[Stability of long-term professional objectives of young physicians during postgraduate training. Results of a multicenter cohort study]

INTRODUCTION

We investigated persistences and changes of career preferences of medical residents in Germany after two years of postgraduate training with regard to future working place and position. The results are compared with those forwarded at graduation from medical school in a gender comparative perspective.

METHODS

The study is based on a standardized postal survey among the participants in the "KarMed" study, originally based on 1012 graduates of the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2107 persons were contacted. The return rate at baseline was 48 %, and the two surveys after the baseline reached return rates of 87 % and 89 % respectively. In all samples 2/3 were women as in actual medical undergraduate education. Descriptive statistics and regression analysis were performed.

RESULTS

After 2 years of residency, residents after 2 years of postgraduate training still preferred the hospital over private practice as their final workplace after postgraduate training. The attractiveness of leading positions in the hospital declined among men, whereas it was already low for women at graduation. A large proportion of those physicians preferring the ambulatory sector, especially women, wishes to work as employee instead of private practice. At the personal level, almost 60 % forwarded the same preferences as those at graduation. Gender, parenthood and region of study (East vs. West Germany) did not influence stability or change of preferences.

CONCLUSION

The results demonstrate the persistence of professional preferences regarding future sector and position of medical work during postgraduate training. These preferences do neither match with principles of gender equality nor with future workforce needs (e. g. in primary care).

The multi-purpose hard X-ray beamline BL10 at the DELTA storage ring

The layout and the characteristics of the hard X-ray beamline BL10 at the superconducting asymmetric wiggler at the 1.5 GeV Dortmund Electron Accelerator DELTA are described. This beamline is equipped with a Si(111) channel-cut monochromator and is dedicated to X-ray studies in the spectral range from ∼4 keV to ∼16 keV photon energy. There are two different endstations available. While X-ray absorption studies in different detection modes (transmission, fluorescence, reflectivity) can be performed on a designated table, a six-axis kappa diffractometer is installed for X-ray scattering and reflectivity experiments. Different detector set-ups are integrated into the beamline control software, i.e. gas-filled ionization chambers, different photodiodes, as well as a Pilatus 2D-detector are permanently available. The performance of the beamline is illustrated by high-quality X-ray absorption spectra from several reference compounds. First applications include temperature-dependent EXAFS experiments from liquid-nitrogen temperature in a bath cryostat up to ∼660 K by using a dedicated furnace. Besides transmission measurements, fluorescence detection for dilute sample systems as well as surface-sensitive reflection-mode experiments are presented.

Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis

BACKGROUND

A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points.

METHODS

Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data.

RESULTS

In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay).

CONCLUSION

Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.

Photochemische Synthese von Pinocarvon-, Pulegon- und Benzalacetophenon-tricarbonyleisen. Ein Beitrag zur Frage der Bindung α, β-ungesättigter Ketone in Eisen-Komplexen / Photochemical Synthesis of Pinocarvone-, Pulegone-, and Benzalacetophenone-tricarbonyliron. A Contribution to the Nature of Bonding in Iron-Complexes of α,β-unsaturated Ketones

The photochemical synthesis of the title compounds is described. It has been established by spectroscopic evidence and by the x-ray structure of pinocarvone tricarbonyliron that in all these cases bonding to the iron involves only the π-system of the α,β-unsaturated ketones and not the nonbonding electrons of the keto group. The preferential site of monodentate coordination of α,β-unsaturated carbonyl compounds to transition metals is discussed on the basis of MO-considerations which are extended to 1,2-dicarbonyl compounds.

Di-μ-halogeno-bis(tricarbonyleisen): Über die Bildung dimerer Halogeneisentricarbonyle bei der thermischen und photochemischen Umsetzung von Eisencarbonylen mit Halogenwasserstoff / Di-μ-halogen-bis (tricarbonyliron) : Formation of Dimeric Halogen Iron Tricarbonyls in the Thermal and Photochemical Reaction of Iron Carbonyls with Hydrogen Halides

The hitherto unknown dimeric halogen iron tricarbonyls [Fe(CO)3X]2 (X = Br, I) have been prepared by reacting HBr or HI with Fe2(CO)9 and by the photoreaction of Fe(CO)5 with HBr. The properties of these compounds are discussed.

Synthese und UV-Spektrum von Thiopyrano[4.3-b]indol

Thiopyrano[4.3-b]indol (1) wird durch Dehydrierung von Tetra-hydro-1 mit Chloranil erhalten und durch das UVS-Spektrum charakterisiert. SCF-LCI-PPP-Berechnungen werden auf Aza-schwefelheterocyclen ausgedehnt und zur Berechnung des Spektrums von 1 verwendet.

