Demographic situation in operative medicine in Switzerland - time to react?

Objective: The decreasing proportion of physicians of Swiss origin and the increasing number of part-time jobs in operative medicine might lead to a shortage of physicians in operative disciplines in Switzerland. The objective of the present study was to analyze the current demographic situation in operative medicine in Switzerland. Methods: During the summer of 2011, a 19-item anonymous electronic questionnaire was mailed to all directors of departments in operative medicine in Switzerland. The questionnaire was designed to gather data about the characteristics of the participating departments, the demographics (including the appointment (consultant, attending or resident), the proportion of female and foreign physicians, the latter’s origin, and the number of part-time jobs with a working time between 20 and 90%), and the proportion of vacant posts. Results: Of 775 questionnaires mailed to all directors of departments in operative medicine in Switzerland, 183 (24%) were returned. Overall, 40% were female, and 42% foreign physicians. The proportion of part-time jobs amounted to 17%. Vacant posts were found in 2%. Conclusions: An expansion of study places at the medical universities and of the incentives for the incumbents in operative medicine is necessary to avert a shortage of physicians in Switzerland.

What are the metacognitive costs of young children's overconfidence?

Children typically hold very optimistic views of their own skills but so far, only a few studies have investigated possible correlates of the ability to predict performance accurately. Therefore, this study examined the role of individual differences in performance estimation accuracy as a global metacognitive index for different monitoring and control skills (item-level judgments of learning [JOLs] and confidence judgments [CJs]), metacognitive control processes (allocation of study time and control of answers), and executive functions (cognitive flexibility, inhibition, working memory) in 6-year-olds (N=93). The three groups of under estimators, realists and over estimators differed significantly in their monitoring and control abilities: the under estimators outperformed the over estimators by showing a higher discrimination in CJs between correct and incorrect recognition. Also, the under estimators scored higher on the adequate control of incorrectly recognized items. Regarding the interplay of monitoring and control processes, under estimators spent more time studying items with low JOLs, and relied more systematically on their monitoring when controlling their recognition compared to over estimators. At the same time, the three groups did not differ significantly from each other in their executive functions. Overall, results indicate that differences in performance estimation accuracy are systematically related to other global and item-level metacognitive monitoring and control abilities in children as young as six years of age, while no meaningful association between performance estimation accuracy and executive functions was found.

Similarities and differences between physician and non-physician acupuncturists in using diagnostic methods - an explorative study

Purpose: Acupuncture is one of the complementary medicine therapies with the greatest demand in Switzerland and many other countries in the West and in Asia. Over the past decades, the pool of scientific literature in acupuncture has markedly increased. The diagnostic methods upon which acupuncture treatment is based, have only been addressed sporadically in scientific journals. The goal of this study is to assess the use of different diagnostic methods in the acupuncture practices and to investigate similarities and differences in using these diagnostic methods between physician and non-physician acupuncturists. Methods: 44 physician acupuncturists with certificates of competence in acupuncture – traditional chinese medicine (TCM) from ASA (Assoziation Schweizer Ärztegesellschaften für Akupunktur und Chinesische Medizin: the Association of Swiss Medical Societies for Acupuncture and Chinese Medicine) and 33 non-physician acupuncturists listed in the EMR (Erfahrungsmedizinisches Register: a national register, which assigns a quality label for CAM therapists in complementary and alternative medicine) in the cantons Basel-Stadt and Basel-Land were asked to fill out a questionnaire on diagnostic methods. The responder rate was 46.8% (69.7% non-physician acupuncturists and 29, 5% physician acupuncturists). Results: The results show that both physician and non-physician acupuncturists take patients’ medical history (94%), use pulse diagnosis (89%), tongue diagnosis (83%) and palpation of body and ear acupuncture points (81%) as diagnostic methods to guide their acupuncture treatments. Between the two groups, there were significant differences in the diagnostic tools being used. Physician acupuncturists do examine their patients significantly more often with western medical methods (p<.05) than this is the case for nonphysician acupuncturists. Non-physician acupuncturists use pulse diagnosis more often than physicians (p<.05). A highly significant difference was observed in the length of time spent with collecting patients’ medical history, where nonphysician acupuncturists clearly spent more time (p<.001). Conclusion: Depending on the educational background of the acupuncturist, different diagnostic methods are used for making the diagnosis. Especially the more time consuming methods like a comprehensive anamnesis and pulse diagnosis are more frequently employed by non-physician practitioners. Further studies will clarify if these results are valid for Switzerland in general, and to what extent the differing use of diagnostic methods has an impact on the diagnosis itself and on the resulting treatment methods, as well as on the treatment success and the patients’ satisfaction.

