RESEARCH OF THE GERMAN AUTOMOTIVE INDUSTRY

The title of the following research is “Research of the German automotive industry”. The German automotive industry and its well-being and growth is a key sector of the German economy. Therefore it is of importance to analyse this industry. The aim of this research is to provide an analysis of the German automotive industry and its growth. The tasks to achieve the set aim are as follows: turnover, production of motor vehicles and passenger and the strategy of internalization of the German automotive industry. The primary methods used in this research are: logically constructive method, analysis, descriptive method, document study and descriptive statistical methods. Based on these methods the turnover, production of motor vehicles and passenger and the strategy of internalization of the German automotive industry is analysed. This research shows that the German automotive industry constitutes a growth industry between 2005 and 2015. Furthermore, it shows the importance of the strategy of internalization of the German automotive industry for its growth: the two-pillar strategy which consists of production on site an export. Due to the fact that the export numbers are stagnating on a high level in recent years the future focus of the German automotive industry should be set on the production abroad

LATVIA AS A TOURISM DESTINATION FOR GERMAN TOURISTS

The German source market offers a high potential for the Latvian tourism industry. This paper provides an analysis of the German outgoing tourism which allows evaluating how good the Latvian tourism market can satisfy the needs of the German outgoing tourists. This research study assesses the conformity between the needs of German travellers and the Latvian tourism offers. The methods used in this research study are as follows: evaluation and analysis of surveys, content analysis, graphical analysis and synthesis, logical and abstract constructive methods, reference methods

Hovering

Hovering is an attempt to navigate the contemporary digital environment through traditional means. The imagery created function as paintings, photographs, prints, and drawings. They explore and raise questions about visual perception and sensory awareness, as well as highlighting the modular limitations of the pixelated image and the illusion of reality in the digital landscape

A Pilot and Feasibility Study of Virtual Reality Guided Meditations in First-Year Medical Students

Virtual reality (VR) is a popular technology that places users in an interactive 3D environment. VR has been used to enhance surgery training, rehabilitation of brain injury survivors, and telepsychiatry. Our aim for this study is to assess the perception of first-year medical students on the value of a VR meditation program on stress reduction, both immediate and longer term. We recruited 10 volunteer participants. Each participant completed a guided meditation using a commercially available VR headset paired with a meditation app and oximeter that calculates a heart rate variability (HRV) index. Each meditation was five minutes long and participants were asked to do the exercise once a day for five consecutive days. Participants completed surveys before and after each meditation exercise. Additionally, a follow-up survey was administered two months later. Of the 10 participants, seven completed the five-minute meditation exercises for five consecutive days; three performed the exercise for four consecutive days. Every participant except one completed all of the required surveys (1-7 scale, 7 high). Participants gave their stress level before each meditation, reporting a mean score of 4; after each meditation, the average stress score decreased to 3.3. On the last day, seven participants (78%) reported a decrease in overall stress; two (22%) reported no change. Over the course of the study, the average HRV index increase was 10%. During the two-month follow-up, six (60%) volunteers reported a decrease in their overall stress compared to seven (78%) on the last day of the study. When asked about the usefulness of the intervention on managing stress, participants reported an average score of 6.0—a slight increase from the rating of 5.6 given before beginning the study. Participants perceived that the VR program decreased their stress levels in the short and longer term—after each five-minute VR exercise, at the end of the five-day study and during the two-month follow-up. Their favorable perception of the usefulness of breathing exercises prior to the study, relatively high to begin with, stayed steady for two months post-intervention. Their perception that the intervention is useful for stress reduction is objectively supported by the increased HRV index, which current research shows is positively correlated with mental and physical health

