Career choice in medicine

Background: Career Choice in Medicine is an important and problematic topic. Medical education has been framed as professional identity development, yet career choice has not been viewed as a matter of identity. My primary aim was to offer new insights by exploring career choice using Figured Worlds theory, a socio-cultural theory of identity. Graduate retention is a challenge for many countries, including Ireland. My secondary aim was to address a gap in the data on postgraduate trainees in Ireland and to use the Irish case to illustrate points transferable to other contexts. Methodology & Methods: This was a predominantly qualitative Mixed Methods programme of research. My qualitative studies were oriented towards social constructionism. I collated existing data from the Royal College of Physicians of Ireland (RCPI) and HSE-MET to describe trainees and their career paths. I surveyed Basic Specialist Training trainees (n=333) about their career plans. I surveyed new trainees (n=527) about their expectations of training and all RCPI trainees about their experiences of training (n=1246). I conducted semi-structured interviews with 18 medical students and doctors. A subgroup (n=6) provided longitudinal data. Figured Worlds theory and Gee’s discourse tools were used for analysis. Results: I have used the case of medical training and career choice in Ireland to explain how social, political and cultural context, and day to day experiences in the cultural world of medicine, shaped doctors’ career choices. My qualitative findings described a unifying model of career choice, consisting of priming, exposure, positioning and open-endedness, which can guide the design of interventions to shape and support career choice. Conclusion: My original contribution has been to demonstrate the fruitfulness of framing career choice in terms of identity development. This represents a turn in the conversation about career choice, which brings new starting points and moves the dialogue forward.

Cross-cultural dimensions of meaning in the evaluation of events in world history? Perceptions of historical calamities and progress in cross-cultural data from 30 societies

The universality versus culture specificity of quantitative evaluations (negative-positive) of 40 events in world history was addressed using World History Survey data collected from 5,800 university students in 30 countries/societies. Multidimensional scaling using generalized procrustean analysis indicated poor fit of data from the 30 countries to an overall mean configuration, indicating lack of universal agreement as to the associational meaning of events in world history. Hierarchical cluster analysis identified one Western and two non-Western country clusters for which adequate multidimensional fit was obtained after item deletions. A two-dimensional solution for the three country clusters was identified, where the primary dimension was historical calamities versus progress and a weak second dimension was modernity versus resistance to modernity. Factor analysis further reduced the item inventory to identify a single concept with structural equivalence across cultures, Historical Calamities, which included man-made and natural, intentional and unintentional, predominantly violent but also nonviolent calamities. Less robust factors were tentatively named as Historical Progress and Historical Resistance to Oppression. Historical Calamities and Historical Progress were at the individual level both significant and independent predictors of willingness to fight for one’s country in a hierarchical linear model that also identified significant country-level variation in these relationships. Consensus around calamity but disagreement as to what constitutes historical progress is discussed in relation to the political culture of nations and lay perceptions of history as catastrophe.

A strategy to advance the evidence base in palliative medicine: formation of a palliative care research cooperative group.

BACKGROUND: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. METHODS: A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care. RESULTS: The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success.

CABARET: MIRROR OF SOCIETIES

The basic definition of a cabaret is a café that offers live entertainment performed by singers, musicians and dancers and serves food and drink. It is generally housed in small, intimate spaces. Starting in the middle of the nineteenth century, artists, composers and writers met at Parisian cafés and salons to share their works. The cabaret was a suitable place for social activities. Artists could meet, discuss their opinions, and share their art in a relaxed setting. Even though cabaret music was often based on popular idioms, social and political commentary coupled with satirical settings represented the true soul of the genre. This trend flourished in the late nineteenth and early twentieth centuries. The first cabaret in Paris, Le Chat Noir inspired the growth of similar places in major cities throughout Europe besides Paris. The three recitals that comprise this dissertation project were performed at University of Maryland venues: the Robert & Arlene Kogod Theatre on 11 May 2011, Ulrich Recital Hall on 4 December 2011, and Gildenhorn Recital Hall on 4 March 2012. The repertoire for the first recital included works by Erik Satie with mezzo-soprano Monica Soto-Gil, Friedrich Hollaender with soprano Gabrielle DeMers, William Bolcom with baritone Ethan Watermeier and mezzo-soprano Stepanie Sadownik, and Poulenc with baritone Andrew McLaughlin. André Previn‘s Tango Song and Dance with violinist Jennifer Kim served as the instrumental interlude. The second recital included songs by Friedrich Hollaender with mezzo-soprano Monica Soto-Gil, Hanns Eisler and Viktor Ullmann with mezzo-soprano Stephanie Sadownik, and Mischa Spoliansky with soprano CarrieAnne Winter. Victor Hollaender‘s Romance and Albumblatt were the instrumental interludes with violinist Jennifer Kim. The last recital featured works for piano and violin, the Graceful Ghost Rag by William Bolcom with violinist Jenny Wu, Four Souvenirs by Paul Schoenfield with violinist Jennifer Kim, Cabaret Songs by Benjamin Britten with soprano Linda Mabbs, and Souvenirs for piano four-hands by Samuel Barber with pianist Rita Sloan. The recitals were recorded on compact discs and are archived within the Digital Repository at the University of Maryland (DRUM).