Preschool children's eye-movements during pictorial recall

We investigated eye-movements during preschool children’s pictorial recall of seen objects. Thirteen 3- to 4-year-old children completed a perceptual encoding and a pictorial recall task. First, they were exposed to 16 pictorial objects, which were positioned in one of four distinct areas on the computer screen. Subsequently, they had to recall these pictorial objects from memory in order to respond to specific questions about visual details. We found that children spent more time fixating the areas in which the pictorial objects were previously displayed.We conclude that as early as age 3–4 years old, children show specific eye-movements when they recall pictorial contents of previously seen objects.

Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care

BACKGROUND: This study is part of a cross-sectional evaluation of complementary medicine providers in primary care in Switzerland. It compares patient satisfaction with anthroposophic medicine (AM) and conventional medicine (CON). METHODS: We collected baseline data on structural characteristics of the physicians and their practices and health status and demographics of the patients. Four weeks later patients assessed their satisfaction with the received treatment (five items, four point rating scale) and evaluated the praxis care (validated 23-item questionnaire, five point rating scale). 1946 adult patients of 71 CON and 32 AM primary care physicians participated. RESULTS: 1. Baseline characteristics: AM patients were more likely female (75.6% vs. 59.0%, p < 0.001) and had higher education (38.6% vs. 24.7%, p < 0.001). They suffered more often from chronic illnesses (52.8% vs. 46.2%, p = 0.015) and cancer (7.4% vs. 1.1%). AM consultations lasted on average 23,3 minutes (CON: 16,8 minutes, p < 0.001). 2. Satisfaction: More AM patients expressed a general treatment satisfaction (56.1% vs. 43.4%, p < 0.001) and saw their expectations completely fulfilled at follow-up (38.7% vs. 32.6%, p < 0.001). AM patients reported significantly fewer adverse side effects (9.3% vs. 15.4%, p = 0.003), and more other positive effects from treatment (31.7% vs. 17.1%, p < 0.001). Europep: AM patients appreciated that their physicians listened to them (80.0% vs. 67.1%, p < 0.001), spent more time (76.5% vs. 61.7%, p < 0.001), had more interest in their personal situation (74.6% vs. 60.3%, p < 0.001), involved them more in decisions about their medical care (67.8% vs. 58.4%, p = 0.022), and made it easy to tell the physician about their problems (71.6% vs. 62.9%, p = 0.023). AM patients gave significantly better rating as to information and support (in 3 of 4 items p [less than or equal to] 0.044) and for thoroughness (70.4% vs. 56.5%, p < 0.001). CONCLUSION: AM patients were significantly more satisfied and rated their physicians as valuable partners in the treatment. This suggests that subject to certain limitations, AM therapy may be beneficial in primary care. To confirm this, more detailed qualitative studies would be necessary.

Tenofovir or zidovudine in second-line antiretroviral therapy after stavudine failure in southern Africa

BACKGROUND There is debate over using tenofovir or zidovudine alongside lamivudine in second-line antiretroviral therapy (ART) following stavudine failure. We analyzed outcomes in cohorts from South Africa, Zambia and Zimbabwe METHODS: Patients aged ≥16 years who switched from a first-line regimen including stavudine to a ritonavir-boosted lopinavir-based second-line regimen with lamivudine or emtricitabine and zidovudine or tenofovir in seven ART programs in southern Africa were included. We estimated the causal effect of receiving tenofovir or zidovudine on mortality and virological failure using Cox proportional hazards marginal structural models. Its parameters were estimated using inverse probability of treatment weights. Baseline characteristics were age, sex, calendar year and country. CD4 cell count, creatinine and hemoglobin levels were included as time-dependent confounders. RESULTS 1,256 patients on second-line ART, including 958 on tenofovir, were analyzed. Patients on tenofovir were more likely to have switched to second-line ART in recent years, spent more time on first-line ART (33 vs. 24 months) and had lower CD4 cell counts (172 vs. 341 cells/μl) at initiation of second-line ART. The adjusted hazard ratio comparing tenofovir with zidovudine was 1.00 (95% confidence interval 0.59-1.68) for virologic failure and 1.40 (0.57-3.41) for death. CONCLUSIONS We did not find any difference in treatment outcomes between patients on tenofovir or zidovudine; however, the precision of our estimates was limited. There is an urgent need for randomized trials to inform second-line ART strategies in resource-limited settings.

