[Virtual palliative care : Pilot study of an electronic tool to test cognitive, psychomotor and affective palliative medical and pain therapeutic learning contents during medical training]. / Virtuelle Palliativversorgung : Pilotierung eines elektronischen Tools zur Prüfung kognitiver, psychomotorischer und affektiver palliativmedizinischer und schmerztherapeutischer Lerninhalte während der ärztlichen Ausbildung.

BACKGROUND: This article describes a first use of an electronic case-based assessment tool in undergraduate palliative care education. It describes the development of the tool presenting strengths and shortcomings in order to contribute to an innovative design of assessment tools in medical education. DESIGN AND METHOD: An electronic (virtual) case-based assessment tool (the virtual palliative patient, vPp) was developed. Palliative care levels of knowledge, skills and attitude of students were tested at a computer workplace as a voluntary and non-performance-relevant pilot project at four faculties. RESULTS: On average the students achieved 80% of the points using the vPp tool, which is below the average score of 91% achieved in the regular examination. In particular, the free text task on reflection of dealing with the patient's death wish caused uncertainty, while multiple choice questions and an interactive conversation sequence were perceived as relatively easy. Technical problems were also identified in the evaluation but overall the concept was evaluated positively and establishment as a regular examination or e­learning tool was desired. CONCLUSION: The implementation of an innovative assessment tool in medical education is technically challenging. A coordination with contents of the individual faculties is necessary in order that students do not have a feeling of a lack of preparation. The development of the vPp describes an innovative assessment format. In the long term, all interested faculties could receive a form of toolbox containing the technical framework of the assessment tool, which can then be fed with new contents.

Noise thresholds in harmonic series maskers.

The presence of noise is a salient cue to the perception of breathiness and aspiration in speech sounds. The detection of noise within harmonic series (maskers) composed of unresolved components was found to depend on the fundamental frequency (fo) and the overall level of the masker [Gockel, Moore, and Patterson (2002). J. Acoust. Soc. Am., 111 (6), 2759-2770]. In the present study, noise detection thresholds were measured as a function of the frequency range, the fo, and the overall level of harmonic maskers. Frequency range was specified in equivalent rectangular bandwidth (ERB) units (3-13, 13-23, 23-33, or 3-33 ERBs). The results were consistent with the idea that listeners rely on spectral cues when maskers comprise only resolved components (3-13 ERBs), and on temporal (dip listening) cues when maskers contain only unresolved components (23-33 ERBs). Noise detection thresholds were generally lower when masker level was high (70 dBA) than when it was low (50 dBA). Masker fo affected thresholds only when listeners relied on spectral cues for noise detection. With the wideband (3-33 ERBs) masker, listeners likely detected noise by focusing on the frequency band (23-33 ERBs) with the most advantageous noise-to-harmonic ratio.

The effect of vocal tract parameters on aspiration noise discrimination.

Previous research showed that aspiration noise difference limens in moderately breathy /a/ vowels decreased as the spectral slope of the glottal source spectrum became increasingly steep [Kreiman and Gerratt, J. Acoust. Soc. Am. 131(1), 492-500 (2012)]. The current study investigated whether discrimination of aspiration noise levels was affected by differences in spectral shape due to vowel quality (/æ/ and /i/) and speaker identity (three male speakers) when the slope of the glottal source spectrum was fixed. The results showed that discrimination performance was worse overall for /i/ than /æ/, but the result may have resulted from relatively poor performance for the /i/ vowel of one speaker. Acoustic analyses of the stimuli were performed to estimate the association between acoustic properties and the perceptual outcomes. The results showed that both the smoothed cepstral peak prominence and the harmonic energy level between 2 and 5 kHz may account for the observed differences in aspiration noise discrimination among speakers within each vowel, but not for differences between vowel categories. It is possible that the relationship between the aspiration noise discrimination and aforementioned acoustic properties may be modulated by the spectral distribution of energy across frequency.

