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Physicians' Social Skills – Conceptualization, Taxonomy, and Behavioral Assessment
No full textSocial skills (e.g., assertiveness, empathy, ability to accept criticism) are essential for the medical profession and therefore also for the selection and development of medical students. However, the term "social skills" is understood differently in different contexts. There is no agreed upon taxonomy for classifying physicians' social skills, and skills with the same meaning often have different names. This conceptual ambiguity presents a hurdle to cross-context communication and to the development of methods to assess social skills. Drawing from behavioral psychology, we aim to contribute to a better understanding of social skills in the medical context. To this end, we introduce a theoretically and empirically informed taxonomy that can be used to integrate the large number of different social skills. We consider how skills manifest at the behavioral level to ensure that we focus only on skills that are actually observable, distinguishable, and measurable. Here, behavioral research has shown that three overarching skill dimensions can be seen in interpersonal situations and are clearly distinguishable from each other: agency skill (i.e., getting ahead in social situations), communion skill (i.e., getting along in social situations), and interpersonal resilience (i.e., staying calm in social situations). We show that almost all social skills relevant for physicians fit into this structure. The approach presented allows redundant descriptions to be combined under three clearly distinguishable and behavior-based dimensions of social skills. This approach has implications for the assessment of social skills in both the selection and development of students
Potentiated early neural responses to fearful faces are not driven by specific face parts
No full textPrioritized processing of fearful compared to neutral faces is reflected in increased amplitudes of components of the event-related potential (ERP). It is unknown whether specific face parts drive these modulations. Here, we investigated the contributions of face parts on ERPs to task-irrelevant fearful and neutral faces using an ERP-dependent facial decoding technique and a large sample of participants (N = 83). Classical ERP analyses showed typical and robust increases of N170 and EPN amplitudes by fearful relative to neutral faces. Facial decoding further showed that the absolute amplitude of these components, as well as the P1, was driven by the low-frequency contrast of specific face parts. However, the difference between fearful and neutral faces was not driven by any specific face part, as supported by Bayesian statistics. Furthermore, there were no correlations between trait anxiety and main effects or interactions. These results suggest that increased N170 and EPN amplitudes to task-irrelevant fearful compared to neutral faces are not driven by specific facial regions but represent a holistic face processing effect
Ravulizumab and Efgartigimod in Myasthenia Gravis:A Real-World Study
No full textBackground and Objectives: Biologics that target pathogenic antibodies (Abs) and their effector functions such as the complement inhibitor ravulizumab and the neonatal Fc receptor agonist efgartigimod have recently been approved for the treatment of acetylcholine receptor (AChR)-Ab–positive myasthenia gravis (MG), but comparative studies are lacking.
Methods: In a prospective, exploratory real-world study, we assessed clinical efficacy, safety, and biological effects of ravulizumab and efgartigimod treatment initiation. Myasthenia Gravis-Activities of Daily Living and Quantitative Myasthenia Gravis scores were used as clinical endpoints. Ab effector functions were determined by AChR-Ab–dependent complement activation and phagocytosis assays and systemic complement activation profiling.
Results: We observed similar moderate short-term efficacy of ravulizumab and efgartigimod in achieving clinical improvement. Ravulizumab reduced systemic terminal complement activation, but neither treatment showed significant effects on complement pathways proximal to C5 or functional capacities of AChR-Abs. Both treatment modalities were well tolerated with no serious adverse events reported.
Discussion: Clinical benefits obtained with ravulizumab and efgartigimod can be remarkably heterogeneous in daily clinical practice. Neither treatment relevantly changed effector functions of pathogenic AChR-Abs, supporting the concept that durable disease control in MG requires continuous administration of both fast-acting agents.