Early metacognitive abilities: The interplay of monitoring and control processes in 5- to 7-year-old children

The goal of the current investigation was to compare two monitoring processes (judgments of learning [JOLs] and confidence judgments [CJs]) and their corresponding control processes (allocation of study time and selection of answers to maximize accuracy, respectively) in 5- to 7-year-old children (N=101). Children learned the meaning of Japanese characters and provided JOLs after a study phase and CJs after a memory test. They were given the opportunity to control their learning in self-paced study phases, and to control their accuracy by placing correct answers into a treasure chest and incorrect answers into a trash can. All three age groups gave significantly higher CJs for correct compared to incorrect answers, with no age-related differences in the magnitude of this difference, suggesting robust metacognitive monitoring skills in children as young as 5. Furthermore, a link between JOLs and study time was found in the 6- and 7-year-olds, such that children spent more time studying items with low JOLs compared to items with high JOLs. Also, 6- and 7-year-olds but not 5-year-olds spent more time studying difficult items compared to easier items. Moreover, age-related improvements were found in children's use of CJs to guide their selection of answers: although children as young as 5 placed their most confident answers in the treasure chest and least confident answers in the trash can, this pattern was more robust in older children. Overall, results support the view that some metacognitive judgments may be acted upon with greater ease than others among young children.

Does the Use of Mobile Devices (Tablets and Smartphones) Affect Stated Choice Behavior in Web Surveys? An Application to Environmental Valuation

Web surveys are becoming increasingly popular in survey research. Compared with face-to-face, telephone and mail surveys, web surveys may contain a different and new source of measurement error and bias: the type of device that respondents use to answer the survey questions. To the best of our knowledge, this is the first study that tests whether the use of mobile devices affects survey characteristics and stated preferences in a web-based choice experiment. The web survey was carried out in Germany with 3,400 respondents, of which 12 per cent used a mobile device (i.e. tablet or smartphone), and comprised a stated choice experiment on externalities of renewable energy production using wind, solar and biomass. Our main finding is that survey characteristics such as interview length and acquiescence tendency are affected by the device used. In contrast to what might be expected, we find that, compared with respondents using desktop computers and laptops, mobile device users spent more time to answer the survey and are less likely to be prone to acquiescence bias. In the choice experiment, mobile device users tended to be more consistent in their stated choices, and there are differences in willingness to pay between both subsamples.

Use of outdoor ranges by laying hens in different sized flocks.

In studies assessing outdoor range use of laying hens, the number of hens seen on outdoor ranges is inversely correlated to flock size. The aim of this study was to assess individual ranging behavior on a covered (veranda) and an uncovered outdoor run (free-range) in laying hen flocks varying in size. Five to ten percent of hens (aged 9–15 months) within 4 small (2–2500 hens), 4 medium (5–6000), and 4 large (≥9000) commercial flocks were fitted with radio frequency identification (RFID) tags. Antennas were placed at both sides of all popholes between the house and the veranda and the veranda and the free-range. Ranging behavior was directly monitored for approximately three weeks in combination with hourly photographs of the free-range for the distribution of hens and 6h long video recordings on two parts of the free-range during two days. Between 79 and 99% of the tagged hens were registered on the veranda at least once and between 47 and 90% were registered on the free-range at least once. There was no association between the percentage of hens registered outside the house (veranda or free-range) and flock size. However, individual hens in small and medium sized flocks visited the areas outside the house more frequently and spent more time there than hens from large flocks. Foraging behavior on the free-range was shown more frequently and for a longer duration by hens from small and medium sized flocks than by hens from large flocks. This difference in ranging behavior could account for the negative relationship between flock size and the number of hens seen outside at one point of time. In conclusion, our work describes individual birds’ use of areas outside the house within large scale commercial egg production.

Digital Personal Assistant for Cognitive Cities: A Paper Prototype

This chapter presents an evaluation and initial testing of a meta-application (meta-app) for enhanced communication and improved interaction (e.g., appointment scheduling) between stakeholders (e.g., citizens) in cognitive cities. The underlying theoretical models as well as the paper prototype are presented to ensure the comprehensibility of the user interface. This paper prototype of the meta-app was evaluated through interviews with various experts in different fields (e.g., a strategic consultant, a small and medium-sized enterprises cofounder in the field of online marketing, an IT project leader, and an innovation manager). The results and implications of the evaluation show that the idea behind this meta-app has the potential to improve the living standards of citizens and to lead to a next step in the realization and maturity of the meta-app. The meta-app helps citizens more effectively manage their time and organize their personal schedules and thus allows them to have more leisure time and take full advantage of it to ensure a good work-life balance to enable them to be the most efficient and productive during their working time.

