Discrimination and sexual harassment – Results from the largest German medical university

Background

Discrimination and sexual harassment in the workplace and in higher education institutions are important public health issues. Here we aim at analyzing the prevalence of discrimination and sexual harassment of lecturers and students at one of the largest teaching hospitals in Europe. We assess whether there are differences between lecturers and students, women and men, and different study programs.

Methods

An online questionnaire was sent to N = 7095 students of all study programs and N = 2528 lecturers at Charité - Universitätsmedizin Berlin. The survey was conducted from November 2018 to February 2019. We investigated experienced or observed discrimination or sexual harassment at the medical faculty. Furthermore, we analyzed frequency, perpetrators, situational factors, attributed reasons and forms of harassment encountered.

Results

A total of 964 (14%) students (S) and 275 (11%) of lecturers (L) participated in the survey. Discriminatory behavior was witnessed and/or experienced by 49,6% of students (L: 31%), sexual harassment by 23,6% of students (L: 19,2%). Students state lecturers (85,9%) as main source of discriminatory behavior (L: directors/supervisors: 47,4%; students 41,0%). Sex/Gender (S: 71%; L: 60,3%) is cited most frequently as reason for discriminatory experiences. Female students and faculty experience more discrimination and sexual harassment.

Conclusions

Discrimination and sexual harassment are prevalent in academic medicine. There are differences in the reasons and sources of discrimination and sexual harassment between students and lecturers. Specific programs for lecturers and students are necessary to educate the faculty on how to prevent and respond to it and whom to address.

Key messages

• National preventive strategies should be implemented to tackle issues of discrimination and harassment in higher education institutions.

• Special attention should be paid to female students and lecturers.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Functional echocardiographic and serum biomarker changes following surgical and percutaneous atrial septal defect closure in children

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation

Background

Ventricular performance is temporarily reduced following surgical atrial septal defect (ASD) closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous ASD closure and to relate biomarkers to ventricular performance following intervention.

Methods

In this multicenter prospective study, children scheduled for surgical or percutaneous ASD closure were included. Subjects were assessed pre-operatively (T1); in the 2nd week post-intervention (T2) and 1 year post-intervention (T3). At each time point an echocardiographic study and a panel of biomarkers was obtained.

Results

Sixty-three patients (age 4.1 [3.1–6.1] years) were included. Forty-three patients underwent surgery. At T2 right ventricular (RV) global longitudinal strain (GLS) was decreased for the surgical, but not the percutaneous, group (-17.6 ± 4.1 versus -27.1 ± 3.4, p<.001). A smaller decrease was noted for left ventricular (LV) GLS at T2 for the surgical group (surgical -18.6 ± 3.2 versus percutaneous -20.2 ± 2.4, p=.040). At T3 LV performance returned to baseline, while RV performance improved, but did not reach pre-intervention levels. Cadherin-5, chitotriosidase-1, integrin-beta-2 and urokinase differed across time points and related to favorable RV GLS at T2.

Conclusions

Right, and to a lesser degree left, ventricular performance was reduced early after surgical ASD closure, possibly related to cardiopulmonary bypass. RV performance at T3 remained below baseline levels, probably related to changed loading conditions. Several biomarkers showed a pattern over time similar to ventricular performance and related to cardiac function at early follow-up. These markers may provide insight into the processes that affect ventricular function.

Fourfold Differential Photoelectron Circular Dichroism

We report on a joint experimental and theoretical study of photoelectron circular dichroism (PECD) in methyloxirane. By detecting O 1s photoelectrons in coincidence with fragment ions, we deduce the molecule's orientation and photoelectron emission direction in the laboratory frame. Thereby, we retrieve a fourfold differential PECD clearly beyond 50%. This strong chiral asymmetry is reproduced by ab initio electronic structure calculations. Providing such a pronounced contrast makes PECD of fixed-in-space chiral molecules an even more sensitive tool for chiral recognition in the gas phase.

Isotope Shifts of Radium Monofluoride Molecules

Isotope shifts of ^{223-226,228}Ra^{19}F were measured for different vibrational levels in the electronic transition A^{2}Π_{1/2}←X^{2}Σ^{+}. The observed isotope shifts demonstrate the particularly high sensitivity of radium monofluoride to nuclear size effects, offering a stringent test of models describing the electronic density within the radium nucleus. Ab initio quantum chemical calculations are in excellent agreement with experimental observations. These results highlight some of the unique opportunities that short-lived molecules could offer in nuclear structure and in fundamental symmetry studies.