Assessment of Determinants of Emission Potentially Affecting the Concentration of Airborne Nano-Objects and Their Agglomerates and Aggregates.

Background: Nano-specific inhalation exposure models could potentially be effective tools to assess and control worker exposure to nano-objects, and their aggregates and agglomerates (NOAA). However, due to the lack of reliable and consistent collected NOAA exposure data, the scientific basis for validation of the existing NOAA exposure models is missing or limited. The main objective of this study was to gain more insight into the effect of various determinants underlying the potential on the concentration of airborne NOAA close to the source with the purpose of providing a scientific basis for existing and future exposure inhalation models. Method: Four experimental studies were conducted to investigate the effect of 11 determinants of emission on the concentration airborne NOAA close to the source during dumping of ~100% nanopowders. Determinants under study were: nanomaterial, particle size, dump mass, height, rate, ventilation rate, mixing speed, containment, particle surface coating, moisture content of the powder, and receiving surface. The experiments were conducted in an experimental room (19.5 m3) with well-controlled environmental and ventilation conditions. Particle number concentration and size distribution were measured using real-time measurement devices. Results: Dumping of nanopowders resulted in a higher number concentration and larger particles than dumping their reference microsized powder (P < 0.05). Statistically significant more and larger particles were also found during dumping of SiO2 nanopowder compared to TiO2/Al2O3 nanopowders. Particle surface coating did not affect the number concentration but on average larger particles were found during dumping of coated nanopowders. An increase of the powder's moisture content resulted in less and smaller particles in the air. Furthermore, the results indicate that particle number concentration increases with increasing dump height, rate, and mass and decreases when ventilation is turned on. Discussion: These results give an indication of the direction and magnitude of the effect of the studied determinants on concentrations close to the source and provide a scientific basis for (further) development of existing and future NOAA inhalation exposure models.

Surface modification of layered zirconium phosphate with PNIPAM.

A new method was reported to modify layered zirconium phosphate (ZrP) with thermoresponsive polymer PNIPAM (poly N-isopropylacrylamide). PNIPAM was proved to be covalently grafted onto ZrP. (60)Co γ-rays irradiation produced peroxide groups on the surface which, upon heating, initiated free radical polymerization and subsequent attachment of PNIPAM.

[Student assessments in palliative medicine as the cross-disciplinary subject 13: Survey of 34 medical faculties in Germany]. / Prüfungen im Querschnittsbereich Palliativmedizin (QB 13) : Befragung an 34 medizinischen Fakultäten in Deutschland.

BACKGROUND: In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs. MATERIAL AND METHODS: Palliative care coordinators at German MFs were surveyed by using a standardized telephone interview. Closed-ended questions were analyzed by descriptive analysis and open-ended questions by content analysis. RESULTS: A total of 34 out of 36 MFs participated. Multiple choice tests were the major form of assessment (94.1%) and 9 MFs planned to implement another form of assessment, mainly an objective structured clinical examination (OSCE) station (55.5%). The majority of the MFs (91.2%) had no blueprint to develop assessments but conducted a review (78.8%) afterwards. A successful implementation of the assessment was mostly achieved when the concept of the assessment was felt to be suitable. The lack of human resources was found to be the most relevant obstacle for the implementation of a practical assessment format. CONCLUSION: The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.

Thermo-sensitive discotic colloidal liquid crystals.

We fabricated for the first time thermo-sensitive discotic liquid crystals by grafting poly(N-isopropylacrylamide) (PNIPAM) onto zirconium phosphate (ZrP) platelets using pre-irradiated polymerization. The I-N transition was investigated by adjusting the temperature for a single set of samples. We found that soft disks self-assemble into nematic liquid crystals in a wider thickness-over-diameter ratio than do hard disks.

Preparation of stimuli for timbre perception studies.