The IGNITE network: a model for genomic medicine implementation and research.

BACKGROUND: Patients, clinicians, researchers and payers are seeking to understand the value of using genomic information (as reflected by genotyping, sequencing, family history or other data) to inform clinical decision-making. However, challenges exist to widespread clinical implementation of genomic medicine, a prerequisite for developing evidence of its real-world utility. METHODS: To address these challenges, the National Institutes of Health-funded IGNITE (Implementing GeNomics In pracTicE; www.ignite-genomics.org ) Network, comprised of six projects and a coordinating center, was established in 2013 to support the development, investigation and dissemination of genomic medicine practice models that seamlessly integrate genomic data into the electronic health record and that deploy tools for point of care decision making. IGNITE site projects are aligned in their purpose of testing these models, but individual projects vary in scope and design, including exploring genetic markers for disease risk prediction and prevention, developing tools for using family history data, incorporating pharmacogenomic data into clinical care, refining disease diagnosis using sequence-based mutation discovery, and creating novel educational approaches. RESULTS: This paper describes the IGNITE Network and member projects, including network structure, collaborative initiatives, clinical decision support strategies, methods for return of genomic test results, and educational initiatives for patients and providers. Clinical and outcomes data from individual sites and network-wide projects are anticipated to begin being published over the next few years. CONCLUSIONS: The IGNITE Network is an innovative series of projects and pilot demonstrations aiming to enhance translation of validated actionable genomic information into clinical settings and develop and use measures of outcome in response to genome-based clinical interventions using a pragmatic framework to provide early data and proofs of concept on the utility of these interventions. Through these efforts and collaboration with other stakeholders, IGNITE is poised to have a significant impact on the acceleration of genomic information into medical practice.

Nations' income inequality predicts ambivalence in stereotype content: How societies mind the gap

Income inequality undermines societies: The more inequality, the more health problems, social tensions, and the lower social mobility, trust, life expectancy. Given people's tendency to legitimate existing social arrangements, the stereotype content model (SCM) argues that ambivalence-perceiving many groups as either warm or competent, but not both-may help maintain socio-economic disparities. The association between stereotype ambivalence and income inequality in 37 cross-national samples from Europe, the Americas, Oceania, Asia, and Africa investigates how groups' overall warmth-competence, status-competence, and competition-warmth correlations vary across societies, and whether these variations associate with income inequality (Gini index). More unequal societies report more ambivalent stereotypes, whereas more equal ones dislike competitive groups and do not necessarily respect them as competent. Unequal societies may need ambivalence for system stability: Income inequality compensates groups with partially positive social images. © 2012 The British Psychological Society.

Modeling the dynamics of electromagnetically agitated metallurgical flows: levitation, cold crucible, aluminium electrolysis, etc.

We present practical modelling techniques for electromagnetically agitated liquid metal flows involving dynamic change of the fluid volume and shape during melting and the free surface oscillation. Typically the electromagnetic field is strongly coupled to the free surface dynamics and the heat-mass transfer. Accurate pseudo-spectral code and the k-omega turbulence model modified for complex and transitional flows with free surfaces are used for these simulations. The considered examples include magnetic suspension melting, induction scull remelting (cold crucible), levitation and aluminium electrolysis cells. The process control and the energy savings issues are analysed.

Impacts of climate change on marine ecosystem production in societies dependent on fisheries

Growing human populations and changing dietary preferences are increasing global demands for fish, adding pressure to concerns over fisheries sustainability. Here we develop and link models of physical, biological and human responses to climate change in 67 marine national exclusive economic zones, which yield approximately 60% of global fish catches, to project climate change yield impacts in countries with different dependencies on marine fisheries. Predicted changes in fish production indicate increased productivity at high latitudes and decreased productivity at low/mid latitudes, with considerable regional variations. With few exceptions, increases and decreases in fish production potential by 2050 are estimated to be <10% (mean C3.4%) from present yields. Among the nations showing a high dependency on fisheries, climate change is predicted to increase productive potential in West Africa and decrease it in South and Southeast Asia. Despite projected human population increases and assuming that per capita fish consumption rates will be maintained1, ongoing technological development in the aquaculture industry suggests that projected global fish demands in 2050 could be met, thus challenging existing predictions of inevitable shortfalls in fish supply by the mid-twenty-first century. This conclusion, however, is contingent on successful implementation of strategies for sustainable harvesting and effective distribution of wild fish products from nations and regions with a surplus to those with a deficit. Changes in management effectiveness2 and trade practices5 will remain the main influence on realized gains or losses in global fish production.