Swiss residents' speciality choices--impact of gender, personality traits, career motivation and life goals

BACKGROUND: The medical specialties chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical specialty. METHODS: As part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what specialty they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance. RESULTS: In their fourth year of residency 439 (84.1%) participants had made their specialty choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialties, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialties. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialties; the other specialties did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on specialty choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals. CONCLUSION: Gender had the greatest impact on specialty and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored.

Development and simultaneous application of multiple care protocols in critical care: a multicenter feasibility study

OBJECTIVE: To test the feasibility of and interactions among three software-driven critical care protocols. DESIGN: Prospective cohort study. SETTING: Intensive care units in six European and American university hospitals. PATIENTS: 174 cardiac surgery and 41 septic patients. INTERVENTIONS: Application of software-driven protocols for cardiovascular management, sedation, and weaning during the first 7 days of intensive care. MEASUREMENTS AND RESULTS: All protocols were used simultaneously in 85% of the cardiac surgery and 44% of the septic patients, and any one of the protocols was used for 73 and 44% of study duration, respectively. Protocol use was discontinued in 12% of patients by the treating clinician and in 6% for technical/administrative reasons. The number of protocol steps per unit of time was similar in the two diagnostic groups (n.s. for all protocols). Initial hemodynamic stability (a protocol target) was achieved in 26+/-18 min (mean+/-SD) in cardiac surgery and in 24+/-18 min in septic patients. Sedation targets were reached in 2.4+/-0.2h in cardiac surgery and in 3.6 +/-0.2h in septic patients. Weaning protocol was started in 164 (94%; 154 extubated) cardiac surgery and in 25 (60%; 9 extubated) septic patients. The median (interquartile range) time from starting weaning to extubation (a protocol target) was 89 min (range 44-154 min) for the cardiac surgery patients and 96 min (range 56-205 min) for the septic patients. CONCLUSIONS: Multiple software-driven treatment protocols can be simultaneously applied with high acceptance and rapid achievement of primary treatment goals. Time to reach these primary goals may provide a performance indicator.

Opportunities and limits of the ecosystem services framework in capturing the cultural dimension of sustainable regional and landscape development in protected areas

With regard to protected areas, the concepts of ecosystem services and the cultural dimension of sustainable development (SD) are increasingly under debate. This contribution analyses the role of cultural aspects within the ecosystem services framework using the Millennium Ecosystem Assessment classification as a reference. The limits of the ecosystem services framework in capturing the cultural dimension are highlighted. Potential ways of strengthening the position of cultural values within this framework are discussed.

Solar forcing of North Atlantic surface temperature and salinity over the past millennium

There were several centennial-scale fluctuations in the climate and oceanography of the North Atlantic region over the past 1,000 years, including a period of relative cooling from about AD 1450 to 1850 known as the Little Ice Age1. These variations may be linked to changes in solar irradiance, amplified through feedbacks including the Atlantic meridional overturning circulation2. Changes in the return limb of the Atlantic meridional overturning circulation are reflected in water properties at the base of the mixed layer south of Iceland. Here we reconstruct thermocline temperature and salinity in this region from AD 818 to 1780 using paired δ18O and Mg/Ca ratio measurements of foraminifer shells from a subdecadally resolved marine sediment core. The reconstructed centennial-scale variations in hydrography correlate with variability in total solar irradiance. We find a similar correlation in a simulation of climate over the past 1,000 years. We infer that the hydrographic changes probably reflect variability in the strength of the subpolar gyre associated with changes in atmospheric circulation. Specifically, in the simulation, low solar irradiance promotes the development of frequent and persistent atmospheric blocking events, in which a quasi-stationary high-pressure system in the eastern North Atlantic modifies the flow of the westerly winds. We conclude that this process could have contributed to the consecutive cold winters documented in Europe during the Little Ice Age.

Adaptation of career goals to self and opportunities in early adolescence

Development of career goals that are adapted to self and opportunities is a central component of adolescent career preparation. The present longitudinal study (conducted throughout the eighth grade with three assessment points) investigated how 330 Swiss adolescents simultaneously adapt career goals to interests, scholastic achievement and environmental opportunities. Results demonstrated that students increasingly adapt their goals to the environment. Mean adaptation to environment related positively to degree of adaption to interests and achievement. Increased adaptation to environment over time related to increased adaptation to achievement but to decreased adaptation to interests. Gender, attended school type and nationality moderated adaptation processes. Structurally disadvantaged students (girls, lower requirements school track, immigrant students) reported more conflict in aligning adaptation to environment with adaptation to interests.

Monitoring the temporal development of natural hazard risks as a basis indicator for climate change adaptation.

The potential effects of climatic changes on natural risks are widely discussed. But the formulation of strategies for adapting risk management practice to climate changes requires knowledge of the related risks for people and economic values. The main goals of this work were (1) the development of a method for analysing and comparing risks induced by different natural hazard types, (2) highlighting the most relevant natural hazard processes and related damages, (3) the development of an information system for the monitoring of the temporal development of natural hazard risk and (4) the visualisation of the resulting information for the wider public. A comparative exposure analysis provides the basis for pointing out the hot spots of natural hazard risks in the province of Carinthia, Austria. An analysis of flood risks in all municipalities provides the basis for setting the priorities in the planning of flood protection measures. The methods form the basis for a monitoring system that periodically observes the temporal development of natural hazard risks. This makes it possible firstly to identify situations in which natural hazard risks are rising and secondly to differentiate between the most relevant factors responsible for the increasing risks. The factors that most influence the natural risks could be made evident.

