Search

The final year offers students the opportunity to explore their future role as a physician in different environments. Learning success depends in large part on how students experience these assignments. The aim of this study is to analyze students' self-reported experiences to derive factors that promote experience-based learning in the transition phase during the final year of medical school in order to optimally prepare students for professional practice. Data were collected from 2013 to 2019 via written survey after each assignment in the final year. Students were asked to report their pleasant and unpleasant experiences in free-text fields. The text material was analyzed using quantitative content analysis. The authors included 1762 questionnaires for analysis. They formed 12 main categories from the text material, equally covering pleasant and unpleasant experiences. Supervisors and teamwork played a central role in both questions, responsibility and working areas frequently led to positive experiences, and working conditions to negative ones. This study confirms the great importance of supervision. Above all, successful collaboration serves as a door opener into a feeling of security which students need to take on responsibility. The authors adapted Dornan's model of experience-based learning to the transition phase to help medical schools establish tailored conditions for students' successful entry into professional practice. [ABSTRACT FROM AUTHOR]

Today's investigations on electrothermal-chemical (ETC) guns concentrate on different methods of electrothermal plasma ignition technologies to be combined with ETC tailored propellants and their charge designs. It is the goal to obtain increased gun performance in terms of muzzle energy, muzzle velocity, and temperature compensation of the propellants. In the German ETC program, governmental agencies, research institutes, and industry are involved to investigate proper ETC technologies to be applied in large-caliber guns. Basic investigations as well as large-caliber firing demonstrations are included in the program. It is the goal of the current ETC phase to demonstrate muzzle energies up to 15 MJ out of a 120-mm smooth-bore gun barrel under operating conditions. This paper gives an overview of the program structure and briefly addresses the content of the subprograms performed in institutes as well as of the industrial investigations. Index Terms--Compact pulsed power supply, electrothermal-chemical gun, plasma ignition.

There is a well-known risk of thrombosis in patients with inflammatory bowel disease. Documented cases of intracranial sinus thrombosis in this setting are rare. We present the case of a 30-year-old man with Crohn disease who spontaneously developed a superior sagittal sinus thrombosis and bifrontal infarcts that resulted in death. The patient was heterozygous for factor V Leiden mutation. The literature was searched to assess the frequency of cerebral venous infarcts in inflammatory bowel disease and the role that factor V Leiden plays in thrombosis in such patients. [ABSTRACT FROM AUTHOR]

We present new results of the recently introduced approach to surface-multiple attenuation through sparse inversion. This method aims to attenuate surface multiples of all periodicities without the need for an adaptive subtraction or a near offset extrapolation. The aim of our paper is twofold. First, we subject the sparse inversion method to data beyond previously published proof-of-principle models and present results on highly complex 2D synthetics and real data, demonstrating that sparse inversion may, in principle, serve as a powerful tool to attenuate short and long period multiples in complex settings. We illustrate the competitive nature of the sparse inversion predictions by benchmarking the method's results to standard processing flows. In addition, we demonstrate the correspondence of the estimated primaries to the underlying impedance models. Next, we show results of a 2D sparse inversion approach to real 3D deep-marine data and demonstrate, through a further synthetic study, that the presence of cross-line dip leads to a time shift of the predicted multiples, resulting in reduced multiple attenuation. Our results confirm that future developments of this technique will require a full 3D approach in order for the sparse inversion method to be widely effective in practice. [ABSTRACT FROM AUTHOR]

