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Co-creation of education for sustainable development (ESD) in higher education – a case study in physical education teacher education (PETE) in Germany
No full textThe decision-making process for sedation in specialist palliative care: a qualitative interview study with team members, relatives, and patients
No full textBackground
The decision-making process for sedation in palliative care remains under-researched, with evidence of limited involvement of patients and their relatives despite guidelines. The aim of this study was to explore the decision-making process for sedation in specialist palliative care in Germany, including all types of sedation (light to deep, temporary or continuous (until death)).
Methods
Qualitative semi-structured interviews with 26 physicians, 22 nurses, eleven other members of the multiprofessional care team, eight relatives, and six patients. Recruitment took place via contact person in ten palliative care units and seven specialist palliative home care services in Germany. We analysed the transcripts by Framework Analysis and applied the shared treatment decision-making model by Charles et al.
Results
Findings could be assigned to the adapted 5-phase decision-making process: (1) In the initiation phase, preemptive discussions were typically limited to patients with chronic diseases or potential catastrophic events, with some physicians avoiding early discussions due to fears of pressure. (2) During information exchange, the amount of detail varied by sedation type, with often only little information given for mild forms. (3) In the deliberation phase, informed consent was more common for deep sedation, and some team members criticized inadequate documentation of consent. (4) Decisions to start sedation were usually collaborative, though challenges arose when there was no defined starting point for deep sedation. (5) Re-evaluation was partly described to be challenging due to concerns about reintroducing suffering if sedation was reduced.
Conclusions
This study highlights the processual nature of the decision-making process for sedation in palliative care and proposes re-evaluation as a fifth phase. It underscores the importance of early communication, addressing professionals’ concern, and supporting shared decision-making throughout all phases
'Living means learning to die' – theological perspectives on immortality, autonomy and character formation
No full text
Enhancing pandemic surveillance and testing: a simulation modeling study utilizing german multicenter data with federated machine learning
No full textThe COVID-19 pandemic has starkly exposed queryPlease check author names and affiliation if presented correctly.vulnerabilities in the management of surveillance and testing. Significant challenges associated with physical tests, i.e., PCR and antigen tests, include their high cost, resource-intensive nature, turnaround time, and sensitivity. Although the literature has underscored the potential of Machine Learning-based methods for the digital diagnosis of COVID-19, developing high-performing models crucially depends on extensive datasets exceeding the amount available in one healthcare institution. Federated Machine Learning offers a solution to that dilemma. The aim of this research is to evaluate the potential impact of Federated Learning-based digital COVID-19 diagnosis on the trajectory of a pandemic. Therefore, we design a multidimensional evaluation framework, consisting of a simulation study utilizing real-world lab parameters from multiple hospitals and a newly developed performance indicator, named Testing Evaluation for Pandemics. We find that Federated Learning can significantly support the decision-making process of diagnosing COVID-19 at the beginning of a pandemic while saving scarce resources. However, a warm-up phase is needed until constant performance similar to physical tests is reached. In addition, lab parameters have a high prediction power for the diagnosis and are well suited because of patient welfare reasons
Evaluation of the relationship between inflammation and typical chest pain in ST-elevation myocardial infarction
No full textBackground: Previous investigations have shown that the absence of typical breast symptoms is associated with unfavorable outcomes after an acute myocardial infarction (AMI). Delayed diagnosis and therapy could not explain these results, so other causes seem to be involved. Therefore, in the present analysis the association between inflammatory plasma proteins and typical chest pain symptoms in hospitalized patients with acute ST-elevation myocardial infarction (STEMI) was investigated.
Methods: Data from 395 STEMI patients registered by the population-based Myocardial Infarction Registry Augsburg between 2009 and 2013 were used for analysis. The OLINK inflammatory panel including a total of 92 cytokines was measured in arterial blood samples, which were obtained immediately after hospital admission within the scope of cardiac catheterization. The associations between the inflammation markers and typical chest pain were examined by multiple logistic regression analyses.
Results: Altogether, 10.9% of the STEMI patients did not present with typical chest pain. The inflammatory markers IL8, IL6, FGF-21, CD40, CST5, ADA, OPG, PD-L1, TNFRSF9 and STAMBP were significantly inversely associated with typical chest pain after FDR-adjustment. The strongest associations were found for FGF-21, CST5 and CD40.
Conclusions: These results suggest that a dysregulated inflammatory status is associated with a lack of typical chest pain in AMI patients. Beyond acute-phase inflammatory interleukins elevated within the early phase of an AMI, such as IL-6, hepatokines and transmembrane proteins seem to be associated with AMI symptoms. Further research into the causal mechanisms of these associations is necessary
DNA twist at high alkali ion concentrations: evidence against C-form DNA in solution
No full textDNA is highly negatively charged, making its structure strongly dependent on the ionic environment. DNA twist—a central DNA property—varies with ion concentration and identity. Prior studies have focused on salt concentrations below 1 M, and it is unclear whether twist trends persist at higher concentrations. It has been proposed that at high salt, DNA transitions from its canonical B-form to C-form, originally observed by fiber diffraction. Here, we use single-molecule magnetic tweezers to measure DNA twist in high concentrations of LiCl, NaCl, KCl, and CsCl. For all salts, twist initially increases approximately as ∼[salt]1/2, but plateaus and even decreases above 3 M. LiCl causes the largest twist increase, by ≤ 0.9° bp−1, compared with physiological salt, still far below the suggested C-form values of 2–3° bp−1. We perform extensive all-atom molecular dynamics simulations for DNA in LiCl solutions with different force fields. For parmbsc1, we observe good agreement with experiments when ion activities are taken into account. We find that simulations initiated in the C-form rapidly convert to the B-form, while the B-form remains stable. Our results demonstrate ion-specific, systematic changes in DNA twist beyond 1 M salt, but do not support a transition to the C-form for DN
