Virtual Patients in continuing medical education and residency training: a pilot project for acceptance analysis in the framework of a residency revision course in pediatrics.

AIM Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. METHODS Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. RESULTS N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. CONCLUSION VPs may reasonably complement existing learning activities in residency training.

Seltene Krankheiten - eine Herausforderung für das schweizerische Gesundheitsrecht

Der Beitrag widmet sich dem durch technologische Entwicklungen herausgeforderten schweizerischen Gesundheitsrecht. Am Beispiel der seltenen Krankheiten wird aufgezeigt, dass das geltende Recht der medizinisch-technischen Realität hinterher hinkt und den Bedürfnissen von Menschen mit seltenen Krankheiten nur unzureichend gerecht wird. Es gilt abzuwarten, ob die demnächst vom BAG vorzulegende nationale Strategie für seltene Krankheiten den Betroffenen zu einem rechtsgleichen und transparenten Zugang zum Gesundheitswesen verhilft.

Entwicklung und Implementierung von Modellen für ein Skills-Training-Parcours für internistische Assistenzärzte

„Entwicklung und Implementierung von Modellen für ein Skills-Training-Parcours für internistische Assistenzärzte “ V. Maier1 - K. Schnabel2 1 Universitätslinik für Allgemeine Innere Medizin, Inselspital, Bern 2 Berner interdisziplinäres Skills- und Schauspielpatientenzentrum (BiSS), Institut für Medizinische Lehre (IML), Abteilung für Unterricht und Medien (AUM) Einleitung: Im klinischen Alltag sind praktische Fertigkeiten gefordert, um Patienten sicher zu behandeln. Auch in der Schweizer Fachgesellschaft FMH kam es zu einer stärkeren Gewichtung der praktischen Fertigkeiten und müssen jetzt ein Logbuch über Art und Zeitpunkt der Intervention führen [1]. Am Inselspital Bern wurde dafür ein Skillsparcours etabliert, da in vielen Bereichen simulationsbasierte Ausbildungen traditionellen Methoden überlegen ist [2]. Der Skillsparcours besteht aus einem Nachmittag mit 4 nicht-invasiven Prozeduren und einem Nachmittag mit 5 invasiven Prozeduren. Eigens dafür wurden drei Modelle entwickelt und deren Tauglichkeit evaluiert. Fragestellung: Bilden die selbst gefertigten Modelle die Realität ausreichend ab? Material und Methoden: Innerhalb der 9 Posten (5 invasiv und 4 nichtinvasiv) wurden für die 5 invasiven Posten zwei Modelle aus dem Skillslab (BiSS) genutzt (Lumbalpunktion (LP) und Blasenkatheter (BK)) und drei Modelle neu entwickelt (Pleura-(PP), Aszites-(AP) und Knochenmarks-Punktion (KMP)). Die Modelle wurden mit Materialien aus dem Baumarkt entwickelt (Material ca. CHF 50/Stück). Der Aufbau der Modelle soll auf der Tagung demonstriert werden. Die Teilnehmer (N=12) und Dozenten (N=5) wurden zu der Qualität mittels Fragebogen befragt. Dabei wurde die individuelle Vorerfahrung und die Einschätzung der Teilnehmer erfragt. Die Frage zur Eignung des Modells war: „Das Modell war zum Üben geeignet“. Als Skala wurde eine Likert-Skala von 0 bis 5 (1=sehr ungeeignet, 5=sehr geeignet) benutzt. Ergebnisse: Die Assistenzärzte beurteilten die Modelleignung wie folgt (Median (Min;Max)): LP: 5 (4;5) KMP: 4.5 (3;5), PP: 4 (3;5), AP: 4.5 (2;5), BK-Einlage: 4.5 (4;6). Die Oberärzte, die jeweils nur das Modell bewerteten, an welchem sie den Kurs durchführten, beurteilten die Modelleignung wie folgt: LP 5.0, KMP: 5.0, PP 5.0, AP: 4.0, BK-Einlage: 3.0. Diskussion: Alle Modelle wurden sowohl von den Oberärzten als auch von den Assistenzärzten als zum Üben tauglich eingeschätzt. Zwischen den selbst hergestellten Low-Fidelity Modellen und den High-Fidelity Modellen gab es hierein keinen signifikanten Unterschied. Als am wenigsten tauglich wurde von den Oberärzten mit der Simulation der Blasenkatheter-Einlage ein High-Fidelity-Modell bewertet. Schlussfolgerungen: Alle Modelle für die Simulation der Punktionstechniken haben gut bis sehr gut funktioniert. Die selbst hergestellten Modelle bilden die Wirklich zum Üben der Techniken hinreichend gut und nicht schlechter als die High-Fidelity-Modelle ab. Selbst gebaute Modelle mit Materialien aus dem Baumarkt können das sonst sehr materialaufwändige Training mit Simulatoren genauso effektiv aber wesentlich effizienter durchführbar machen. Literatur bei den Autoren (1) Weiterbildungsordnung FMH 2014 (letzte Revision 4. September 2014). www.fmh.ch/files/pdf15/wbo_d.pdf (2) McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB (2011) Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011 Jun;86(6):706-11