Resource to Develop Medical Students into Peer Mentors

The primary goal of the Peer Mentoring Guide is to develop fourth year medical students (MS-4s) into mentors for first year medical students (MS-1s). The purpose of this resource is to provide others who want to develop a peer mentoring program as part of an advanced students-as-teachers curriculum. The George Washington University was one of the first schools to have a program to prepare medical students for their teaching role as residents and practicing physicians, which was called TALKS (Teaching and Learning Knowledge and Skills). We recently recognized that some participants were interested in going beyond the boundaries of the program to learn advanced teaching skills. Thus, we created an Advanced TALKS program to meet this demand. Peer mentoring was the primary focus for the Advanced TALKS program. For this program we developed the Peer Mentoring Guide presented here for others to use as a resource. There has been increasing recognition of the need to prepare medical students for their teaching role as residents and practicing physicians.1 In one review of the literature, 39 programs were identified where students were trained to be teachers. The roles taken on by the student teacher included portraying standardized patients, tutoring students in academic trouble, teaching clinical skills, simulating a learner, administering an elective course, and teaching peers. Though a recent survey of US medical schools documented 43 formal programs in the 99 schools that responded to the survey, almost all of the other schools had informal programs.2 In addition, there is a growing literature on the value of near peer teaching programs.1,2,3 The course was piloted at our institution with a small group of MS4s (N=5). Although MS4s are a select group and this limits the numbers, the intention was to provide an educational experience that went beyond the general education elective at GWU (the TALKS course) to individuals who wanted more. We created the mentoring program for those students with further interest as an addition to their current curriculum. Over the course of an academic year, the students all completed 2 workshops and then a longitudinal mentoring experience with first year medical students. The primary goal of the Peer Mentoring Guide is to develop fourth year medical students (MS-4s) into mentors for first year medical students (MS-1s). The purpose of this resource is to provide others who want to develop a peer mentoring program as part of an advanced students-as-teachers curriculum. The George Washington University was one of the first schools to have a program to prepare medical students for their teaching role as residents and practicing physicians, which was called TALKS (Teaching and Learning Knowledge and Skills). We recently recognized that some participants were interested in going beyond the boundaries of the program to learn advanced teaching skills. Thus, we created an Advanced TALKS program to meet this demand. Peer mentoring was the primary focus for the Advanced TALKS program. For this program we developed the Peer Mentoring Guide presented here for others to use as a resource. There has been increasing recognition of the need to prepare medical students for their teaching role as residents and practicing physicians.1 In one review of the literature, 39 programs were identified where students were trained to be teachers. The roles taken on by the student teacher included portraying standardized patients, tutoring students in academic trouble, teaching clinical skills, simulating a learner, administering an elective course, and teaching peers. Though a recent survey of US medical schools documented 43 formal programs in the 99 schools that responded to the survey, almost all of the other schools had informal programs.2 In addition, there is a growing literature on the value of near peer teaching programs.1,2,3 The course was piloted at our institution with a small group of MS4s (N=5). Although MS4s are a select group and this limits the numbers, the intention was to provide an educational experience that went beyond the general education elective at GWU (the TALKS course) to individuals who wanted more. We created the mentoring program for those students with further interest as an addition to their current curriculum. Over the course of an academic year, the students all completed 2 workshops and then a longitudinal mentoring experience with first year medical students

Antioxidant Programs Are Essential for Enzalutamide-Resistant Prostate Cancer

Therapy resistance to second generation androgen receptor (AR) antagonists, such as enzalutamide, is common in patients with advanced prostate cancer (PCa). In order to identify which patients will develop therapy resistance and the underlying cause, it is critical to characterize detailed mechanisms of resistance to improve patient outcomes. To identify the metabolic alterations involved in enzalutamide resistance, we performed metabolomic, transcriptomic, and cistromic analyses of enzalutamide-sensitive and -resistant PCa cells, xenografts, patient-derived organoids, patient-derived explants, and tumors. We noted that enzalutamide-resistant PCa cells and castration-resistant PCa (CRPC) tumors had dramatically higher levels of both basal and inducible levels of reactive oxygen species (ROS) than either enzalutamide-sensitive PCa cells or primary therapy-naïve tumors, respectively. Unbiased metabolomic evaluation identified that glutamine metabolism was consistently upregulated in enzalutamide-resistant PCa cells and CRPC tumors. Stable isotope tracing studies suggest that this enhanced glutamine metabolism drives an antioxidant program that allows these cells to tolerate higher basal levels of ROS. Inhibition of glutamine metabolism with either a small-molecule glutaminase inhibitor or genetic knockout blocked this antioxidant pathway, further enhanced ROS levels, and blocked the growth of enzalutamide-resistant PCa. The critical role of the compensatory antioxidant pathways in maintaining enzalutamide-resistant PCa cells was further validated by targeting another antioxidant program driver, ferredoxin 1. Taken together, our data identify a metabolic need to maintain antioxidant programs and a potentially targetable metabolic vulnerability in enzalutamide-resistant PCa