Closed-loop recycling of rare liquid samples for gas-phase experiments

Many samples of current interest in molecular physics and physical chemistry exist in the liquid phase and are vaporized for use in gas cells, diffuse gas targets, or molecular gas jets. For some of these techniques, the large sample consumption is a limiting factor. When rare, expensive molecules such as custom-made chiral molecules or species with isotopic labels are used, wasting them in the exhaust line of the pumps is quite an expensive and inefficient approach. Therefore, we developed a closed-loop recycling system for molecules with vapor pressures below atmospheric pressure. Once filled, only a few valves have to be adjusted, and a cold trap must be moved after each phase of recycling. The recycling efficiency per turn exceeds 95%.

Prasugrel compared to ticagrelor in primary PCI

Background

Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited.

Purpose

To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI.

Methods and results

We prospectively enrolled 5365 patients treated with prasugrel (n=2785, 51.9%) or ticagrelor (n=2580; 48.1%) in the setting of primary PCI from January 2011 to December 2018 in a nationwide registry. In-hospital outcomes were compared and multiple logistic regression analysis was performed. Prasugrel treated patients were younger, less often in cardiogenic shock, with lower rates of previous stroke and had shorter ischemic time. Both groups showed similar rates of previous MI, diabetes and current resuscitation. In the univariate analysis mortality was lower in patients with prasugrel (2.5% vs. 4.4% p<0.01). Similarly, MACE (3.3% vs. 5.3%, p<0.01) and NACE (4.0% vs. 5.7% p<0.01) were lower in prasugrel treated patients, whereas major bleeding events did not differ (0.4% vs. 0.6% p=0.24).

After adjustment in multivariable analysis mortality (0.99 95% CI 0.57 to 1.72), MACE (OR 0.99 95% CI 0.65 to 1.52) as well as NACE (0.86 95% CI 0.61 to 1.22) did not differ in patients treated with prasugrel compared to ticagrelor.

Conclusion

Patients treated with prasugrel showed improved outcomes compared to ticagrelor in a large cohort of primary PCI. However, after adjustment for confounders the Advantage of prasugrel in primary PCI did not persist.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Austrian Society of Cardiology

Mechanical circulatory support for cardiovascular complications in a young COVID-19 patient

Background: The current coronavirus (COVID‐19) pandemic is associated with severe pulmonary and cardiovascular complications.

Case presentation: This report describes a young patient with COVID‐19 without any comorbidity presenting with severe cardiovascular complications, manifesting with pulmonary embolism, embolic stroke, and right heart failure.

Conclusion: Management with short‐term mechanical circulatory support, including different cannulation strategies, resulted in a successful outcome despite his critical cardiovascular status.

Spectroscopy of short-lived radioactive molecules

Molecular spectroscopy offers opportunities for the exploration of the fundamental laws of nature and the search for new particle physics beyond the standard model1-4. Radioactive molecules-in which one or more of the atoms possesses a radioactive nucleus-can contain heavy and deformed nuclei, offering high sensitivity for investigating parity- and time-reversal-violation effects5,6. Radium monofluoride, RaF, is of particular interest because it is predicted to have an electronic structure appropriate for laser cooling6, thus paving the way for its use in high-precision spectroscopic studies. Furthermore, the effects of symmetry-violating nuclear moments are strongly enhanced5,7-9 in molecules containing octupole-deformed radium isotopes10,11. However, the study of RaF has been impeded by the lack of stable isotopes of radium. Here we present an experimental approach to studying short-lived radioactive molecules, which allows us to measure molecules with lifetimes of just tens of milliseconds. Energetically low-lying electronic states were measured for different isotopically pure RaF molecules using collinear resonance ionisation at the ISOLDE ion-beam facility at CERN. Our results provide evidence of the existence of a suitable laser-cooling scheme for these molecules and represent a key step towards high-precision studies in these systems. Our findings will enable further studies of short-lived radioactive molecules for fundamental physics research.