Background: Cancer patients benefit from Virtual Reality (VR) in burdensome situations, but evidence is scarce for palliative situations. Based on earlier work in palliative care, individualized VR interventions like seeing the patient's home may address a patient's wish to be at home and thus have a greater effect compared to standard VR content. Yet, some patients and relatives may be concerned about their privacy. Also, patient stakeholders raised concerns about triggering depressed mood or homesickness., Aim: To test the feasibility and safety of individualized vs. standard 360°video VR interventions in palliative cancer inpatients., Methods: Prospective observational study with patient-reported outcome measurement using validated instruments of well-being (MDBF), symptoms and psychosocial burden (IPOS), cybersickness (SSQ), presence experience (SPES), subjective benefit (2 items), content analysis of interviews, and field notes. Individualized VR content was recorded with action camcorder-technology to protect the patients' privacy., Results: Seventeen patients participated, median age 65 years (range 20-82), 9 women (53%), 8 single or widowed (47%), 4 childless (23.5%), 4 academics (23.5%), with a median length of stay of 9 days (1-75) in the hematology (10), palliative care (3), or radiotherapy (2) unit of a German university hospital. Eight patients (53.3%) chose their own home environments or family for individualized VR-content. All participants enjoyed the intervention. Compared to standard VR content the individualized VR tended to have a stronger effect on well-being and emotional touch. It was not inferior in terms of psychosocial burden and cybersickness. No subjective and relevant side effects occurred. The patients well tolerated the assessments. However, most patients demanded a lighter headset and a desire for more interactivity., Conclusions: Individualization of VR content shows potential for enhancement of immersion, which improves the VR experience and does not harm in terms of depressed mood or worsening of symptoms. The patients' and family desire for privacy is feasible with the support of family members who recorded the individualized videos, which is easily manageable today. We suggest a pragmatic randomized clinical trial to compare the effects of individualized vs. standard VR-content., Trial Registration: Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023., (© 2024. The Author(s).)

Objectives: Surgical site infections (SSIs) represent a major source of preventable patient harm. Safety climate in the operating room personnel is assumed to be an important factor, with scattered supporting evidence for the association between safety climate and infection outcome so far. This study investigated perceptions and knowledge specific to infection prevention measures and their associations with general assessments of safety climate level and strength., Methods: We invited operating room personnel of hospitals participating in the Swiss SSI surveillance program to take a survey (response rate, 38%). A total of 2769 responses from 54 hospitals were analyzed. Two regression analyses were performed to identify associations between subjective norms toward, commitment to, as well as knowledge about prevention measures and safety climate level and strength, taking into account professional background and number of responses per hospital., Results: Commitment to perform prevention measures even when situational pressures exist, as well as subjective norm of perceiving the expectation of others to perform prevention measures were significantly ( P < 0.05) related to safety climate level, while for knowledge about preventative measures this was not the case. None of the assessed factors was significantly associated with safety climate strength., Conclusions: While pertinent knowledge did not have a significant impact, the commitment and the social norms to maintain SSI prevention activities even in the face of other situational demands showed a strong influence on safety climate. Assessing the knowledge about measures to prevent SSIs in operating room personnel opens up opportunities for designing intervention efforts in reducing SSIs., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The aim of this study was to investigate the association between surgical site infections (SSIs), a major source of patient harm, and safety and teamwork climate. Prior research has been unclear regarding this relationship., Design: Based on the Swiss national SSI surveillance and a survey study assessing (a) safety climate and (b) teamwork climate, associations were analysed for three kinds of surgical procedures., Setting and Participants: SSI surveillance data from 20 434 surgeries for hip and knee arthroplasty from 41 hospitals, 8321 for colorectal procedures from 28 hospitals and 4346 caesarean sections from 11 hospitals and survey responses from Swiss operating room personnel (N=2769) in 54 acute care hospitals., Primary and Secondary Outcomes: The primary endpoint of the study was the 30-day (all types) or 1-year (knee/hip with implants) National Healthcare Safety Network-adjusted SSI rate. Its association with climate level and strength was investigated in regression analyses, accounting for respondents' professional background, managerial role and hospital size as confounding factors., Results: Plotting climate levels against infection rates revealed a general trend with SSI rate decreasing as the safety climate increased, but none of the associations were significant (5% level). Linear models for hip and knee arthroplasties showed a negative association between SSI rate and climate perception (p=0.02). For climate strength, there were no consistent patterns, indicating that alignment of perceptions was not associated with lower infection rates. Being in a managerial role and being a physician (vs a nurse) had a positive effect on climate levels regarding SSI in hip and knee arthroplasties, whereas larger hospital size had a negative effect., Conclusions: This study suggests a possible negative correlation between climate level and SSI rate, while for climate strength, no associations were found. Future research should study safety climate more specifically related to infection prevention measures to establish clearer links., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Objective: Final-year training is becoming increasingly important in medical studies and requires a high degree of personal responsibility from students. It is the task of supervising physicians to make informal learning opportunities available to students when working with and on patients and to gradually transfer responsibility to them. Both students and physicians have a great need for information regarding the contextual conditions and didactic realization of this transfer of responsibility. Up to now, the faculties have only provided information and support in a sporadic manner and with little standardization. With MERLIN, the joint project undertaken by the Competence Network for Teaching Medicine in Baden-Württemberg, a platform for the final year was developed and released on the web. The aim was to bundle information in order to support students and supervising physicians in their teaching-learning process and to improve the quality of teaching in the final year., Project Description: The development process of this platform took place in several steps across all faculties. Content and materials were compiled and structured based on a needs assessment. The first draft was evaluated by means of a simulation by students and then revised. A professional internet agency was involved for the technical implementation. The newly designed website PJ-input ("PJ" being the abbreviation for "Praktisches Jahr", the final year) contains areas for students and supervising physicians, as well as faculty-specific and general information about the final year. Faculty-specific content can be entered directly by the respective staff via an input mask and updated at any time. The provision of didactic materials can support competency-oriented teaching and learning in the final year. Here, for example, the concept of the Entrustable Professional Activities (EPA) was taken up, which gives students and supervising physicians orientation for the gradual assumption or transfer of responsibility. The platform was launched in spring 2021. Usage behavior is continuously recorded via the web application., Results and Conclusion: The evaluation results show that the website is visited often and perceived as supportive. Increasing usage figures and the high frequency of use by students in the sections "im PJ" (during the final year) and "nach dem PJ" (after the final year) for the faculties involved in the MERLIN project confirm the target group-oriented design and use. The site should be promoted even more to pre-final-year students, as well as across state borders and to the target group of faculties. It is expected that nationwide faculty participation will make a significant contribution to the competency-based shift in teaching and the standardization of training during the final year of study under the new licensing regulations., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Homberg et al.)

