Incremental value of heart-type fatty acid-binding protein in suspected acute myocardial infarction early after symptom onset.

BACKGROUND The early diagnosis of acute myocardial infarction (AMI) very soon after symptom onset remains a major clinical challenge, even when using high-sensitivity cardiac troponin (hs-cTnT). METHODS AND RESULTS We investigated the incremental value of heart-type fatty acid-binding protein (hFABP) in a pre-specified subgroup analysis of patients presenting with suspected AMI within 1 h of symptom onset to the emergency department (ED) in a multicentre study. HFABP was measured in a blinded fashion. Two independent cardiologists using all available clinical information, including hs-cTnT, adjudicated the final diagnosis. Overall, 1411 patients were enrolled, of whom 105 patients presented within 1 h of symptom onset. Of these, 34 patients (32.4%) had AMI. The diagnostic accuracy as quantified by the area under the receiver-operating characteristics curve (AUC) of hFABP was high (0.84 (95% CI 0.74-0.94)). However, the additional use of hFABP only marginally increased the diagnostic accuracy of hs-cTnT (AUC 0.88 (95% CI 0.81-0.94) for hs-cTnT alone to 0.90 (95% CI 0.83-0.98) for the combination; p=ns). After the exclusion of 18 AMI patients with ST-segment elevation, similar results were obtained. Among the 16 AMI patients without ST-segment elevation, six had normal hs-cTnT at presentation. Of these, hFABP was elevated in two (33.3%) patients. CONCLUSIONS hFABP does not seem to significantly improve the early diagnostic accuracy of hs-cTnT in the important subgroup of patients with suspected AMI presenting to the ED very early after symptom onset.

Treeline Fluctuations Recorded for 12,500 Years by Soil Profiles, Pollen, and Plant Macrofossils in the Central Swiss Alps

Past treelines can rarely be recorded by pollen percentages alone, but pollen concentration, pollen influx, and plant macrofossils (including stomata of conifers) are more reliable indicators. In addition, ancient forest soils above today's treeline may trace the maximum upper expansion of the forest since the last glaciation. Charcoal in such soil profiles may be radiocarbon dated. Our example from the Central Swiss Alps at the Alpe d'Essertse consists of a plant-macrofossil diagram and pollen diagrams of the pond Gouille Rion at 2343 m a.s.l. and a sequence of soil profiles from 1780 m to 2600 m a.s.l. The area around the pond was forested with LariJc decidua and Pinus cembra between 9500 and 3600 BP. After 4700 BP the forest became more open and Juniperus nana and Alnus viridis expanded (together with Picea abies in the subalpine forest). Between 1700 and 900 BP the Juniperus nana and Alnus viridis scrubs declined while meadows and pastures took over, so that the pond Gouille Rion was definitively above timber­ line. The highest Holocene treeline was at 2400 to 2450 m a.s.l. (i.e. 50 to 100 m higher than the uppermost single specimen of Pinus cembra today) between 9000 and 4700 BP, but it is not yet dated in more detail. The highest charcoal of Pinus cembra at 2380 m a.s.l. has a radiocarbon date of 6010 ± 70 BP. Around 6900 BP a strong climatic deterioration caused an opening of timberline forest. First indicators of anthropogenic influence occurred at 4700 BP, when the forest limit started to move down. The lowering of timberline after 4700 BP was probably due to combined effects of human and climatic impact.

Motivational profiles of sporting event volunteers

This article presents an approach for segmenting sporting event volunteers according to differences in their motives. Empirical data were obtained from a sample of 1169 volunteers who registered for the 2014 European Athletics Championships in Zürich. They completed the ‘Volunteer Motivation Scale for International Sporting Events’ (VMS-ISE) questionaire. The validity of the VMS-ISE was replicated by confirmatory factor analysis and the data were cluster analysed to identify distinct motivation-based volunteer profiles. These segmented volunteers on the basis of mutually exclusive motivational characteristics. The external validity of the four motivation-based types (‘community supporters’, ‘material incentive seekers’, ‘social networkers’ and ‘career and personal growth orienteers’) was confirmed with socio-economic, sport-related and volunteer activity-related variables. It is concluded that motivation-based segmentation represents a useful way of gaining a clearer understanding of the patterns underlying the heterogeneity of sporting events volunteers.

Career adaptability profiles and their relationship to adaptivity and adapting

Research on career adaptability predominantly uses variable-centered approaches that focus on the average effects in terms of the predictors and outcomes within a given sample. Extending this research, the present paper used a person-centered approach to determine whether subgroups with distinct adaptability profiles in terms of concern, control, curiosity and confidence can be identified. We also explored the relationship between the various adaptability profiles and adapting (career planning, career decision-making difficulties, career exploration, and occupational self-efficacy beliefs) and adaptivity (core self-evaluations and proactivity). Using latent profile analysis, we found distinct adaptability profiles among 350 German university students. Students with different profiles differed significantly in their levels of adapting. This finding was confirmed in a second study of 1226 students selected from the same population. In both samples, the adaptability profiles differed mainly in terms of their adaptability levels but not their shape. Moreover, in both samples, the students whose profiles indicated generally higher adaptability showed more adapting compared with the students whose profiles indicated generally lower adaptability. Study 2 also showed that students with higher-adaptability profiles showed significantly higher adaptivity. The results suggest that level effects dominate adaptability profiles, implying the existence of a general adaptability factor within university students that is meaningfully related to adapting and adaptivity.