A Model for a Structured Clinical Development Program for First-Year Residents: Utilizing the Entrance OSCE, Individualized Learning Plans (ILPs), and Peer Clinical Coaching

Identification of incoming residents’ unique strengths and weaknesses in a clinical setting is important for developing an individualized educational curriculum and ultimately addressing specific needs. This resource presents and describes materials for a clinical development program for first year residents. The program is structured around three educational elements: an entrance Objective Structured Clinical Examination (OSCE), Individualized Learning Plan (ILP), and peer clinical coaching. The included files, which describe these three elements, are intended to serve as a resource for residency directors and/or graduate medical education faculty interested in constructing a similar program. In the described clinical development program, first-year Obstetrics and Gynecology residents participated in an entrance OSCE as a component of their orientation to residency. Their performance was evaluated through Faculty and Self-assessment tools and scored on a nine-point scale in accordance with the ACGME core competency scoring evaluation system. These evaluations were utilized in the creation of ILPs. Stated goals were translated into discrete learning objectives and then developed further through a learning strategy and timeline using the SMART model. As a component of a research study, first-year residents were randomized into one of two groups: clinical coaching group or individual implementation group. Senior resident volunteers served as peer clinical coaches after participating in a two-hour interactive workshop. The peer clinical coaches met with first-year residents on a monthly basis for four months to develop the resident’s ILP. Exit questionnaires were completed at the conclusion of the year-long program. The OSCE is a well-utilized tool to ensure direct observation, evaluate clinical performance in a simulated environment, and provide timely feedback. Another potential application of the OSCE is to provide a baseline evaluation of clinical performance that may be utilized in determining a starting point for clinical competencies. Utilizing the feedback from the OSCE to create an ILP may translate valuable feedback into measurable objectives and competencies, while also providing a model for reassessment and follow up. While the OSCE and the faculty mentored ILP have been well characterized in the literature, the concept of clinical coaching is relatively novel to medicine. Teaching and coaching differ in that teachers disseminate knowledge whereas coaches ensure performance. Seeking to elaborate on this relatively novel paradigm, we sought to characterize how resident’s global clinical experience was affected within this working model. Despite time constraints, both first-year residents and peer clinical coaches reported that clinical coaching improved their clinical experience. A structured clinical program incorporating an entrance OSCE, ILP, and peer clinical coaching holds promise in documentation of milestones and promoting life-long learning. AAMC MedEdPORTAL publication ID 10084. Link to original

Exploring Standardized Patients’ Perspectives on Working with Medical Students

Little is known about how working with emerging medical professionals affects Standardized Patients’ (SPs’) professional identities, yet understanding the SP-medical student interaction could be useful for screening SPs, supporting SP professional identity formation, and bridging the SP and medical student cultures. This project provides the unique perspective of SPs involved in the growth of medical students into physicians. Qualitative methods were used to understand the SPs’ perspectives. Two researchers, without evaluative relationships with the SPs, conducted 2 one-hour focus group interviews (n=3; n=9) using a semi-structured interview protocol. Interviews were audio-recorded and transcribed verbatim. Three researchers independently analyzed the transcripts to identify clusters of meaning and codes. Codes identified by consensus and analysis continued until saturation was reached, followed by identification of categories and themes. To ensure credibility and trustworthiness of the results, investigators used triangulation of methods and researchers, prolonged engagement with the data, and presentation of thick rich descriptions as evidence of each theme. A number of themes were identified in these focus group interviews. SPs experienced a transformation of purpose and the emergence of a new professional identity, including genuine professional, guide, teacher, counselor and surrogate parent. They discovered personal meaning and mutuality in their relationships with students, like the satisfaction of helping others, benefiting society, and growing personally. SPs found themselves reacting to student behaviors in a variety of ways including admiration, dislike, surprise, and discomfort. Finally, SPs confronted challenges in moving between their simulated and real selves. This analysis provided insights into transformations SPs underwent as a result their work. It revealed a self-actualization process in which SPs experienced an emergence of new roles and a discovery of new meaning in their relationships similar to the professional identity formation process of students. Understanding this process may prove useful to SP educators in knowing how to best nurture identity, train SPS, reinforce job meaningfulness and increase SP recruitment and retention. SP perspectives about their students’ behaviors may be useful to SP educators in acclimatizing them to the simulation process

