the same degree as has been found in studies outside medicine. Despite large differences in performance, no variations in self-monitoring across semesters (with the exception of the first semester) were observed

InterAKTions with FKBPs - mutational and pharmacological exploration

The FK506-binding protein 51 (FKBP51) is an Hsp90-associated co-chaperone which regulates steroid receptors and kinases. In pancreatic cancer cell lines, FKBP51 was shown to recruit the phosphatase PHLPP to facilitate dephosphorylation of the kinase Akt, which was associated with reduced chemoresistance. Here we show that in addition to FKBP51 several other members of the FKBP family bind directly to Akt. FKBP51 can also form complexes with other AGC kinases and mapping studies revealed that FKBP51 interacts with Akt via multiple domains independent of their activation or phosphorylation status. The FKBP51-Akt1 interaction was not affected by FK506 analogs or Akt active site inhibitors, but was abolished by the allosteric Akt inhibitor VIII. None of the FKBP51 inhibitors affected AktS473 phosphorylation or downstream targets of Akt. In summary, we show that FKBP51 binds to Akt directly as well as via Hsp90. The FKBP51-Akt interaction is sensitive to the conformation of Akt1, but does not depend on the FK506-binding pocket of FKBP51. Therefore, FKBP inhibitors are unlikely to inhibit the Akt-FKBP-PHLPP network

Learning from, through and about Differences: A Multiple Case Study on Schools as Practice Grounds for Citizenship

Learning to relate to others that differ from you is one of the central aims of citizenship education. Schools can be understood as practice grounds for citizenship, where students’ citizenship is not only influenced by the formal curriculum, but also by their experiences in the context of teacher-student and student-student relations. In this article we therefore investigate: How is the practice of dealing with difference enacted in schools? Data were collected through an exploratory multiple case study in four secondary schools, combining interviews and focus groups. Despite the differences between the schools in terms of population and location, in all schools ‘being different’ was understood primarily in relation to other students within the school. Relevant differences for citizenship were confined to ‘ethnic and cultural diversity’. Furthermore, in all schools there was limited reflection on being different in relation to the broader community. This article calls for preparing teachers to consider a broader array of differences to practice dealing with differences with their students and to support students in reflecting on the societal implications of being different from each other

Classical ratchet effects in heterostructures with a lateral periodic potential

We study terahertz radiation induced ratchet currents in low dimensional semiconductor structures with a superimposed one-dimensional lateral periodic potential. The periodic potential is produced by etching a grating into the sample surface or depositing metal stripes periodically on the sample top. Microscopically, the photocurrent generation is based on the combined action of the lateral periodic potential, verified by transport measurements, and the in-plane modulated pumping caused by the lateral superlattice. We show that a substantial part of the total current is caused by the polarization-independent Seebeck ratchet effect. In addition, polarization-dependent photocurrents occur, which we interpret in terms of their underlying microscopical mechanisms. As a result, the class of ratchet systems needs to be extended by linear and circular ratchets, sensitive to linear and circular polarizations of the driving electro-magnetic force.Comment: 11 pages, 9 figures, 2 column

Association between the A-2518G polymorphism in the monocyte chemoattractant protein-1 gene and insulin resistance and Type 2 diabetes mellitus

Aims/hypothesis: The molecular mechanisms of obesity-related insulin resistance are incompletely understood. Macrophages accumulate in adipose tissue of obese individuals. In obesity, monocyte chemoattractant protein-1 (MCP-1), a key chemokine in the process of macrophage accumulation, is overexpressed in adipose tissue. MCP-1 is an insulin-responsive gene that continues to respond to exogenous insulin in insulin-resistant adipocytes and mice. MCP-1 decreases insulin-stimulated glucose uptake into adipocytes. The A-2518G polymorphism in the distal regulatory region of MCP-1 may regulate gene expression. The aim of this study was to investigate the impact of this gene polymorphism on insulin resistance. Methods: We genotyped the Ludwigshafen Risk and Cardiovascular Health (LURIC) cohort (n=3307). Insulin resistance, estimated by homeostasis model assessment, and Type 2 diabetes were diagnosed in 803 and 635 patients respectively. Results: Univariate analysis revealed that plasma MCP-1 levels were significantly and positively correlated with WHR (p=0.011), insulin resistance (p=0.0097) and diabetes (p<0.0001). Presence of the MCP-1 G-2518 allele was associated with decreased plasma MCP-1 (p=0.017), a decreased prevalence of insulin resistance (odds ratio [OR]=0.82, 95% CI: 0.70-0.97, p=0.021) and a decreased prevalence of diabetes (OR=0.80, 95% CI: 0.67-0.96, p=0.014). In multivariate analysis, the G allele retained statistical significance as a negative predictor of insulin resistance (OR=0.78, 95% CI: 0.65-0.93, p=0.0060) and diabetes (OR=0.80, 95% CI: 0.66-0.96, p=0.018). Conclusions/interpretation: In a large cohort of Caucasians, the MCP-1 G-2518 gene variant was significantly and negatively correlated with plasma MCP-1 levels and the prevalence of insulin resistance and Type 2 diabetes. These results add to recent evidence supporting a role for MCP-1 in pathologies associated with hyperinsulinaemi