Stimuli used in timbre perception studies must be controlled carefully in order to yield meaningful results. During psychoacoustic testing of individual timbre properties, (1) it must be ensured that timbre properties do not co-vary, as timbre properties are often not independent from one another, and (2) the potential influence of loudness, pitch, and perceived duration must be eliminated. A mathematical additive synthesis method is proposed which allows complete control over two spectral parameters, the spectral centroid (corresponding to brightness) and irregularity, and two temporal parameters, log rise-time (LRT) and a parameter characterizing the sustain/decay segment, while controlling for covariation in the spectral centroid and irregularity. Thirteen musical instrument sounds were synthesized. Perceptual data from six listeners indicate that variation in the four timbre properties mainly influences loudness and that perceived duration and pitch are not influenced significantly for the stimuli of longer duration (2 s) used here. Trends across instruments were found to be similar.

[Implementation of intersectional field 13: a survey of medical faculties in Germany]. / Implementierung des Querschnittsbereichs 13: Umfrage an den medizinischen Fakultäten in Deutschland.

BACKGROUND: In 2013 palliative medicine (PM) will be integrated into the undergraduate curriculum as part of the mandatory education in German medical universities. The aim of this study is to determine the current state of implementation at German medical faculties (MF). METHODS: All German MFs were contacted using a written postal survey in June 2012. RESULTS: A total of 32 out of 36 MFs participated. Teaching staff consists of 15 or more lecturers in 8 MFs (30 %) and includes psychologists in 24 MFs (75 %) and also nurses in 18 MFs (56 %). Participating physicians are specialized in anesthesiology, internal medicine and general medicine. Teaching staff include palliative outpatient (20 MFs, 63 %) and consultation services (22 MFs, 69 %). Bedside teaching is provided in 15 MFs (47 %). Multiple choice tests are the major form of assessment (29 MFs, 84 %). The total number of teaching units in PM is between 12 and 43 and is usually provided at the end of medical school education. Nurses are employed in the education significantly more in MFs with a chair in PM. General practitioners were engaged only by faculties without a chair in PM. CONCLUSIONS: The implementation of the mandatory training in PM at MFs in Germany is inhomogeneous. Further steps include in particular the development of a competence-based curriculum and assessment.

Palliative Care teaching in Germany - concepts and future developments.

BACKGROUND: Following recent modifications of the Medical Licensure Act (ÄApprO) in the year 2009, palliative care was introduced as a compulsory 13(th) cross-disciplinary subject (Q13) in the undergraduate curriculum. Its implementation must have taken place before the beginning of the final year ('practical year') in August 2013 and has to be substantiated for the medical exams taking place in October 2014. Very diverse structures pertaining to palliative care teaching were described in previous surveys at various medical faculties in Germany. As a result, the current and future plans and concepts related to content and exams of a mandatory Q13 course at the respective faculty sites should be ascertained. METHODS: Since 2006, the German Medical Students' Association (bvmd) has been carrying out a bi-annual survey at all medical faculties in Germany regarding the current situation of teaching in the field of palliative care. After designing and piloting an online survey in May 2010, a one-month online survey took place. The data was assessed using a descriptive approach. RESULTS: 31 of 36 medical faculties took part in the survey. At the time of questioning, 15 faculties already taught courses according to the requirements of the new ÄApprO; at three sites the Q13 is yet to be introduced commencing in 2012. A teaching curriculum for Q13 already existed at 15 faculty sites, partly based on the curricular requirements of the German Association for Palliative Medicine (DGP). Six sites described an implementation process as yet without an independent curriculum. Most of the faculties aim for 21-40 course hours, which will for the most part be provided as lectures, seminars or less often in more assisted and intense formats. The majority of the participating faculties intend an examination containing multiple choice questions. At 8 universities there is an independent Chair for palliative medicine (5 more are planned); this was linked with a higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned. CONCLUSION: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care.

Predicting beef tenderness using color and multispectral image texture features.