Objective: The aim was to assess the impact of operating room (OR) ventilation quality on surgical site infections (SSIs) using a novel ventilation index., Background: Previous studies compared laminar air flow with conventional ventilation, thereby ignoring many parameters that influence air flow properties., Methods: In this cohort study, we surveyed hospitals participating in the Swiss SSI surveillance and calculated a ventilation index for their ORs, with higher values reflecting less turbulent air displacement. For procedures captured between January 2017 and December 2019, we studied the association between ventilation index and SSI rates using linear regression (hospital-level analysis) and with the individual SSI risk using generalized linear mixed-effects models (patient-level analysis)., Results: We included 47 hospitals (182 ORs). Among the 163,740 included procedures, 6791 SSIs were identified. In hospital-level analyses, a 5-unit increase in the ventilation index was associated with lower SSI rates for knee and hip arthroplasty (-0.41 infections per 100 procedures, 95% confidence interval: -0.69 to -0.13), cardiac (-0.89, -1.91 to 0.12), and spine surgeries (-1.15, -2.56 to 0.26). Similarly, patient-level analyses showed a lower SSI risk with each 5-unit increase in ventilation index (adjusted odds ratio 0.71, confidence interval: 0.58-0.87 for knee and hip; 0.72, 0.49-1.06 for spine; 0.82, 0.69-0.98 for cardiac surgery). Higher index values were mainly associated with a lower risk for superficial and deep incisional SSIs., Conclusions: Better ventilation properties, assessed with our ventilation index, are associated with lower rates of superficial and deep incisional SSIs in orthopedic and cardiac procedures. OR ventilation quality appeared to be less relevant for other surgery types., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Optimal surveillance and prevention of healthcare-associated infections (HAI) are crucial for a well-functioning health care system. With a view to establishing a national state-of-the-art programme for surveillance and prevention of HAIs, the Swiss National Center for Infection Control, Swissnoso, developed a survey to explore the options for expanding the existing Swiss HAI surveillance system., Methods: An online survey was sent to all Swiss acute care hospitals. Local infection prevention and control (IPC) professionals were asked to answer on behalf of their institutions. The questions covered the structure and organisation of IPC programmes, current preventive measures, availability and capacity of electronic medical record (EMR) systems, and ability and willingness to establish and participate in the proposed new surveillance modules. An invitation was sent to the 156 acute care hospitals and hospital networks in June 2020. Responses were collected up to the end of August 2020., Results: Ninety-four hospitals and hospital networks out of 156 (60%) completed the survey. Among 84 hospitals reporting the number of acute care beds, 61 (73%) were small (&lt;200 beds), 16 (19%) medium (200&ndash;650 beds) and 7 (8%) large hospitals (&gt;650 beds). Twenty-nine different EMR systems were used in the participating hospitals. Twenty-two hospitals were using a different EMR system in their intensive care unit. There were 17 hospitals (18%) without an EMR system but which planned to introduce one soon, and eight small hospitals (9%) neither had an EMR system nor were preparing to introduce one. Surveillance for central-line associated bloodstream infection, catheter-associated urinary tract infection and ventilator-associated pneumonia were already established in 26 (28%), 15 (16%) and 15 (16%) hospitals, respectively. Thirty hospitals (36%) would be willing to participate in the pilot phase of a new surveillance system. Of these, 15 stated that they wanted to be part of the pilot hospital network, 6 could provide hospital-wide surveillance denominators (such as catheter-days and patient-days) to compute incidence rates, and 8 indicated interest in doing both. Large hospitals interested in participating in the pilot phase reported more full-time equivalent staff available for surveillance activities than those who did not declare an interest., Conclusions: Baseline information on hospital IPC structure and process indicators are essential for the roll-out of national surveillance programmes and for improving surveillance activities. Having an EMR system in place and adequate personnel resources dedicated for surveillance activities are crucial prerequisites for developing and implementing an effective HAI surveillance system. The lack of an EMR system and the diversity and capacities of EMR solutions will be the main challenges for successful implementation of national HAI surveillance modules.