Clinical, biochemical and haemathological effects in Rhamdia quelen exposed to cypermethrin

The acute intoxication of Cypermethrin in Silver Catfish (Rhamdia quelen) was evaluated. Animals weighing 56.67±4.43g and measuring 18.92±1.16cm were exposed to sublethal concentrations of Cypermethrin for the species in hydrological conditions during 96 hours. A total of 52 fish divided into three groups were used and received the following concentrations of Cypermethrin: 0 (n=12); 1.5 (n=20) and 2.5 (n=20)mg/L. The intoxicated animals suffered behavioral changes such as loss of balance, swimming alteration, dyspnea, upright swimming and sudden spiral swimming movements. As soon as the 96-hour period was over, a blood collection for hematological and biochemical analyses was performed. A complete haemogram test, plasmatic protein test, albumin, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma glutamyltransferase and alkaline phosphatase (ALP) were studied. The values of erythrocytes, hematocrits, haemoglobin, total number of leukocytes, thrombocyte, ALT, AST and ALP changed according to the groups. The results have shown that the environmental contamination by Cypermethrin is toxic to the species.

Age-dependent association of serum prolactin with glycaemia and insulin sensitivity in humans

The dopamine agonist bromocriptine has been approved for the treatment of type 2 diabetes in the United States. Bromocriptine inhibits prolactin secretion, and patients with hyperprolactinaemia display impaired insulin sensitivity. We therefore hypothesized that low prolactin levels are associated with lower glycaemia and higher insulin sensitivity in healthy subjects. Prolactin levels were determined from fasting serum in participants without diabetes from the cross-sectional Tübingen family study for type 2 diabetes (m/f = 562/1,121, age = 40 ± 13 years, BMI = 30 ± 9 kg/m(2)). A 75 g oral glucose tolerance test was performed, and the area under the glucose curve (AUC(0-120)Glucose) and insulin sensitivity index were calculated. A subgroup (n = 494) underwent hyperinsulinaemic-euglycaemic clamp tests. Prolactin associated positively with insulin sensitivity (p = 0.001, adjusted for gender, age, and BMI). Age strongly interacted (p < 0.0001) with the effect of prolactin on insulin sensitivity, inverting the positive relationship to a negative one in younger participants. Glycated haemoglobin (HbA1c) and AUC(0-120)Glucose correlated negatively with prolactin, and an interaction with age was found as well. Higher prolactin levels are associated with improved insulin sensitivity and lower glucose in individuals without diabetes. This relationship turns to its opposite in younger persons. As prolactin is a proxy for the dopaminergic tone in the central nervous system, these associations may indicate an age-dependent influence of the brain on peripheral insulin sensitivity.

[The professional and private situation of male and female physicians entering postgraduate medical education in Germany]

AIM

This study investigated the professional and the private situation of medical interns at the onset of their postgraduate training in Germany. We analysed the contractual situation and the working hours in the hospital, the professional situation of the partner and the number of hours invested in private life with special reference to gender and children.

METHOD

A standardised postal survey was conducted among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg after entering postgraduate training. 1 009 were contacted for a first follow-up one year later and 87% responded. Descriptive statistics and regression analysis were performed.

RESULTS

The analysis shows that female physicians are disadvantaged compared to males with regard to various professional and private conditions relevant for career development, especially when children are present. We found a large number of hints pointing towards a persistence of traditional role patterns within the couple relationship. These conditions differed substantially between the regions of former German Federal and former German Democratic Republic.

CONCLUSIONS

A growing number of children in the study population in the course of the longitudinal analysis will show if these gender-related differences persist in the course of the training period and which influences on career development can be observed.

Structural changes in amorphous Ge(x)SiO(y) on the way to nanocrystal formation

Temperature induced changes of the local chemical structure of bulk amorphous GexSiOy are studied by Ge K-edge x-ray absorption near-edge spectroscopy and Si L2/3-edge x-ray Raman scattering spectroscopy. Different processes are revealed which lead to formation of Ge regions embedded in a Si oxide matrix due to different initial structures of as-prepared samples, depending on their Ge/Si/O ratio and temperature treatment, eventually resulting in the occurrence of nanocrystals. Here, disproportionation of GeOx and SiOx regions and/or reduction of Ge oxides by pure Si or by a surrounding Si sub-oxide matrix can be employed to tune the size of Ge nanocrystals along with the chemical composition of the embedding matrix. This is important for the optimization of the electronic and luminescent properties of the material.

Insulin resistant phenotype of polycystic ovary syndrome does not seem to be caused by variation in FTO

Genetic variation in the FTO gene is associated with increased body weight and reduced insulin sensitivity. We investigated whether genetic variation in FTO is associated with polycystic ovary syndrome (PCOS), a condition also characterized by insulin resistance. Furthermore, we tested whether insulin resistance is specifically associated with genetic variation in FTO in women with PCOS. Sixty-two nondiabetic patients with PCOS defined by the Rotterdam criteria were compared to BMI and age-matched women. Each PCOS case was matched to 2 controls. All participants underwent an oral glucose tolerance test and were genotyped for the single nucleotide polymorphism rs8050136 in the FTO gene. There was no difference in the frequency of FTO genotypes between the PCOS and the non-PCOS groups. In non-PCOS participants, genetic variation in FTO is associated with insulin sensitivity (p=0.03). This association remained significant after adjustment for age and/or BMI (p<= 0.03). In subjects with PCOS, however, FTO did not associate with insulin sensitivity (p=0.67). Genetic variation in FTO does not have an impact on insulin sensitivity in women with PCOS and is therefore not involved in the pathogenesis of the insulin resistant phenotype seen in patients with PCOS.