The objective of this study was to investigate the usefulness of raw meat surface characteristics (texture) in predicting cooked beef tenderness. Color and multispectral texture features, including 4 different wavelengths and 217 image texture features, were extracted from 2 laboratory-based multispectral camera imaging systems. Steaks were segregated into tough and tender classification groups based on Warner-Bratzler shear force. The texture features were submitted to STEPWISE multiple regression and support vector machine (SVM) analyses to establish prediction models for beef tenderness. A subsample (80%) of tender or tough classified steaks were used to train models which were then validated on the remaining (20%) test steaks. For color images, the SVM model correctly identified tender steaks with 100% accurately while the STEPWISE equation identified 94.9% of the tender steaks correctly. For multispectral images, the SVM model predicted 91% and STEPWISE predicted 87% average accuracy of beef tender.

Effects of increasing field pea (Pisum sativum) level in high-concentrate diets on growth performance and carcass traits in finishing steers and heifers.

Three experiments were conducted to determine the effect of increasing field pea level in high-concentrate finishing cattle diets on ADG, DMI, G:F, and carcass traits, and to estimate the NE of field pea. In Exp. 1, 118 yearling heifers (417.9 +/- 2.4 kg initial BW) were blocked by initial BW and assigned randomly to 1 of 4 treatments (0, 10, 20, or 30% dry-rolled field pea, DM basis; 4 pens/treatment). In Exp. 2, 143 beef steers (433 +/- 19 kg initial BW) were blocked by BW and assigned randomly to 1 of 4 treatments (0, 10, 20, or 30% dry-rolled field pea, DM basis; 6 pens/treatment). In Exp. 3, 80 beef steers (372.4 +/- 0.4 kg initial BW) were assigned randomly to 1 of 4 treatments (0, 18, 27, or 36% cracked field pea, DM basis; 4 pens/treatment). Field pea replaced a portion of the grain (dry-rolled and high moisture corn, dry-rolled corn, and barley and barley sprouts; Exp. 1, 2, and 3, respectively) and protein supplement. In Exp. 1, field pea inclusion decreased DMI linearly (P = 0.03), whereas ADG and G:F were not affected by treatment (P > or = 0.17); however, dietary NE(g) increased quadratically with increasing field pea level (P = 0.04). Fat thickness responded quadratically (P = 0.008) where heifers fed 20% field pea had greatest fat thickness and 30% field pea inclusion the least. Marbling tended (P < or = 0.09) to respond quadratically as field pea increased. No differences (P > or = 0.17) were observed for HCW, LM area, or KPH. In Exp. 2, DMI, ADG, G:F, dietary NE(g), HCW, marbling, LM area, 12th-rib fat, and USDA yield grade (YG) were unaffected by dietary field pea inclusion (P > or = 0.12). In Exp. 3, marbling score increased linearly (P = 0.05), fat thickness increased quadratically (P = 0.01), and YG tended to increase (P = 0.07) quadratically as field pea increased. Field pea inclusion did not affect (P > or = 0.38) DMI, ADG, G:F, dietary NE(g), HCW, or LM area. These results indicate that field pea can be included successfully into rations at levels up to 36% of DM without negatively affecting growth performance and most carcass characteristics of finishing beef cattle; however, effects on marbling score were variable. These data also indicate the energy content of field peas is similar to cereal grains, such as corn and barley, when included in high-concentrate finishing diets.

Effects of dexamethasone treatment on iodothyronine deiodinase activities and on metamorphosis-related morphological changes in the axolotl (Ambystoma mexicanum).