Extrachromosomal circularization of DNA is an important genomic feature in cancer. However, the structure, composition and genome-wide frequency of extrachromosomal circular DNA have not yet been profiled extensively. Here, we combine genomic and transcriptomic approaches to describe the landscape of extrachromosomal circular DNA in neuroblastoma, a tumor arising in childhood from primitive cells of the sympathetic nervous system. Our analysis identifies and characterizes a wide catalog of somatically acquired and undescribed extrachromosomal circular DNAs. Moreover, we find that extrachromosomal circular DNAs are an unanticipated major source of somatic rearrangements, contributing to oncogenic remodeling through chimeric circularization and reintegration of circular DNA into the linear genome. Cancer-causing lesions can emerge out of circle-derived rearrangements and are associated with adverse clinical outcome. It is highly probable that circle-derived rearrangements represent an ongoing mutagenic process. Thus, extrachromosomal circular DNAs represent a multihit mutagenic process, with important functional and clinical implications for the origins of genomic remodeling in cancer.

The majority of patients with neuroblastoma due to MYCN oncogene amplification and consequent N-Myc oncoprotein over-expression die of the disease. Here our analyses of RNA sequencing data identify the long noncoding RNA lncNB1 as one of the transcripts most over-expressed in MYCN-amplified, compared with MYCN-non-amplified, human neuroblastoma cells and also the most over-expressed in neuroblastoma compared with all other cancers. lncNB1 binds to the ribosomal protein RPL35 to enhance E2F1 protein synthesis, leading to DEPDC1B gene transcription. The GTPase-activating protein DEPDC1B induces ERK protein phosphorylation and N-Myc protein stabilization. Importantly, lncNB1 knockdown abolishes neuroblastoma cell clonogenic capacity in vitro and leads to neuroblastoma tumor regression in mice, while high levels of lncNB1 and RPL35 in human neuroblastoma tissues predict poor patient prognosis. This study therefore identifies lncNB1 and its binding protein RPL35 as key factors for promoting E2F1 protein synthesis, N-Myc protein stability and N-Myc-driven oncogenesis, and as therapeutic targets.

Introduction: In Switzerland, estimations of smoking-attributable deaths were based on age- and sex-adjusted hazard ratios (HRs) from foreign cohorts, precluding consideration of country-specific properties and adjustment for confounding. In order to overcome this, we analyzed recently available individual data from Switzerland., Methods: We included 17,861 individuals aged ≥16 years who participated between 1977-1993 in health studies and were anonymously linked with the Swiss National Cohort. Adjusted Cox regression was used to calculate mortality HRs. Smoking status at baseline was categorized into never-smokers, former smokers, and current light or heavy smokers (<20 or ≥20 cigarettes/day). As covariates, we selected education, marital status, lifestyle, alcohol consumption, and body mass index. We differentiated between cardiovascular disease (CVD), cancer, and noncancer-non-CVD deaths. Smoking-attributable deaths were estimated with a HR-based approach and with age-specific prevalence rates and mortality estimates from 2007., Results: Smoking men and women not only had an increased risk for all-cause (HR and 95% confidence interval vs. never-smokers: 1.71 [1.53-1.90]; 1.54 [1.36-1.75]), CVD (1.72 [1.43-2.06]; 1.50 [1.19-1.90]) and cancer (1.87 [1.56-2.25]; 1.58 [1.30-1.93]), but also for noncancer-non-CVD death (1.57 [1.29-1.89]; 1.58 [1.30-1.93]). Former smoking men had an increased risk for all-cause (1.16 [1.03-1.31]) and cancer death (1.35 [1.10-1.65]). Multivariate adjustment only slightly modified the association between smoking and mortality. Overall, 7,153 deaths per year could be attributed to smoking., Conclusions: Smoking is an important avoidable health burden in Switzerland, and its consequences may persist for decades after quitting. This stresses the need for putting more efforts in strategies aimed at preventing the onset of smoking.

