Verbesserung der medizinischen Lehre durch Einbezug zukunftsrelevanter Praxisinhalte und nicht-kognitiver Faktoren in den medizinischen Lehr-Lernprozess

In einer ersten Studie befasse ich mich mit der Lehre praktischer Fertigkeiten während der medizinischen Ausbildung, um eine Aussage unterstützen zu können, welche praktischen Fertigkeiten in Zukunft von Relevanz sein werden. In einer zweiten Studie beschäftige ich mich mit der Selbstsicherheit, welche durch Simulationstrainings signifikant erhöht werden kann. Die dritte Studie bezieht sich auf das Erlernen praktischer Fertigkeiten am Beispiel der Brustuntersuchung der Frau und auf den Einfluss von Schamgefühlen auf die Performance. Der ersten Studie liegt eine Expertenbefragung zugrunde, die zur Entwicklung von elf Thesen zum Gesundheitswesen 2025 führte. In einer sich anschließenden, zweistufigen explorativen Delphi-Methode wurden 288 Lernziele im Hinblick auf ihre zukünftige Relevanz für die ärztliche Ausbildung einem Bewertungsprozess unterzogen. Insgesamt wurden 231 Lernziele als relevant und 57 Lernziele als irrelevant bewertet. Die Delphi-Methode mit ihren Ergebnissen soll dazu dienen, auch zukünftige Curricula in Einklang mit den sich immer verändernden Anforderungen an die Absolventen des Medizinstudiums zu bringen. Die zweite Studie basiert auf einer Nachtdienst-Simulation mit sieben Stationen und 30 Teilnehmenden. Die Fünferteams bestanden aus Teamleiter, Teammitgliedern und Beobachtern. Das Gefühl des Vorbereitetseins wurde zu Beginn und nach fünf Tagen per Fragebogen erhoben; „Selbstsicherheit“ wurde nach jeder durchlaufenen Station erhoben. Für das Einschätzen der Selbstsicherheit war die Rolle innerhalb der Gruppe unerheblich, insgesamt hat die Simulation die Selbstsicherheit verbessert. Bei der dritten Studie handelt es sich um eine randomisierte, kontrollierte Studie mit 49 Medizinstudierenden, die alle eine theoretische Einführung zur Untersuchung der weiblichen Brust erhielten. Danach erfolgte die Aufteilung in zwei Gruppen (Gruppe A übte mit Puppe, Gruppe B mit Simulationspatientin). Abschließend fand eine einheitliche Prüfung mit einer Simulationspatientin mit pathologischem Brustmodell statt. Variablen waren das situative Schamgefühl und die Untersuchungsqualität. Es lassen sich Schamgefühle hervorrufen und diese durch geeignete Trainingsvarianten im Verlauf verändern. Statistisch signifikant korreliert in einer Teilgruppe die Abnahme des situativen Schamgefühls mit dem besseren Auffinden pathologischer Befunde. Zukünftige Simulationen sollten die emotional affektiven Komponenten des praktischen Handelns beachten, um sie für den Lernprozess fruchtbar machen zu können.My first study deals with practical skills in undergraduate medical education in order to make a prediction of which practical skills will be relevant in the future. A second study addresses students’ self-efficacy and how it can be significantly improved by simulation trainings. The third study deals with the acquisition of intimate examination skills for the clinical breast exam and the effect of shame on subsequent performance. The first study is based on consultation with experts leading to 11 theses about general, future developments in healthcare by 2025. This was followed by a two-stage, exploratory Delphiprocess to evaluate 288 learning goals and their future relevance for medical education. A total of 231 learning goals were deemed relevant; 57 learning goals were rated as irrelevant. The Delphi-method and the results provide a guide for future curricula and the ever-changing requirements for medical school graduates. The second study is based on a night shift simulation with seven cases and 30 participants. The groups of five students consisted of a leader, members and an observer. Feelings of preparedness were measured with a questionnaire at baseline and five days after the event; confidence was surveyed after every completed case. The role within the group was negligible for estimating confidence. Overall self-efficacy improved with the simulation. The third study is a randomised controlled study with 49 medical students who all received basic clinical breast examination training. Afterwards they were split into two groups (group A practiced with a mannequin, group B with a standardized patient). Finally, all students went through the same exam with a standardized patient wearing a pathological strap-on breast model. Variables were measures of situational shame and outcome and process quality. It was possible to elicit feelings of shame and change them over the course of training. A decline of state shame correlated significantly with a better performance in finding breast lumps. Future simulations should include affective components relevant to training in order to improve learning outcomes

Sicherung von Dämmen, Deichen und Stauanlagen : Handbuch für Theorie und Praxis ; Vol. V - 2015