Latent profiles of work motivation in adolescents in relation to work expectations, goal engagement, and changes in work experiences

Motivation plays a key role in successful entry into working life. Based on a cross-sectional and a one-year longitudinal study, we used a person-centered approach to explore work-related motivation (i.e., autonomous goals, positive affect, and occupational self-efficacy) among 577 students in 8th grade (Study 1) and 949 adolescents in vocational training (Study 2). Based on latent profile analysis, in both studies we identified four groups that were characterized by different levels of overall motivation and one group characterized by low positive affect and mean levels in autonomous goals and self-efficacy. Profiles characterized by high levels of motivation showed the highest levels of positive work expectations and goal engagement and the lowest levels of negative work expectations in Study 1 and the highest levels of person-job fit, work engagement, and job satisfaction in Study 2. Moreover, latent difference score analysis showed that motivational profiles predicted changes in person-job fit and work engagement across one year but not in job satisfaction. The results imply that career counselors should be aware of characteristic motivational patterns of clients that may require specific counseling approaches.

Chance Events and Career Decidedness: Latent Profiles in Relation to Work Motivation

Research has shown that chance events affect careers but has not established the nature of their effects. Moreover, the relationship between chance and career decidedness is not well understood. The present study used a person-centered approach with latent profile analysis to examine 312 Swiss adolescents in their first year of vocational training. We identified five qualitatively differing profiles according to levels of perceived chance events and career decidedness: balanced scorers, undecided with mean chance, undecided with high chance, decided with chance, and decided without chance. The groups differed significantly in work motivation (i.e., occupational self-efficacy beliefs, perceived person-job fit, and work engagement). Decided adolescents reported more favorable work motivation regardless of their level of perceived chance events. The results imply that promoting decidedness remains a valuable goal in career counseling despite the occurrence of unpredicted events.

The "Profiles" document: a modern revision of the objectives of undergraduate medical studies in Switzerland

The Joint Commission of the Swiss Medical Schools (SMIFK/CIMS) decided in 2000 to establish a Swiss Catalogue of Learning Objectives (SCLO) for undergraduate medical training, which was adapted from a similar Dutch blueprint. A second version of the SCLO was developed and launched in 2008. The catalogue is a prerequisite for the accreditation of the curricula of the six Swiss medical faculties and defines the contents of the Federal Licensing Examination (FLE). Given the evolution of the field of medicine and of medical education, the SMIFK/CIMS has decided to embark on a total revision of the SCLO. This article presents the proposed structure and content of Profiles, a new document which, in the future, will direct the format of undergraduate studies and of the FLE. Profiles stands for the Principal Relevant Objectives for Integrative Learning and Education in Switzerland. It is currently being developed by a group of experts from the six Swiss faculties as well as representatives of other institutions involved in these developments. The foundations of Profiles are grounded in the evolution of medical practice and of public health and are based on up-to-date teaching concepts, such as EPAs (entrustable professional activities). An introduction will cover the concepts and a tutorial will be displayed. Three main chapters will provide a description of the seven 2015 CanMEDS roles, a list of core EPAs and a series of ≈250 situations embracing the most frequent and current conditions affecting health. As Profiles is still a work in progress, it is hoped that this paper will attract the interest of all individuals involved in the training of medical students.

Significant Differences Characterise the Correlation Coefficients between Biocide and Antibiotic Susceptibility Profiles in Staphylococcus aureus.

There is a growing concern by regulatory authorities for the selection of antibiotic resistance caused by the use of biocidal products. We aimed to complete the detailed information on large surveys by investigating the relationship between biocide and antibiotic susceptibility profiles of a large number of Staphylococcus aureus isolates using four biocides and antibiotics commonly used in clinical practice. The minimal inhibitory concentration (MIC) for most clinically-relevant antibiotics was determined according to the standardized methodology for over 1600 clinical S. aureus isolates and compared to susceptibility profiles of benzalkonium chloride, chlorhexidine, triclosan, and sodium hypochlorite. The relationship between antibiotic and biocide susceptibility profiles was evaluated using non-linear correlations. The main outcome evidenced was an absence of any strong or moderate statistically significant correlation when susceptibilities of either triclosan or sodium hypochlorite were compared for any of the tested antibiotics. On the other hand, correlation coefficients for MICs of benzalkonium chloride and chlorhexidine were calculated above 0.4 for susceptibility to quinolones, beta-lactams, and also macrolides. Our data do not support any selective pressure for association between biocides and antibiotics resistance and furthermore do not allow for a defined risk evaluation for some of the compounds. Importantly, our data clearly indicate that there does not involve any risk of selection for antibiotic resistance for the compounds triclosan and sodium hypochlorite. These data hence infer that biocide selection for antibiotic resistance has had so far a less significant impact than feared.