Classification of Evidence: This study provides Class III evidence that in AChR-Ab–positive patients with generalized MG, ravulizumab and efgartigimod provide comparable modest improvement in MG functional scales
Sex-dependent performance differences in curvilinear aiming arm movements in octogenarians
No full textIn an aging society, it is necessary to detect the cognitive decline of individuals at an early stage using simple measurement methods. This makes early health care possible for those affected. The aim of the study was to develop a classifier for cognitive state in older adults with and without mild cognitive impairment (MCI) based on kinematic parameters of linear and curvilinear aiming arm movements. In a group of 224 older adults over 80 years of age (cognitively healthy and MCI), the movement duration and intersegment intervals of linear and curvilinear arm movements of 20 cm were recorded. Movement duration was significantly longer in the curvilinear condition than in the straight movement, and MCI participants required significantly more time than cognitively healthy participants. Post-hoc analysis on the fluidity of movement in the curvilinear condition showed that MCI men had significantly longer inter-segmental intervals than non-MCI men. No difference was found in women. Based on the inter-segmental intervals, a simple classifier could be developed that correctly classified 63% of the men. In summary, aiming arm movements are only conditionally suitable as a classifier for cognitive states. For the construction of an ideal classifier, age-related degeneration of cortical and subcortical motor areas should be considered
Time trends in survival and causes of death in multiple myeloma: a population-based study from Germany
No full textBackground: Steady evolution of therapies has improved prognosis of patients with multiple myeloma (MM) over the past two decades. Yet, knowledge about survival trends and causes of death in MM might play a crucial role in long-term management of this patient collective. Here, we investigate time trends in myeloma-specific survival at the population level over two decades and analyse causes of death in times of prolonged survival. Methods: Age-standardised and age group-specific relative survival (RS) of MM patients aged < 80 years at diagnosis was estimated for consecutive time periods from 2000–2019 using data from the Cancer Registry of North Rhine-Westphalia in Germany. Conditional RS was estimated for patients who already survived one to five years post diagnosis. Causes of death in MM patients were analysed and compared to the general population using standardised mortality ratios (SMR). Results: Three thousand three hundred thirty-six MM cases were included in the time trend analysis. Over two decades, age-standardised 5-year RS increased from 37 to 62%. Age-specific survival improved from 41% in period 2000–2004 to 69% in period 2015–2019 in the age group 15–69 years, and from 23 to 47% in the age group 70–79 years. Conditional 5-year RS of patients who survived five years after diagnosis slightly improved as compared to unconditional 5-year RS at diagnosis. MM patients are two times more likely to die from non-myeloma malignancies (SMR = 1.97, 95% CI 1.81–2.15) and from cardiovascular diseases (SMR = 2.01, 95% CI 1.86–2.18) than the general population. Conclusions: Prognosis of patients with MM has markedly improved since the year 2000 due to therapeutic advances. Nevertheless, late mortality remains a major concern. As survival improves, second primary malignancies and cardiovascular events deserve increased attention
Opinion on the Amendment to the Fuel Emissions Trading Act
No full textDas Brennstoffemissionshandelsgesetz soll die Treibhausgasemissionen bepreisen, die vom EU-Emissionszertifikatehandel bislang nicht erfasst sind, insbesondere in den Sektoren Verkehr und Wärme. Wichtigster Punkt der geplanten Gesetzesänderung ist die deutliche Erhöhung der Emissionspreise in der Einführungsphase von 2021 bis 2026. So kurz vor der Einführung reduziert das die Planungssicherheit und führt gleich zu Beginn zu Preisen auf dem Niveau der EU-Zertifikate, die danach voraussichtlich deutlich überschritten werden. Besser wäre es, das EU-System auszudehnen, dessen Preise zu übernehmen, in Deutschland früher mit den separaten Versteigerungen von Zertifikaten zu beginnen oder einfach auf die Gesetzesänderung zu verzichten.The Fuel Emissions Trading Act is intended to price greenhouse gas emissions that have not yet been covered by the EU emissions certificate trade, particularly in the transport and heating sectors. The most important point of the planned change in the law is the significant increase in emission prices in the introductory phase from 2021 to 2026. Shortly before the introduction, this reduces planning security and leads to prices at the level of the EU certificates right from the start, which are then likely to be significantly exceeded. It would be better to expand the EU system, to adopt its prices, to start the separate auctioning of certificates earlier in Germany or simply to forego the change in the law
