The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Linking livelihood strategies with a regional level landscape mosaic to explore trade-offs between forest conservation and human wellbeing in a Madagascar biodiversity hotspot

The north-eastern escarpment of Madagascar contains the island’s last remaining large-scale humid forest massifs surrounded by diverse small-scale agricultural mosaics. There is high deforestation mainly caused by shifting cultivation practiced by local land users to produce upland rice for subsistence. Today, large protected areas restrict land users’ access to forests to collect wood and other forest products. Moreover, they are no more able to expand their cultivated land, which leads to shorter shifting cultivation cycles and decreasing plot sizes for irrigated rice and cash crop cultivation. Cash crop production of clove and vanilla is exposed to risks such as extreme inter-annual price fluctuations, pests and cyclones. In the absence of work opportunities, agricultural extension services and micro-finance schemes people are stuck in a poverty trap. New development strategies are needed to mitigate the trade-offs between forest conservation and human well-being. As landscape composition and livelihood strategies vary across the region, these strategies need to be spatially differentiated to avoid implementing generic solutions, which do not fit the local context. However, up to date, little is known about the spatial patterns of shifting cultivation and other land use systems at the regional level. This is mainly due to the high spatial and temporal dynamics inherent to shifting cultivation, which makes it difficult to monitor the dynamics of this land use system with remote sensing methods. Furthermore, knowledge about land users’ livelihood strategies and the risks and opportunities they face stems from very few local case studies. To overcome this challenge, firstly, we used remote sensing data and a landscape mosaic approach to delineate the main landscape types at the regional level. Secondly, we developed a land user typology based on socio-ecological data from household surveys in 45 villages spread throughout the region. Combining the land user typology with the landscape mosaic map allowed us to reveal spatial patterns of the interaction between landscapes and people and to better understand the trade-offs between forest conservation and local wellbeing. While shifting cultivation systems are being transformed into more intensive permanent agricultural systems in many countries around the globe, Madagascar seems to be an exception to this trend. Linking land cover information to human-environmental interactions over large areas is crucial to designing policies and to inform decision making for a more sustainable development of this resource-rich but poverty-prone context.

The Interaction Between Forest Fires and Human Activity in Southern Switzerland

The impact of human activities on the fire regime in southern Switzerland was studied using (pre)historical charcoal and pollen data from lake sediments and statistical data from the 20th century. The cultural impact on forest fire was established by correlating charcoal-influx data with pollen percentages of anthropogenic indicators such as Plantago lanceolata, the Cerealia (sum of Avena t., Triticum t. and Hordeum t.) and Secale. During the 20th century, fire frequency was correlated with precipitation, dry and very dry periods and landscape management indicators. The effects of human activity on the fire regime are clearly recognisable since at least the Neolithic period. Using palaeoecological or statistical data, the variations in fire regime originating from anthropogenic actions may be differentiated from those due to climatic changes if they are sufficiently conspicuous.

Spatial analysis of water body distance and West Nile Virus human cases in Houston, TX

West Nile Virus (WNV) is an arboviral disease that has affected hundreds of residents in Harris County, Texas since its introduction in 2002. Persistent infection, lingering sequelae and other long-term symptoms of patients reaffirm the need for prevention of this important vector-borne disease. This study aimed to determine if living within 400m of a water body increases one’s odds of infection with WNV. Additionally, we wanted to determine if one’s proximity to a particular water type or water body source increased one’s odds of infection with WNV.^ 145 cases’ addresses were abstracted from the initial interview and consent records from a cohort of patients (Epidemiology of Arboviral Encephalitis in Houston study, HSC-SPH-03-039). After applying inclusion criteria, 140 cases were identified for analysis. 140 controls were selected for analysis using a population proportionate to size model and US Census Bureau data. MapMarker USA v14 was used to geocode the cases’ addresses. Both cases’ and controls’ coordinates were uploaded onto a Harris County water shapefile in MapInfo Professional v9.5.1. Distance in meters to the closest water source, closest water source type, and closest water source name were recorded.^ Analysis of Variance (p=0.329, R2 = 0.0034) indicated no association between water body distance and risk of WNV disease. Living near a creek (x2 = 11.79, p < 0.001), or the combined group of creek and gully (x 2 = 14.02, p < 0.001) were found to be strongly associated with infection of WNV. Living near Cypress Creek and its feeders (x2 = 15.2, p < 0.001) was found to be strongly associated with WNV infection. We found that creek and gully habitats, particularly Cypress Creek, were preferential for the local disease transmitting Culex quinquefasciatus and reservoir avian population.^

John Rziha, Perfecting human actions: St. Thomas Aquinas on human participation in eternal law, Catholic University of America Press, Washington, 2009; 300 p., ISBN 978-0-8132-1672-0.