Liquid Chromatographic Method for Determination of Vanillin and Ethyl Vanillin in Imitation Vanilla Extract (Modification of AOAC Official Method 990.25): Collaborative Study

A collaborative study of a method for analysis of vanillin and ethyl vanillin in fortified and imitation vanilla flavors was performed. The method, which is an extension of AOAC Official Method 990.25, Vanillin, Vanillic Acid, p-Hydroxybenzaldehyde, and p-Hydroxybenzoic Acid in Vanilla Extract, Liquid Chromatographic Method, involves reversed-phase high-pressure liquid chromatography (LC) of the sample on a Cβ column with a water-methanol-acetic acid (89 + 10 + 1) mobile phase and UV detection at 254 nm. The method yields good recoveries of vanillin at 484 and 723 mg/100 mL and of ethyl vanillin from 37 to 400 mg/100 mL. For vanillin, repeatability (r) values were 8 mg/100 mL at a level of 155 mg/100 mL, 12 mg/100 mLat a level of 484 mg/100 mL, and 31 mg/100 mL at a level of 723 mg/100 mL. Reproducibility (R) values were 20 mg/100 mL, 55 mg/100 mL, and 137 mg/100 mL over the same range. For ethyl vanillin, r values were 2.4 mg/100 mL at a level of 37 mg/100 mL, 3.2 mg/100 mL at a level of 74 mg/100 mL, and 8.6 mg/100 mL at a level of 180 mg/100 mL. R values were 6.4 mg/100 mL, 5.4 mg/100 mL, and 22.0 mg/100 mL over the same range. AOAC Official Method 990.25 has been modified to include determination of ethyl vanillin in vanilla extract and artificial vanilla flavor.

P4572Lipoprotein(a) is not associated with survival after acute coronary syndromes

Aims

Lipoprotein(a) [Lp(a)] is associated with coronary artery disease in population studies, however studies on its predictive value in patients with established cardiovascular disease, in particular after acute coronary syndromes (ACS), are conflicting. The aim of this study was to investigate whether Lp(a) is associated with survival after ACS.

Methods and results

We analyzed 4469 consecutive patients that underwent coronary angiography for ACS. Lp(a) measurement at time of ACS was available in 1245 patients and median follow-up for cardiovascular and total mortality was 5.0 (IQR 3.2–8.0) years. 655 (52.6%) presented with ST-segment elevation myocardial infarction (STEMI), 424 (34.1%) with Non-ST-segment elevation myocardial infarction (NSTEMI) and 166 (13.3%) underwent coronary angiography for unstable angina. Cardiovascular mortality was 9.1% and total mortality was 15.7%. Patients were stratified into four groups to their Lp(a) levels. (≤15 mg/dL, >15–30 mg/dL, >30–60 mg/dL, and >60 mg/dL). Multivessel disease was significantly more common in patients with Lp(a) >60 mg/dL (p<0.05). Increased levels of Lp(a) were not associated with cardiovascular mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.0, respectively; p=0.69) and not with total mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.2, respectively; p=0.46).

Central Figure

Conclusion

Lp(a) levels at time of ACS were neither associated with cardiovascular nor with total mortality. Although Lp(a) has been shown to be associated with incidence of coronary artery disease, this study does not support any role of Lp(a) as a risk factor after ACS. This should be taken into account for development of outcome studies for agents targeting Lp(a) plasma levels.

P5627Automated detection of calcified plaques in coronary optical coherence tomography images using image segmentation based on machine learning

Background and aim

Automated image recognition based on machine learning methods was proven to be feasible in several medical imaging applications recently. Beside image classification methods to categorize input images for example into healthy or suspicious, image segmentation allows accurate localization of pathologies and thereby facilitates a wide area of applications. Because of the unique composition of every machine learning problem the applicability of image segmentation methods for detecting coronary pathologies in optical coherence tomography images remains unclear. Furthermore, the prediction accuracy of deep learning methods usually depends on vast amounts of training data which are often not available for particular medical questions. Therefore special strategies need to be applied to achieve satisfying results with smaller training datasets. We aimed to investigate the applicability of machine learning methods for plaque detection in coronary OCT images, especially considering the challenge of a small training dataset.