Neocortical hyperexcitability defect in a mutant mouse model of spike-wave epilepsy, {\it stargazer}

Single-locus mutations in mice can express epileptic phenotypes and provide critical insights into the naturally occurring defects that alter excitability and mediate synchronization in the central nervous system (CNS). One such recessive mutation (on chromosome (Chr) 15), stargazer(stg/stg) expresses frequent bilateral 6-7 cycles per second (c/sec) spike-wave seizures associated with behavioral arrest, and provides a valuable opportunity to examine the inherited lesion associated with spike-wave synchronization.^ The existence of distinct and heterogeneous defects mediating spike-wave discharge (SWD) generation has been demonstrated by the presence of multiple genetic loci expressing generalized spike-wave activity and the differential effects of pharmacological agents on SWDs in different spike-wave epilepsy models. Attempts at understanding the different basic mechanisms underlying spike-wave synchronization have focused on $\gamma$-aminobutyric acid (GABA) receptor-, low threshold T-type Ca$\sp{2+}$ channel-, and N-methyl-D-aspartate receptor (NMDA-R)-mediated transmission. It is believed that defects in these modes of transmission can mediate the conversion of normal oscillations in a trisynaptic circuit, which includes the neocortex, reticular nucleus and thalamus, into spike-wave activity. However, the underlying lesions involved in spike-wave synchronization have not been clearly identified.^ The purpose of this research project was to locate and characterize a distinct neuronal hyperexcitability defect favoring spike-wave synchronization in the stargazer brain. One experimental approach for anatomically locating areas of synchronization and hyperexcitability involved an attempt to map patterns of hypersynchronous activity with antibodies to activity-induced proteins.^ A second approach to characterizing the neuronal defect involved examining the neuronal responses in the mutant following application of pharmacological agents with well known sites of action.^ In order to test the hypothesis that an NMDA receptor mediated hyperexcitability defect exists in stargazer neocortex, extracellular field recordings were used to examine the effects of CPP and MK-801 on coronal neocortical brain slices of stargazer and wild type perfused with 0 Mg$\sp{2+}$ artificial cerebral spinal fluid (aCSF).^ To study how NMDA receptor antagonists might promote increased excitability in stargazer neocortex, two basic hypotheses were tested: (1) NMDA receptor antagonists directly activate deep layer principal pyramidal cells in the neocortex of stargazer, presumably by opening NMDA receptor channels altered by the stg mutation; and (2) NMDA receptor antagonists disinhibit the neocortical network by blocking recurrent excitatory synaptic inputs onto inhibitory interneurons in the deep layers of stargazer neocortex.^ In order to test whether CPP might disinhibit the 0 Mg$\sp{2+}$ bursting network in the mutant by acting on inhibitory interneurons, the inhibitory inputs were pharmacologically removed by application of GABA receptor antagonists to the cortical network, and the effects of CPP under 0 Mg$\sp{2+}$aCSF perfusion in layer V of stg/stg were then compared with those found in +/+ neocortex using in vitro extracellular field recordings. (Abstract shortened by UMI.) ^

Horizontal profiles of longwave and shortwave radiation components over sea ice near Barrow, Alaska during the 2011 melt

An integrated instrument package for measuring and understanding the surface radiation budget of sea ice is presented, along with results from its first deployment. The setup simultaneously measures broadband fluxes of upwelling and downwelling terrestrial and solar radiation (four components separately), spectral fluxes of incident and reflected solar radiation, and supporting data such as air temperature and humidity, surface temperature, and location (GPS), in addition to photographing the sky and observed surface during each measurement. The instruments are mounted on a small sled, allowing measurements of the radiation budget to be made at many locations in the study area to see the effect of small-scale surface processes on the large-scale radiation budget. Such observations have many applications, from calibration and validation of remote sensing products to improving our understanding of surface processes that affect atmosphere-snow-ice interactions and drive feedbacks, ultimately leading to the potential to improve climate modelling of ice-covered regions of the ocean. The photographs, spectral data, and other observations allow for improved analysis of the broadband data. An example of this is shown by using the observations made during a partly cloudy day, which show erratic variations due to passing clouds, and creating a careful estimate of what the radiation budget along the observed line would have been under uniform sky conditions, clear or overcast. Other data from the setup's first deployment, in June 2011 on fast ice near Point Barrow, Alaska, are also shown; these illustrate the rapid changes of the radiation budget during a cold period that led to refreezing and new snow well into the melt season.

