Refine
Document Type
- Article (5)
Has Fulltext
- yes (5)
Is part of the Bibliography
- no (5)
Keywords
- Blended-Learning (1)
- Clinical frailty scale (1)
- Frailty (1)
- Gemeinsames Lernen (1)
- Inklusiver Unterricht (1)
- Intensive care outcome (1)
- Lehrerfortbildung (1)
- Mathematik (1)
- NF-κB (1)
- Professionalisierung (1)
Institute
- Medizin (4)
- Biowissenschaften (1)
- Erziehungswissenschaften (1)
- Georg-Speyer-Haus (1)
Der vorliegende Beitrag beschreibt den theoretischen Hintergrund und das Design des Projekts GLUE (Gemeinsame Lern-Umgebungen Entwickeln). Die Konzeption der Gemeinsamen Lern-Umgebungen zielt im Sinne der Prinzipien des ‚Universal Design of Learning‘ (Hall, Meyer & Rose, 2012) darauf ab, den inklusiven Mathematikunterricht von einem gemeinsamen Lerngegenstand aus zu denken, der einerseits Zugänglichkeit für alle Lernenden schafft und andererseits Unterstützungsmaßnahmen auf unterschiedlichen Niveaustufen zulässt.
Das Projekt geht der Frage nach, wie sich die Kompetenzentwicklung von berufserfahrenen Lehrkräften der allgemeinen Schule und für sonderpädagogische Förderung durch Fortbildungsangebote zum inklusiven Mathematikunterricht wirksam unterstützen lässt. Hierzu wurde ein Blended-Learning-Angebot zur Entwicklung gemeinsamer Lernumgebungen für alle Kinder einer Lerngruppe erarbeitet, die sich auch von mehreren Lehrkräften gemeinsam entwickeln lassen.
In diesem Beitrag werden der theoretische Hintergrund, die Konzeption und die methodische Anlage des Projekts vorgestellt. Kapitel 1 befasst sich mit Differenzieren und Fördern im Mathematikunterricht der Primarstufe, Kapitel 2 diskutiert zentrale Befunde zur Wirksamkeit von Lehrerfortbildungsmaßnahmen sowie zu Blended-Learning-Angeboten. Im dritten Kapitel werden auf dieser Grundlage die Ziele des Projekts (Kap. 3.1), die Inhalte und die Struktur des Fortbildungsangebots (Kap., 3.2), die Forschungsfragen (Kap. 3.3) und das Design der Interventionsstudie dargestellt (Kap. 3.4). Die Wirksamkeit wird in einem ausbalancierten Prä-Post-Follow-Up-Test-Design im Vergleich zu unbegleiteten Online-Angeboten evaluiert, die Ergebnisse sollen in einer Folgepublikation kommuniziert werden.
Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.
Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.
Results: Patients had a median age of 84 [IQR 82–87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.
Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.
Trial registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807) on May 1, 2017.
Brain metastases are the most common intracranial tumor in adults and are associated with poor patient prognosis and median survival of only a few months. Treatment options for brain metastasis patients remain limited and largely depend on surgical resection, radio- and/or chemotherapy. The development and pre-clinical testing of novel therapeutic strategies require reliable experimental models and diagnostic tools that closely mimic technologies that are used in the clinic and reflect histopathological and biochemical changes that distinguish tumor progression from therapeutic response. In this study, we sought to test the applicability of magnetic resonance (MR) spectroscopy in combination with MR imaging to closely monitor therapeutic efficacy in a breast-to-brain metastasis model. Given the importance of radiotherapy as the standard of care for the majority of brain metastases patients, we chose to monitor the post-irradiation response by magnetic resonance spectroscopy (MRS) in combination with MR imaging (MRI) using a 7 Tesla small animal scanner. Radiation was applied as whole brain radiotherapy (WBRT) using the image-guided Small Animal Radiation Research Platform (SARRP). Here we describe alterations in different metabolites, including creatine and N-acetylaspartate, that are characteristic for brain metastases progression and lactate, which indicates hypoxia, while choline levels remained stable. Radiotherapy resulted in normalization of metabolite levels indicating tumor stasis or regression in response to treatment. Our data indicate that the use of MR spectroscopy in addition to MRI represents a valuable tool to closely monitor not only volumetrical but also metabolic changes during tumor progression and to evaluate therapeutic efficacy of intervention strategies. Adapting the analytical technology in brain metastasis models to those used in clinical settings will increase the translational significance of experimental evaluation and thus contribute to the advancement of pre-clinical assessment of novel therapeutic strategies to improve treatment options for brain metastases patients.
Background: Blunt chest (thoracic) trauma (TxT) and haemorrhagic shock with subsequent resuscitation (H/R) induce strong systemic and local inflammatory response, which is closely associated with apoptotic cell loss and subsequently impaired organ function. The underlying mechanisms are not completely understood, therefore, the treatment of patients suffering from TxT+H/R is challenging. In our recent studies, we have demonstrated local anti-inflammatory effects of ethyl pyruvate (EtP) in lung and liver after TxT+H/R. Here, the therapeutic potential of a reperfusion regime with EtP on the early post-traumatic systemic inflammatory response and apoptotic changes after TxT followed by H/R were investigated.
Methods: Female Lewis rats underwent TxT followed by haemorrhagic shock (60 min). Resuscitation was performed with own blood transfusion and either lactated Ringers solution (LR) or LR supplemented with EtP (50 mg/kg). Sham group underwent the surgical procedures. After 2 h blood as well as lung and liver tissues were obtained for analyses. Systemic activation of neutrophils (expression of CD11b and CD62L), leukocyte phagocytosis, apoptosis (caspase-3/7 activation), pyroptosis (caspase-1 activation) and NF-κB p65 activity were assessed. p < 0.05 was considered significant.
Results: TxT+H/R-induced systemic activation of neutrophils (increased CD11b and reduced CD62L expression) was significantly reduced by EtP. Trauma-induced delayed neutrophil apoptosis was further reduced by EtP reperfusion but remained unaltered in monocytes. Reperfusion with EtP significantly increased the phagocytizing capacity of granulocytes. Trauma-induced inflammasome activation, which was observed in monocytes and not in neutrophils, was significantly reduced by EtP in both cell entities. NF-κB p65 activation, which was increased in neutrophils and monocytes was significantly decreased in monocytes.
Conclusion: TxT+H/R-induced systemic activation of both neutrophils and monocytes concomitant with increased systemic inflammation was reduced by a reperfusion with EtP and was associated with a down-regulation of NF-κB p65 activation.