Methods

Originating from a dataset of 104 OCT frames containing calcified plaques, we performed image preprocessing using a custom build OCT image processing software to crop the luminal part as well as the areas outside the circular OCT signal to reduce entropy. Furthermore, plaques were identified and marked by an experienced OCT analyst, drawing plaque-enclosing polygonal masks using the same software. We also performed common image augmentation strategies, primarily applying rotation and zoom operations. Subsequently, we split the samples randomly into training, validation and test datasets (80:10:10%). To train the segmentation model, we fed the training and validation samples into an U-Net Convolutional Neuronal Network implementation with domain-specific adaptions using the RMSprop optimizer based on the publicly available PyTorch library.

Results

After 50 training epochs, we could achieve a prediction accuracy of 74.4% with the current configuration measured by the Sørensen–Dice coefficient comparing the similarity of the predicted plaque masks with the ground truth samples (figure 1 illustrates an exemplary comparison between predicted and ground truth plaque masks).

Exemplary projection of a predicted mask

Conclusion

We were able to show that image segmentation based on machine learning strategies is a feasible way for automated plaque detection in coronary OCT imaging even based on small training datasets. Larger training datasets are necessary to raise prediction accuracy.

C-06 Differential and Dual Diagnosis of Alzheimer’s Disease and Personality Disorders: Performance on WAIS-IV Subtests

Objective

Certain personality disorder (PD) diagnoses are related to the development of dementing disorders. There is a higher rate of comorbidity of PD in samples of patients with dementing disorders compared to healthy controls, which can lead to difficulties during the diagnostic process. The present study seeks to identify the neurocognitive correlates of those diagnosed with Alzheimer’s dementia (AD) compared to PD, potentially aiding in differential diagnosis.

Method

Data was collected as part of a large assessment outpatient clinical practice. The data contained 580 participants who came to the clinic with a variety of referral questions (e.g., neurological diagnosis, personality functioning, ADHD assessment). To measure cognitive functioning, participants were administered the WAIS-IV. Participants included 43 people diagnosed with AD and 18 with PD.

Results

Subtest scores for participants diagnosed with AD were lower than participants with PD. We adjusted the mean level difference using vocabulary. Using regression, we pulled out the variance associated with vocabulary as it is not susceptible to cognitive decline. Block design was significantly different for the two groups even after controlling for vocabulary (r-square = .06; p = .017). Matrix reasoning was significantly different for the two groups even after controlling for vocabulary (r-square = .09; p = .005).

Conclusions

The differential diagnosis of PD and dementing disorders is important, and thus these findings are important in beginning to understand the cognitive patterns in those with AD and PD. Past research has not controlled for intellectual functioning. However, additional research utilizing larger sample sizes and an extensive test battery is necessary.

C-11 Neurocognitive Differences in Alzheimer’s Dementia Compared to Healthy Controls on the WAIS-IV

Objective

The present study seeks to identify neurocognitive patterns of those diagnosed with Alzheimer’s dementia (AD) compared to those with no diagnosis (ND), potentially aiding in the diagnostic process. Previous research found visuospatial differences, but on previous versions of the WAIS.

Method

Participants (n = 580) were referred to a large assessment outpatient clinic with a variety of presenting problems, such as neurological diagnosis, personality functioning, and ADHD assessment. To measure cognitive functioning, participants were administered the WAIS-IV. Participants included individuals diagnosed with AD (n = 43) and those with ND (n = 40).

Results

Subtest scores for those diagnosed with AD were lower than participants with ND. We adjusted the mean level difference using vocabulary (VC). Using regression, variance associated with VC was pulled out, as it is not susceptible to cognitive decline. Both Matrix Reasoning (MR) (r-square = .04; p =.001) and Digit Span (DS) (r-square = .04; p = .001) were significantly different for the two groups even after controlling for VC. Block Design (BD) was not significantly different (p = 0.07).

Conclusions

While previous research indicates patterns of visuospatial difficulties in neurocognitive functioning among those with AD, the current findings suggest impairments in perceptual reasoning and working memory. Previous research also suggests that BD predicts AD. However, the current study indicates MR and DS predicts AD, whereas BD does not. While these results may be due to small sample size, this study did control for intellectual functioning. Additional research involving an extensive test battery is needed to further examine these findings.