Export of algal biomass from the melting Arctic sea ice

In the Arctic, under-ice primary production is limited to summer months and is not only restricted by ice thickness and snow cover but also by the stratification of the water column, which constrains nutrient supply for algal growth. RV Polarstern visited the ice-covered Eastern Central basins between 82 to 89°N and 30 to 130°E in summer 2012 when Arctic sea ice declined to a record minimum. During this cruise, we observed a widespread deposition of ice algal biomass of on average 9 g C per m**2 to the deep-sea floor of the Central Arctic basins. Data from this cruise will contribute to assessing the impact of current climate change on Arctic productivity, biodiversity, and ecological function.

Turbulent flux and meteorological measurements during ARCTEX-2006 campaign

This dataset present result from the DFG- funded Arctic-Turbulence-Experiment (ARCTEX-2006) performed by the University of Bayreuth on the island of Svalbard, Norway, during the winter/spring transition 2006. From May 5 to May 19, 2006 turbulent flux and meteorological measurements were performed on the monitoring field near Ny-Ålesund, at 78°55'24'' N, 11°55'15'' E Kongsfjord, Svalbard (Spitsbergen), Norway. The ARCTEX-2006 campaign site was located about 200 m southeast of the settlement on flat snow covered tundra, 11 m to 14 m above sea level. The permanent sites used for this study consisted of the 10 m meteorological tower of the Alfred Wegener Institute for Polar- and Marine Research (AWI), the international standardized radiation measurement site of the Baseline Surface Radiation Network (BSRN), the radiosonde launch site and the AWI tethered balloon launch sites. The temporary sites - set up by the University of Bayreuth - were a 6 m meteorological gradient tower, an eddy-flux measurement complex (EF), and a laser-scintillometer section (SLS). A quality assessment and data correction was applied to detect and eliminate specific measurement errors common at a high arctic landscape. In addition, the quality checked sensible heat flux measurements are compared with bulk aerodynamic formulas that are widely used in atmosphere-ocean/land-ice models for polar regions as described in Ebert and Curry (1993, doi:10.1029/93JC00656) and Launiainen and Cheng (1995). These parameterization approaches easily allow estimation of the turbulent surface fluxes from routine meteorological measurements. The data show: - the role of the intermittency of the turbulent atmospheric fluctuation of momentum and scalars, - the existence of a disturbed vertical temperature profile (sharp inversion layer) close to the surface, - the relevance of possible free convection events for the snow or ice melt in the Arctic spring at Svalbard, and - the relevance of meso-scale atmospheric circulation pattern and air-mass advection for the near-surface turbulent heat exchange in the Arctic spring at Svalbard. Recommendations and improvements regarding the interpretation of eddy-flux and laser-scintillometer data as well as the arrangement of the instrumentation under polar distinct exchange conditions and (extreme) weather situations could be derived.

Field measurements on Atka Bay landfast sea ice in 2012

Basal melt of ice shelves may lead to an accumulation of disc-shaped ice platelets underneath nearby sea ice, to form a sub-ice platelet layer. Here we present the seasonal cycle of sea ice attached to the Ekström Ice Shelf, Antarctica, and the underlying platelet layer in 2012. Ice platelets emerged from the cavity and interacted with the fast-ice cover of Atka Bay as early as June. Episodic accumulations throughout winter and spring led to an average platelet-layer thickness of 4 m by December 2012, with local maxima of up to 10 m. The additional buoyancy partly prevented surface flooding and snow-ice formation, despite a thick snow cover. Subsequent thinning of the platelet layer from December onwards was associated with an inflow of warm surface water. The combination of model studies with observed fast-ice thickness revealed an average ice-volume fraction in the platelet layer of 0.25 +/- 0.1. We found that nearly half of the combined solid sea-ice and ice-platelet volume in this area is generated by heat transfer to the ocean rather than to the atmosphere. The total ice-platelet volume underlying Atka Bay fast ice was equivalent to more than one-fifth of the annual basal melt volume under the Ekström Ice Shelf.

Radiation balance in the tropical Atlantic during the Atlantic Expedition ATEX 1969

This paper presents the components of the radiation balance and the balance itself, which are measured from "Meteor" during ATEX from January 1 to March 2, 1969 in the Atlantic Ocean. For "Planet", also engaged in ATEX, measurements of the global radiation are shown for the period of February 4 to February 28, 1969. From the results obtained by "Meteor" the albedo of the sea surface has been calculated and is presented for two exemplary days.