Struggle in the bubble - a prospective study on the effect of remote learning and distance education on confidence in practical surgical skills acquired during COVID-19
No full textBackground: The coronavirus disease (COVID-19) has significantly changed healthcare systems and medical education. Universities were required to develop innovative curricula based on remote and distance education to continue medical education. This prospective questionnaire-based study aimed to investigate the impact of COVID-19-associated remote learning on the surgical training of medical students. Methods: A 16-item questionnaire-based survey was distributed to medical students at the University Hospital of Münster before and after a surgical skills laboratory (SSL). Two cohorts were included: summer semester 2021 (COV-19), with rigorous social-distancing restrictions requiered SSL to be remotely, and winter semester 2021 (postCOV-19), in which the SSL was provided as a face-to-face, hands-on course. Results: Both, cohorts showed a significant improvement in self-assessment of pre- and post-course confidence. While no significant difference in the average gain in self-confidence for sterile working was observed between the two cohorts, improvement in self-confidence was significantly higher in the COV-19 cohort regarding skin suturing and knot tying (p < 0.0001). However the average improvement regarding history and physical was significantly higher in the postCOV-19 cohort (p < 0.0001). In subgroup analysis, gender-associated differences varied in the two cohorts and were not related to specific subtasks, while age-stratified analysis revealed superior results for younger students. Conclusion: The results of our study underline the usability, feasibility, and adequacy of remote learning for the surgical training of medical students. The on-site distance education version, presented in the study, allows the continuing of hands-on experience in a safe environment in compliance with governmental social-distancing restrictions
Teresa von Ávila und Edith Stein.:Zum Ziel durch Ausklammerungen in Mystik und Philosophie
No full textDer Text untersucht die Beziehung zwischen Teresa von Ávila und Edith Stein, insbesondere wie Edith Stein durch die Lektüre von Teresas Schriften zum Katholizismus konvertierte und philosophische Parallelen zwischen Teresas mystischer Praxis und der Philosophie von Descartes und Husserl zog. Stein vergleicht den mystischen Weg Teresas mit der phänomenologischen Methode Husserls, wobei beide Ansätze durch Ausklammerung und Konzentration auf das Wesentliche zur Erkenntnis führen. Edith Stein sieht in der mystischen Vereinigung nicht nur ein religiöses Ereignis, sondern auch einen philosophischen Zugang zur Wirklichkeit, ähnlich dem cartesianischen Zweifel
Economic Ethical Considerations on Climate Change
No full textNaturwissenschaftliche Fragen rund um den Klimawandel sind von Naturwissenschaftlern zu beantworten. Ökonomen und Wirtschaftsethiker können jedoch dazu beitragen, den Klimawandel und mögliche Gegenmaßnahmen zu bewerten. Dabei ist ein einheitlicher Preis für die Emission von Treibhausgasen zu empfehlen. Es gibt ein globales Kollektivgutproblem, welches sich am ehesten durch die Vereinbarung einer Zertifikatslösung überwinden lässt. Außerdem sollten die Forschung und Entwicklung gefördert werden.Natural scientific questions regarding climate change have to be answered by natural scientist. However, economists and economic ethicists can contribute to the evaluation of climate change and possible countermeasures. In doing so, a uniform price for the emission of greenhouse gases is advisable. There is a global public good problem that can most likely be resolved by the agreement of a certificate solution. Moreover, research and development should be supported
Autumn migration tracks of Helopsaltes grasshopper-warblers from Northeast Asia support recent taxonomic assignments
No full textMigration strategies are genetically inherited in most songbirds, and closely related species can exhibit markedly contrasting migration programs. Here, we investigate the autumn migration of one 'Helopsaltes' grasshopper-warbler from a population near Magadan, North East Russia, based on light-level geolocation. Although often considered to belong to Middendorff's Grasshopper-warbler 'H. ochotensis', recent genetic studies suggest that birds from this population are more closely related to Pallas's Grasshopper-warbler H. certhiola. We compare the migratory behavior of the Magadan bird with two Pallas's Grasshopper-warblers tracked from populations in the Kolyma River valley and the Amur region, Russia. We found similar migration patterns in all three tracked individuals, with stopover sites in eastern China and wintering sites in mainland Southeast Asia, within the known range for Pallas's Grasshopper-warbler. Furthermore, based on morphological data compiled during bird ringing, we were able to confirm the presence of potential "Magadan grasshopper-warblers" during spring and autumn migration in Thailand. Our scant data provide further evidence that Magadan 'Helopsaltes', notwithstanding their morphological resemblance to Middendorff's Grasshopper-warbler, constitute a population of Pallas's Grasshopper-warbler