An examination of the link between just world belief and schadenfreude

Schadenfreude is a pleasure derived from someone else’s misfortune. Just world belief is a desire to belief that people get what they deserve and deserve what they get (Lerner, 1965,1980). Interestingly, previous scholars documented the link between schadenfreude, responsibility and deservingness (e.g. van Dijk, Goslinga, & Ouwerkerk, 2008), i.e. the more failure is deserved, the more perceived responsibility for the failure, and subsequently more schadenfreude is evoked. Thus, the present study tested if a threat of a just world belief intensifies experience of schadenfreude. The participants (N=48, 31 women and 17 men, M age = 23.72), were randomly assigned to one of two experimental conditions (just world belief: threat versus no-threat) between-participant design. They read scenarios which were designed to threaten or maintain their just world belief. Next, they were transferred to an online magazine presenting funny stories about other peoples’ failures. The stories were selected in a pilot study in order to evoke schadenfreude. As presumed, the participants exposed to the threat of just world belief experienced more schadenfreude, i.e. spent more time on reading schadenfreude stories. The results confirmed the existence of a link between just world threat and schadenfreude.

Schadenfreude and just world belief

The present study tested the hypothesis that a threat of a just world belief intensifies experience of schadenfreude (i.e., pleasure at another's misfortune). The participants read scenarios which were designed to threaten or maintain their just world belief. Subsequently, they were transferred to an online magazine presenting funny stories about other peoples' failures. As presumed, the participants exposed to the threat of just world belief spent more time on reading. These results confirmed the existence of a link between just world threat and schadenfreude.

Simulation in vascular access surgery training.

Rapidly growing technical developments and working time constraints call for changes in trainee formation. In reality, trainees spend fewer hours in the hospital and face more difficulties in acquiring the required qualifications in order to work independently as a specialist. Simulation-based training is a potential solution. It offers the possibility to learn basic technical skills, repeatedly perform key steps in procedures and simulate challenging scenarios in team training. Patients are not at risk and learning curves can be shortened. Advanced learners are able to train rare complications. Senior faculty member's presence is key to assess and debrief effective simulation training. In the field of vascular access surgery, simulation models are available for open as well as endovascular procedures. In this narrative review, we describe the theory of simulation, present simulation models in vascular (access) surgery, discuss the possible benefits for patient safety and the difficulties of implementing simulation in training.

Does the use of mobile devices (tablets and smartphones) affect survey quality and choice behaviour in web surveys?

Web surveys are becoming increasingly popular in survey research including stated preference surveys. Compared with face-to-face, telephone and mail surveys, web surveys may contain a different and new source of measurement error and bias: the type of device that respondents use to answer the survey questions. This is the first study that tests whether the use of mobile devices, tablets or smartphones, affects survey characteristics and stated preferences in a web-based choice experiment. The web survey on expanding renewable energy production in Germany was carried out with 3182 respondents, of which 12% used a mobile device. Propensity score matching is used to account for selection bias in the use of mobile devices for survey completion. We find that mobile device users spent more time than desktop/laptop users to answer the survey. Yet, desktop/laptop users and mobile device users do not differ in acquiescence tendency as an indicator of extreme response patterns. For mobile device users only, we find a negative correlation between screen size and interview length and a positive correlation between screen size and acquiescence tendency. In the choice experiment data, we do not find significant differences in the tendency to choose the status quo option and scale between both subsamples. However, some of the estimates of implicit prices differ, albeit not in a unidirectional fashion. Model results for mobile device users indicate a U-shaped relationship between error variance and screen size. Together, the results suggest that using mobile devices is not detrimental to survey quality.

An Exploration Based Cognitive Bias Test for Mice: Effects of Handling Method and Stereotypic Behaviour

Behavioural tests to assess affective states are widely used in human research and have recently been extended to animals. These tests assume that affective state influences cognitive processing, and that animals in a negative affective state interpret ambiguous information as expecting a negative outcome (displaying a negative cognitive bias). Most of these tests however, require long discrimination training. The aim of the study was to validate an exploration based cognitive bias test, using two different handling methods, as previous studies have shown that standard tail handling of mice increases physiological and behavioural measures of anxiety compared to cupped handling. Therefore, we hypothesised that tail handled mice would display a negative cognitive bias. We handled 28 female CD-1 mice for 16 weeks using either tail handling or cupped handling. The mice were then trained in an eight arm radial maze, where two adjacent arms predicted a positive outcome (darkness and food), while the two opposite arms predicted a negative outcome (no food, white noise and light). After six days of training, the mice were also given access to the four previously unavailable intermediate ambiguous arms of the radial maze and tested for cognitive bias. We were unable to validate this test, as mice from both handling groups displayed a similar pattern of exploration. Furthermore, we examined whether maze exploration is affected by the expression of stereotypic behaviour in the home cage. Mice with higher levels of stereotypic behaviour spent more time in positive arms and avoided ambiguous arms, displaying a negative cognitive bias. While this test needs further validation, our results indicate that it may allow the assessment of affective state in mice with minimal training— a major confound in current cognitive bias paradigms.