Treatment of ADHD in schools has received comparatively little attention, even though children spend more time in school than in most other structured environments and have their most consistent, extensive contact with a variety of trained professionals there. Because schools could play a strategic role in treating ADHD children, a multi-modal treatment model for children with ADHD in school settings is presented, and logistic factors likely to increase its effective implementation are reviewed. Then, a functional approach to the assessment and treatment of ADHD that focuses on identifying individual-specific deficiencies and environmental factors that may prevent these children from performing appropriate behavior is discussed.

Stress inoculation training (SIT) is a cognitive-behavioral intervention that has been applied to a wide array of problems and populations. Although it has received considerable attention in the adult treatment literature, less research has been conducted with child and adolescent populations. Its most appealing qualities include its applicability to a wide variety of populations, settings, and problems, the structured training format it offers practitioners in which to match intervention strategies to identified individual-specific deficits, and format for programming generalization. In this article, the authors provide an overview of SIT, including a description of phase components and issues related to child and adolescent problems, and they review the treatment studies with these populations. Of the eight studies reviewed, none reported an attempt to identify the nature of trainees' performance problems, differentially employing intervention strategies to individual-specific deficits, nor programming for generalization. Implications for SIT with children and adolescents are offered.

A considerable body of literature has accumulated that examines patterns of substance use and abuse among adolescents attending general education classes. However, much less information exists on the prevalence and predictors of substance use among adolescents with learning disabilities. One purpose of this study was to determine the comparative prevalence of tobacco, alcohol, and marijuana use among a sample of 123 students with learning disabilities (91 male and 32 female, mean age = 14.37 years) and 138 nondisabled students (77 male and 61 female, mean age = 13.71 years). A second purpose was to determine whether two psychosocial variables (self-esteem and type of behavior problem) or severity of drinking problem best predicted use of tobacco and marijuana. Students were administered the Self-Esteem Inventory (SEI)-School form (Coopersmith, 1987) and the Adolescent Drinking Index (ADI) (Harrell & Wirtz, 1989); their teachers completed the Revised Behavior Problem Checklist (RBPC) (Quay & Peterson, 1987). Tobacco and marijuana use were proportionally higher for adolescents with learning disabilities; no differences emerged for alcohol use between groups. A discriminant function analysis revealed that scores on the SEI and subscale scores of the RBPC did not reliably predict tobacco or marijuana use for either group. ADI scores were reliable predictors of marijuana use for students with learning disabilities and tobacco use for both groups.

Effects of self-monitoring on-task behavior, academic productivity, and academic accuracy were assessed with 6 elementary-school students with learning disabilities in their general education classroom using a mathematics task. Following baseline, the three self-monitoring conditions were introduced using a multiple schedule design during independent practice sessions. Although all three interventions yielded improvements in either arithmetic productivity, accuracy, or on-task behavior, self-monitoring academic productivity or accuracy was generally superior. Differential results were obtained across age groups: fourth graders' mathematics performance improved most when self-monitoring productivity, whereas sixth graders' performance improved most when self-monitoring accuracy.

Factors related to children's friendships have been empirically related to social development and social status. Identifying specific factors related to peer status is important for teachers and counselors in recognizing children at risk for behavior and emotional problems. 370 teachers' global opinions about the importance of factors associated with peer status were assessed through a statewide survey. Analysis indicated that social skills, physical attractiveness, and outgoingness were the most frequently cited factors contributing to students' social status. Implications for research and practice are discussed.