Die Universität Siegen beschäftigt sich seit über 15 Jahren wissenschaftlich und im Bereich der anwendungsorientierten Forschung mit diesem Thema und hat dazu mittlerweile fünf Symposien durchgeführt. Mit der Veröffentlichung soll die langjährige Tradition als etablierte wissenschaftliche Plattform mit einem Wissensaustausch auf europäischer Ebene fortgesetzt werden. Die Bearbeitung dieser Thematik erfolgt auf der Basis der bewährten Kooperation zwischen Geotechnik und Wasserbau an der Universität Siegen. Aktuelle Ereignisse, wie z.B. die aus England oder Australien im Februar des Jahres 2014, machen uns aber auch deutlich, dass ein absoluter Schutz gegen Extremereignisse nicht möglich ist. Sie zeigen aber auch, dass dort wo technischer Hochwasserschutz konsequent umgesetzt wurde Schäden vermieden werden konnten. Wir sind nach den Ereignissen in den vergangenen Jahren aufgefordert wissenschaftlich noch leistungsfähigere und duktilere Systeme zu entwickeln. Weiter ist die Wissenschaft in der Pflicht, die Zivile Sicherheit im Hochwasser-schutz permanent zu bewerten, zu bearbeiten und ganzheitliche-interdisziplinäre und länderübergreifende Lösungen für die Zivilgesellschaft einzufordern

Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010

Background In the UK, a man’s lifetime risk of being diagnosed with prostate cancer is 1 in 8. We calculated both the lifetime risk of being diagnosed with and dying from prostate cancer by major ethnic group. Methods Public Health England provided prostate cancer incidence and mortality data for England (2008–2010) by major ethnic group. Ethnicity and mortality data were incomplete, requiring various assumptions and adjustments before lifetime risk was calculated using DevCan (percent, range). Results The lifetime risk of being diagnosed with prostate cancer is approximately 1 in 8 (13.3 %, 13.2–15.0 %) for White men, 1 in 4 (29.3 %, 23.5–37.2 %) for Black men, and 1 in 13 (7.9 %, 6.3–10.5 %) for Asian men, whereas that of dying from prostate cancer is approximately 1 in 24 (4.2 %, 4.2–4.7 %) for White men, 1 in 12 (8.7 %, 7.6–10.6 %) for Black men, and 1 in 44 (2.3 %, 1.9–3.0 %) for Asian men. Conclusions In England, Black men are at twice the risk of being diagnosed with, and dying from, prostate cancer compared to White men. This is an important message to communicate to Black men. White, Black, and Asian men with a prostate cancer diagnosis are all as likely to die from the disease, independent of their ethnicity. Nonetheless, proportionally more Black men are dying from prostate cancer in England

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle

The dynamic range of the upgraded surface-detector stations of AugerPrime

The detection of ultra-high-energy cosmic rays by means of giant detector arrays is often limited by the saturation of the recorded signals near the impact point of the shower core at the ground, where the particle density dramatically increases. The saturation affects in particular the highest energy events, worsening the systematic uncertainties in the reconstruction of the shower characteristics. The upgrade of the Pierre Auger Observatory, called AugerPrime, includes the installation of an 1-inch Small PhotoMultiplier Tube (SPMT) inside each water-Cherenkov station (WCD) of the surface detector array. The SPMT allows an unambiguous measurement of signals down to about 250m from the shower core, thus reducing the number of events featuring a saturated station to a negligible level. In addition, a 3.8m2 plastic scintillator (Scintillator Surface Detector, SSD) is installed on top of each WCD. The SSD is designed to match the WCD (with SPMT) dynamic range, providing a complementary measurement of the shower components up to the highest energies. In this work, the design and performances of the upgraded AugerPrime surface-detector stations in the extended dynamic range are described, highlighting the accuracy of the measurements. A first analysis employing the unsaturated signals in the event reconstruction is also presented

Investigating multiple elves and halos above strong lightning with the fluorescence detectors of the Pierre Auger Observatory

ELVES are being studied since 2013 with the twenty-four FD Telescopes of the Pierre Auger Observatory, in the province of Mendoza (Argentina), the world’s largest facility for the study of ultra-high energy cosmic rays. This study exploits a dedicated trigger and extended readout. Since December 2020, this trigger has been extended to the three High levation Auger Telescopes (HEAT), which observe the night sky at elevation angles between 30 and 60 degrees, allowing a study of ELVES from closer lightning. The high time resolution of the Auger telescopes allows us to upgrade reconstruction algorithms and to do detailed studies on multiple ELVES. The origin of multiple elves can be studied by analyzing the time difference and the amplitude ratio between flashes and comparing them with the properties of radio signals detected by the ENTLN lightning network since 2018. A fraction of multi-ELVES can also be interpreted as halos following ELVES. Halos are disc-shaped light transients emitted at 70-80 km altitudes, appearing at the center of the ELVES rings, due to the rearrangement of electric charges at the base of the ionosphere after a strong lightning event