In amphibians, there is a close interaction between the interrenal and the thyroidal axes. Hypothalamic corticotropin-releasing hormone or related peptides stimulate thyroidal activity by increasing thyrotropin synthesis and release, while corticosterone accelerates both spontaneous and thyroid hormone-induced metamorphosis. One of the mechanisms that is thought to contribute to this acceleration is a corticosterone-induced change in peripheral deiodinating activity. The present experiments were designed to investigate further the effects of glucocorticoid treatment on amphibian deiodinase activities and to explore the possible role of these effects in metamorphosis. Neotenic axolotls (Ambystoma mexicanum) were treated either acutely or chronically with dexamethasone (DEX) and changes in type II and type III iodothyronine deiodinase (D2 and D3) activities were studied in liver, kidney, and brain. In addition, gill length, tail height, and body weight were measured at regular intervals in the chronically treated animals in search of metamorphosis-related changes. A single injection of 50 microg DEX decreased hepatic D3 activity (6-48 h) while it increased D2 activity in brain (6-48 h) and to a lesser extent in kidney (24 h). These changes were accompanied by an increase in plasma T(3) levels (48 h). Samples taken during chronic treatment with 20 or 100 microg DEX showed that both hepatic D2 and D3 activities were decreased on day 26, while renal D3 activity was decreased but only in the 20 microg dose group. All other deiodinase activities were not different from those in control animals. At 25 days, all DEX-treated axolotls showed a clear reduction in gill length, tail height, and body weight, changes typical of metamorphosis. Prolongation of the treatment up to 48 days resulted in complete gill resorption by days 44-60. Although probably several mechanisms contribute to these DEX-induced metamorphic changes, the interaction with thyroid function via a sustained downregulation of hepatic D3 may be one of them.

Differential expression of iodothyronine deiodinases in chicken tissues during the last week of embryonic development.

In the current study, the authors examined the type 1 (D1), type 2 (D2), and type 3 deiodinase (D3) activity and mRNA expression patterns in thyroid, lung, brain, pituitary, heart, liver, spleen, gonads, skin, muscle, intestine, Fabricius' bursa, and kidney during the last week of chicken embryonic development and the first 2 days posthatch. The D3 was the most widely expressed, occurring in all examined tissues. Also, the D1 knows a widespread distribution, although no D1 activity or mRNA expression could be detected in the brain, the thyroid, the muscle, and the skin. In contrast, the D2 has a much more restricted expression pattern, since the brain is the only organ where, prior to hatching, both in vitro D2 activity and D2 mRNA expression can be detected. Taken together, these results demonstrate that during the last week of chicken embryonic development, the majority of tissues express D3, together with either D1 or D2, indicating that each tissue possesses the necessary tools to regulate local thyroid hormone levels at least partly independent from T(3) and T(4) levels in plasma. In addition, the deiodinase expression data could be correlated to certain thyroid hormone dependent tissue-specific developmental events. This strongly suggests that in birds, as in mammals and amphibians, the correct spatial and temporal expression of iodothyronine deiodinases are essential for normal embryonic development.

Familial and sporadic renal oncocytomas--a comparative molecular-genetic analysis.

OBJECTIVES: Genetic causes of sporadic and familial renal oncocytomas are not known. We analyzed these tumors genetically in order to detect tumor-specific chromosome alterations. METHODS: DNA from 26 sporadic and 31 familial renal oncocytomas were screened by comparative genomic hybridization according to standard protocols including degenerate oligonucleotide-primed PCR. RESULTS: Chromosome alterations were detected in 19/26 sporadic (73%) and in 4/31 familial renal oncocytomas (13%). Partial or complete losses of chromosome 1 were most frequently found in both sporadic (15/26) and familial tumors (2/4). Less frequently, loss of chromosome 14 (3/26) was detected in sporadic renal oncocytomas as well as losses of 2p, 2q, 4q, 10 and 18 and gains of 1q and 17q in individual sporadic tumors. Inter-tumor variation of chromosome aberrations was prominent in 1 patient, where 1 tumor showed gains of chromosomes 5, 6q, 7, 10p, 12 and 13q, whereas the second tumor exhibited gains of chromosomes 5 and 7 and loss of 10q. In contrast to sporadic renal oncocytomas, most familial tumors (87%) were devoid of chromosome instabilities. CONCLUSION: Our results demonstrate that partial or complete loss of chromosome 1 is the most common alteration in renal oncocytomas, sporadic and familial. However, chromosome changes are much rarer in familial than in sporadic renal oncocytomas.