Interdisciplinary Workshop Using Applied Models to Increase Collaboration and Satisfaction between Medical Students and Standardized Patient Instructors

In an article published in 1993 by Shulman about higher education it was stated that, Teaching takes practice. It takes feedback. It takes instruction. More and more we are becoming aware of that. There has been increasing recognition of the need to prepare medical students for their future teaching roles as intern/residents and physicians. There have been numerous publications addressing peer teaching in undergraduate education, but sparse literature addressing how medical students co-teach physical diagnosis to pre-clinical students in lieu of faculty. Traditionally in North America, full-time faculty members have assumed the major responsibility for teaching first- and second-year medical students physical examination skills. This historic model has its barriers, as recruiting busy faculty without compensation is a problem as is the lack of standardization of teaching content from one faculty member to another. To address these issues, we introduced the concept of Standardized Patient Instructors (SPIs) joining with fourth year medical students (MS-4s) to teach physical examination skills to the first-year medical students (MS-1s) in 2010. The SPIs were trained to teach physical examination maneuvers in a standardized fashion while the MS-4s were in charge of overseeing the MS-1s practice these skills and providing relevant clinical context to the maneuvers. The George Washington University is the first reported school to have such an interdisciplinary program. It has been shown in the literature that with appropriately motivated and mentored senior students, successful courses could be created to meet educational requirements at educational institutions with available resources. Recognizing that some individuals were interested in learning advanced teaching skills and could be used as a valuable asset to teaching alongside appropriate faculty, our goal was to create a program utilizing motivated students and provide a framework that could be implemented in other institutions. The multidisciplinary program was successfully implemented into the curriculum, but not without some unforeseen problems. SPI and MS-4 feedback after the first iteration of this course in the 2010-2011 cycle was fraught with confusion about what were the roles of each group, how the sessions were supposed to run, who assumed a leadership role in the group interaction, and how evaluation was to take place. It was from this feedback that theoretical constructs were examined to help improve the program; namely, the GRPI model and Mezirow\u27s Transformative learning theory. AAMC MedEdPORTAL publication ID 4152. Link to original

Interdisciplinary Workshop to Increase Collaboration Between Medical Students and Standardized Patient Instructors in Teaching Physical Diagnosis to Novices

Traditionally, full-time faculty members have assumed major responsibility for teaching physical examination skills to first- and second-year medical students. Problems with faculty recruitment and adhering to a standardized way of teaching have challenged educators to seek alternatives to teaching the physical examination to novices. To address these problems, we created and implemented a novel curriculum that has standardized the teaching of physical examination skills to novice students by using standardized patient instructors and fourth-year medical students working as an interdisciplinary team (known as a dyad). Feedback after the first iteration of this course revealed confusion about roles, goals, and responsibilities for feedback and evaluation amongst the dyads. To address these issues, an interdisciplinary workshop was created using the theoretical constructs of the GRPI (goals, roles and responsibilities, process, and interpersonal skills) model and Mezirow’s transformative learning theory, both of which address gaps in the dyad relationship. Initial feedback from fourth-year students and standardized patient instructors was enthusiastically positive. Evidence showed the dyad could be strengthened by (1) providing time to learn the theoretical scaffolding underlying working together, (2) meeting and planning approaches to teaching efforts, and (3) enabling medical students and standardized patient instructors to apply the theoretical constructs as the foundation to reflect on their teaching roles in effectively instructing novices in physical exam skills