Between Conservation and Development: Concretizing the First World Natural Heritage Site in the Alps Through Participatory Processes

This article presents an empirical interdisciplinary study of an extensive participatory process that was carried out in 2004 in the recently established World Natural Heritage Site “Jungfrau–Aletsch– Bietschhorn” in the Swiss Alps. The study used qualitative and quantitative empirical methods of social science to address the question of success factors in establishing and concretizing a World Heritage Site. Current international scientific and policy debates agree that the most important success factors in defining pathways for nature conservation and protection are: linking development and conservation, involving multiple stakeholders, and applying participatory approaches. The results of the study indicate that linking development and conservation implies the need to extend the reach of negotiations beyond the area of conservation, and to develop both a regional perspective and a focus on sustainable regional development. In the process, regional and local stakeholders are less concerned with defining sustainability goals than elaborating strategies of sustainability, in particular defining the respective roles of the core sectors of society and economy. However, the study results also show that conflicting visions and perceptions of nature and landscape are important underlying currents in such negotiations. They differ significantly between various stakeholder categories and are an important cause of conflicts occurring at various stages of the participatory process.

Treatment Goals in Diabetes.

The quality of glycaemic control in diabetes mellitus relies on accurate individualization of available treatment options. Treatment targets depend on the type and duration of diabetes, the patients' abilities and characteristics and the individual risk for acute and/or late-stage complications. These complications include hypoglycaemia, which can be severe and life threatening, hyperglycaemia, which is a main factor for the development of cardiovascular disease, and macrovascular and microvascular disease, both of which are hallmark features of diabetes-associated constraints. Moreover, other treatment goals in diabetic patients influence both glycaemic control and quality of life. Lipoproteins, blood pressure, weight control, mental health and lifestyle are important factors that contribute to the frequency of diabetes-associated complications.

Real-time analysis of δ13C- and δD-CH4 in ambient air with laser spectroscopy: method development and first intercomparison results

In situ and simultaneous measurement of the three most abundant isotopologues of methane using mid-infrared laser absorption spectroscopy is demonstrated. A field-deployable, autonomous platform is realized by coupling a compact quantum cascade laser absorption spectrometer (QCLAS) to a preconcentration unit, called trace gas extractor (TREX). This unit enhances CH4 mole fractions by a factor of up to 500 above ambient levels and quantitatively separates interfering trace gases such as N2O and CO2. The analytical precision of the QCLAS isotope measurement on the preconcentrated (750 ppm, parts-per-million, µmole mole−1) methane is 0.1 and 0.5 ‰ for δ13C- and δD-CH4 at 10 min averaging time. Based on repeated measurements of compressed air during a 2-week intercomparison campaign, the repeatability of the TREX–QCLAS was determined to be 0.19 and 1.9 ‰ for δ13C and δD-CH4, respectively. In this intercomparison campaign the new in situ technique is compared to isotope-ratio mass spectrometry (IRMS) based on glass flask and bag sampling and real time CH4 isotope analysis by two commercially available laser spectrometers. Both laser-based analyzers were limited to methane mole fraction and δ13C-CH4 analysis, and only one of them, a cavity ring down spectrometer, was capable to deliver meaningful data for the isotopic composition. After correcting for scale offsets, the average difference between TREX–QCLAS data and bag/flask sampling–IRMS values are within the extended WMO compatibility goals of 0.2 and 5 ‰ for δ13C- and δD-CH4, respectively. This also displays the potential to improve the interlaboratory compatibility based on the analysis of a reference air sample with accurately determined isotopic composition.

Making the most of world natural heritage - linking conservation and sustainable regional development?

Today, more than 1000 World Heritage (WH) sites are inscribed on UNESCO’s list, 228 of which are natural and mixed heritage sites. Once focused primarily on conservation, World Natural Heritage (WNH) sites are increasingly seen as promoters of sustainable regional development. Sustainability-oriented regions, it is assumed, are safeguards for conservation and positively influence local conservation goals. Within UNESCO, discussions regarding the integration of sustainable development in official policies have recently gained momentum. In this article, we investigate the extent to which WNH sites trigger sustainability-oriented approaches in surrounding regions, and how such approaches in turn influence the WNH site and its protection. The results of the study are on the one hand based on a global survey with more than 60% of the WNH sites listed in 2011, and on the other hand on a complementary literature research. Furthermore, we analyze the policy framework necessary to support WNH sites in this endeavor. We conclude that a regional approach to WNH management is necessary to ensure that WNH sites support sustainable regional development effectively, but that the core focus of WNH status must remain environmental conservation.

Carbon dioxide emissions and international trade at the turn of the millennium

We present a new dataset of geographical production-, final (embodied) production-, and consumption-based carbon dioxide emission inventories, covering 78 regions and 55 sectors from 1997 to 2011. We extend previous work both in terms of time span and in bridging from geographical to embodied production and, ultimately, to consumption. We analyse the recent evolution of emissions, the development of carbon efficiency of the global economy, and the role of international trade. As the distribution of responsibility for emissions across countries is key to the adoption and implementation of international environmental agreements and regulations, the final production- and consumption-based inventories developed here provide a valuable extension to more traditional geographical production-based criteria.