Insights into the Electronic Structure of a U(IV) Amido and U(V) Imido Complex

Reaction of the N-heterocylic carbene ligand $^{i}$PrIm (L$^{1}$) and lithium bis(trimethylsilyl)amide (TMSA) as a base with UCl$_{4}$ resulted in U(IV) and U(V) complexes. Uranium\u27s +V oxidation state in (HL$^{1}$)$_{2}$[U(V)(TMSI)Cl$_{5}$] (TMSI=trimethylsilylimido) (2) was confirmed by HERFD-XANES measurements. Solid state characterization by SC-XRD and geometry optimisation of [U(IV)(L$^{1}$)$_{2}$(TMSA)Cl$_{3}$] (1) indicated a silylamido ligand mediated inverse trans influence (ITI). The ITI was examined regarding different metal oxidation states and was compared to transition metal analogues by theoretical calculations

Synthetic tumor-associated glycopeptide antigens.

Glycopeptides with TN antigen (GalNAc)Ser/Thr and T-antigen structures (beta Gall-3GalNAc)Ser/Thr, described as tumor-associated antigens, were synthesized and coupled to bovine serum albumin. Alternatively, synthetic methods for the construction of beta-anomeric analogues of the TN and T-antigen glycopeptides were developed, aiming at antigenic structures having a varied stereochemistry of the linkage between the carbohydrate and the peptide moiety. As a further type of potential tumor-associated antigen, fucosyl-chitobiose asparagine glycopeptides were synthesized, deprotected, and coupled to bovine serum albumin. The chemical methods developed now make the complex sensitive glycoprotein partial structures accessible in analytically pure form and in preparative amounts

Association of RANTES G-403A gene polymorphism with increased risk of coronary arteriosclerosis

Aims Polymorphisms in the RANTES (G-403A), monocyte chemoattractant protein-1 (MCP-1; A-2518G), stromal cell-derived factor-1β (SDF-1β; G801A), and C-C chemokine receptor-5 (CCR5; Δ32) genes have been associated with functional effects. These chemokines have been implicated in leucocyte recruitment to arterial lesions. In a case-control study, we explored relations between these polymorphisms and coronary artery disease (CAD), with respect to angiographic abnormalities and acute coronary syndromes (ACS). Methods and Results The LUdwigshafen Risk and Cardiovascular health (LURIC) cohort was genotyped by RFLP-PCR. Based on coronary angiography, individuals were sub-divided into CAD cases \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(n=2694)$ \end{document} and controls \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(n=530)$ \end{document}. RANTES-403 genotype frequencies were significantly different in cases and controls \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $({\chi}^{2}=4.17,p=0.041)$ \end{document}, as were A allele carrier frequencies (36.01% vs. 30.19%, OR=1.30 [95%-CI=1.06-1.60], \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p=0.010$ \end{document}). By multivariate analysis, RANTES A-403 retained significant association with CAD \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $({\chi}^{2}=8.40,p=0.0038)$ \end{document}. RANTES A-403 was associated with increased ACS prevalence (OR=1.36 [95%-CI=1.08-1.71], \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p=0.0073$ \end{document}). MCP-1 G-2518, SDF-1β A801, and CCR5 Δ32 were not associated with CAD. Conclusions RANTES A-403 was associated with CAD independently from conventional risk factors and CRP or fibrinogen as inflammatory biomarkers. The association was enhanced in smokers and ACS, conditions where platelet activation and inflammation predominate. RANTES A-403 may increase genetic susceptibility to CA