Fil: Peretó Rivas, Rubén.

Local Human Activity in two communities of Formosa, Argentina

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Dangerous unions : mapping human smuggling and human trafficking in international marriage through Japan's legal response

This working paper explores human smuggling and human trafficking through international marriage. It focuses on Japan's criminal justice response, while examining the major stakeholders involved in this activity. The paper focuses on the time period from 2008-2013. International marriages, particularly commercially brokered arrangements, have rapidly increased throughout East and Southeast Asia, with more women from less developed countries moving to richer destinations. The increasing prevalence of brokered marriages, and the overall numbers of marriage migrants, provides cover for criminal organizations to smuggle labor migrants on false marriages, and to send some migrants into what are clearly human trafficking situations.

Perspectives on climate change and human development in the Mediterranean agriculture

The Mediterranean region is one of the world's climate change hotspots. Future climate projections envisage dramatic implications for the agricultural and water sectors that will endanger economic development and lead to natural resources degradation and social instability.

Human Factor in Resilience Systems

This paper shows the importance of a holistic comprehension of the Earth as a living planet, where man inhabits and is exposed to environmental incidences of different nature. The aim of the paper here summarized is a reflection on all these concepts and scientific considerations related to the important role of men in the handling of natural hazards. Our Planet is an unstable and dynamical system highly sensitive to initial conditions, as proposed by Chaos theory (González-Miranda 2004); it is a complex organic whole, which responds to minimal variations which can affect several natural phenomena such as plate tectonics, solar flares, fluid turbulences, landscape formation, forest fires, growth and migration of populations and biological evolution. This is known as the “butterfly effect” (Lorenz 1972), which means that a small change of the system causes a chain of events leading to large-scale unpredictable consequences. The aim of this work is dwelling on the importance of the knowledge of these natural and catastrophic geological, biological and human systems so much sensible to equilibrium conditions, to prevent, avoid and mend their effects, and to face them in a resilient way

El "Anclaje y Ajuste", una herramienta de Marketing para analizar el poder de las referencias en el Arte, el Diseño y la Arquitectura = "Anchoring and Adjustment", a Marketing tool to analyse references in Art, Design and Architecture

El "Anclaje y Ajuste", una herramienta de Marketing para analizar el poder de las referencias en el Arte, el Diseño y la Arquitectura = "Anchoring and Adjustment", a Marketing tool to analyse references in Art, Design and Architecture

Arsenic, antimony and selenium in urban soils: potential risks for human health in urban gardening

The benefits of urban agriculture are many and well documented, ranging from health improvement to community betterment, more sustainable urban development and environment protection. On the negative side, urban soils are commonly enriched in toxic trace elements that have accumulated over time through the deposition of atmospheric particles (generated by automotive traffic, heating systems, historical industrial activities and resuspended street dust), and the uncontrolled disposal of domestic, commercial and industrial wastes. This in turn has given rise to concerns about the level of exposure of urban farmers to these elements and the potential health hazards associated with this exposure. Research efforts in this field have started relatively recently and have almost systematically omitted the influence of Sb and Se, and to a lesser extent of As, although all three have proven toxic effects.

Unified underpinning of human mobility in the real world and cyberspace

Acknowledgments This work is supported by National Science Foundation of China (Grant No. 61573064, 61074116 and 11547188), the Youth Scholars Program of Beijing Normal University (grant No. 2014NT38), and the Fundamental Research Funds for the Central Universities Beijing Nova Programme, China. XYY acknowledges the support from the National Natural Science Foundation of China (Grant No. 61304177) and the Fundamental Research Funds of BJTU (Grant No. 2015RC042).