Enantioselective fragmentation of an achiral molecule in a strong laser field

Chirality is omnipresent in living nature. On the single molecule level, the response of a chiral species to a chiral probe depends on their respective handedness. A prominent example is the difference in the interaction of a chiral molecule with left or right circularly polarized light. In the present study, we show by Coulomb explosion imaging that circularly polarized light can also induce a chiral fragmentation of a planar and thus achiral molecule. The observed enantiomer strongly depends on the orientation of the molecule with respect to the light propagation direction and the helicity of the ionizing light. This finding might trigger new approaches to improve laser-driven enantioselective chemical synthesis.

Pilot testing of an online training module about screening for acute HIV infection in adult patients seeking urgent healthcare

BACKGROUND

Acute HIV infection (AHI) is the phase of HIV infection immediately after acquisition, during which many patients develop symptoms and often seek healthcare. However, clinicians in sub-Saharan Africa are not currently taught about AHI.

METHODS

This study pilot-tested a self-directed AHI training module among clinical officers (COs) in coastal Kenya and assessed knowledge gained and challenges to instituting screening. The training module included four domains: AHI definition and importance of AHI recognition; symptoms and screening algorithms; diagnostic strategies; and management. AHI knowledge was assessed before and immediately after training. Participants' ability to utilize an AHI screening algorithm was evaluated with a case-based exercise.

RESULTS

Self-directed training was completed by 45 COs. Pre-test scores were low (median score 35% IQR 30-45%), but improved significantly after training (median post-test score 75%, IQR 70-85%, Wilcoxon signed-rank test p<0.0001). Participants had challenges in understanding the utility and application of a screening algorithm to identify patients for whom AHI testing would be indicated. Knowledge of AHI was poor at baseline, but improved with self-directed learning. Based on these findings, we revised and improved the AHI training module and pre- and post-assessments, which are now freely available online at www.marps-africa.org.

CONCLUSIONS

Guidelines on AHI screening and diagnosis are urgently needed in high HIV transmission areas.

Absolute ion detection efficiencies of microchannel plates and funnel microchannel plates for multi-coincidence detection

Modern momentum imaging techniques allow for the investigation of complex molecules in the gas phase by detection of several fragment ions in coincidence. For these studies, it is of great importance that the single-particle detection efficiency ε is as high as possible, as the overall efficiency scales with εⁿ, i.e., the power of the number of detected particles. Here we present measured absolute detection efficiencies for protons of several micro-channel plates (MCPs), including efficiency enhanced "funnel MCPs." Furthermore, the relative detection efficiency for two-, three-, four-, and five-body fragmentation of CHBrClF has been examined. The "funnel" MCPs exhibit an efficiency of approximately 90%, gaining a factor of 24 (as compared to "normal" MCPs) in the case of a five-fold ion coincidence detection.

The Effects of Low-Dose Endotoxin on the Umbilicoplacental Circulation in Preterm Sheep

OBJECTIVE

In the present study we examined the effects of low-dose endotoxin (lipopolysaccharides, LPS) on continuously recorded umbilical blood flow.

METHODS

Twenty fetal sheep were catheterized at a gestational age of 107 +/- 1 days. A flow probe was placed around either the common umbilical artery or one single umbilical artery. Three days later fetuses received either 100 or 500 nanograms of LPS (n = 14) or 2 mL saline (n = 6) intravenously. Six fetuses died within 12 hours after LPS. Fetal heart rate (FHR), mean arterial pressure (MAP), and umbilical blood flow (Q(umb)) were monitored for 3 days.

RESULTS

FHR increased by 25 +/- 4% at 4-5 hours after LPS (P <.01) and was elevated for 15 hours after LPS. MAP increased by 18 +/- 5% 1 hour after LPS (P <.01) and returned to control value 4-5 hours after LPS. Q(umb) began to decrease 1 hour after LPS and was minimal (-30 +/- 7%, P <.001) at 4-5 hours after LPS. Q(umb) slowly returned to the control value at 12 hours after LPS. Placental vascular resistance increased by 73 +/- 37% (P <.01), whereas pH did not appreciably change.

CONCLUSION

Intravenous application of endotoxin caused a substantial and long-lasting decrease in umbilical blood flow resulting in fetal hypoxemia without acidemia. These effects may be of significance in the development of fetal brain damage associated with intrauterine infection.