A primer of an in-depth resilience status for German medical graduates: results of a cross-sectional survey on the status quo of resilience among graduates of human medicine in Bavaria, Germany - a necessary step in building an emotionally equipped healthcare work-force

BACKGROUND Resilience is a widely-used catchword in the last couple of years to describe the resistance to psychological strains of life, especially for the healthcare work-force. The promises of resilience to burnout sound great and what we all would want: less health impairment despite stress, higher work satisfaction and last but not least higher work performance. There is research that shows that students and physicians have high emotional distress and low resilience, yet comparably little is known which aspects of resilience are exactly impaired in the upcoming work-force. With our study we investigated the in-depth resilience status of medical graduates from five medical schools within their first year after graduation. In this, additionally to assessing the resilience status as a whole we investigate the answers on the singular items and the relationship of the resilience status with neighboring constructs. METHODS In 2018, 1610 human medical graduates from five Bavarian medical schools were asked to take part at cross-sectional Bavarian graduate survey (Bayerische Absolventenstudie Medizin, MediBAS). The response rate was 38,07, 60% of the participants were female. For the identification of the in-depth resilience status we included the 5-point Likert 10-Item Connor-Davidson Resilience Scale, German Version in a graduate survey posted to 5 medical schools and over 1610 eligible participants of whom 610 (60% female) filled out at least parts of the survey. To identify relationships to other aspects we posed further questionnaires. RESULTS The resilience status showed a mean resilience score of M = 37.1 (SD = 6.30). The score ranges from 3.22 (I am not easily discouraged by failure) to 4.26 (I am able to adapt to change). One third of the participants chose not to answer the item \textquotedblI am able to handle unpleasant feeling\textquotedbl. Relationships to job satisfaction, scientific competence and stress are presented in the article. CONCLUSIONS The study shows that the overall resilience status of medical graduates one year after their graduation is rather high, but subjectively they do not feel equivalently resilient for the different aspects they face in their job. Especially, how to handle their emotions seems to be challenging for some of the young physicians. In the article we sketch ideas how to handle the specific training needs the study has identified

Impact of NOx vehicle emission standards failure on Air Quality in Europe

Vehicle exhaust emission standards have been tightened in the EU for several decades now, in order to protect health and the environment. This has led to a substantial decrease in total pollutant emissions, despite the growing volumes of passenger and freight transport. However, national emissions, particularly of NOx, exceed the ceilings accorded under the Gothenburg Protocol of the UNECE's Convention on Long-Range Transboundary Air Pollution (LRTAP) (EEA 2012) in twelve EU Member States. The main reasons for such exceedances are that more diesel cars have been sold than originally predicted when fixing the targets, and that diesel cars emit much more than expected under real-world driving conditions. The latter appears as a consequence of the effort to achieve high fuel efficiency. While this has largely helped to control CO2 emissions, it was to the detriment of NOx. In this study we estimate what the impact of the different vehicle emission standards has been so far and to predict what the impact of upcoming emission standards will be in the future, using the best current knowledge on road transport activity statistics and emission factors in Europe. We present several sensitivity calculations to reflect the considerable uncertainty about the real-driving NOx emissions of diesel light duty vehicles. The results of this work can be useful in designing both limits for upcoming standards but also in assessing the impact of deviating from such limits. This is necessary in both deciding on the next steps of emission control policy and to relevant air quality prediction models

Compliance with EU air quality limit values - A first set of sensitivity and optimization analyses

This report provides additional information to the baseline and optimized scenarios that have been developed for the review and revision of the Thematic Strategy on Air Pollution in TSAP Reports #6 and #7. The report examines the implications of different assumptions on the implementation of the Euro-6 emission standards for light duty diesel vehicles on compliance with NO2 air quality limit values in Europe. For the baseline assumptions of the TSAP-2012 baseline scenario, i.e., a decline of real-driving emission in two stages down to 1.5 times the value of test cycle value in 2018, it is estimated that almost all AIRBASE stations that have been modelled in this exercise would achieve the NO2 limit values by 2030 at the latest. However, in the least optimistic sensitivity case, i.e., under the assumption of a failure of Euro-6 (no change in real-driving emissions compared to Euro-4), about 100 out of the 1173 AIRBASE monitoring stations would still remain in non-compliance with the limit value in 2030. A second analysis examines the optimization results presented in TSAP Report #7 in more detail and provides, for each of the optimized scenarios, the sectors in which emission reductions would occur in the cost-optimal cases. These emission reductions will lead to lower background pollution concentrations in Europe, which will affect PM10 levels within cities. It is estimated, e.g., for the high ambition case, that in 2030 the number of stations for which non-compliance is robustly estimated will decline by about 20%. The number of stations for which compliance seems possible but not certain would fall by 30% compared to the baseline. In contrast, the optimized scenarios do not yield significant improvements in the compliance with NO2 limit values, as the series of scenarios did not consider further measures for road vehicle emissions. Finally, an initial assessment of current and future emissions of mercury in Europe suggests for the TSAP-2012 baseline a decline of Hg emissions of 22% in 2020 and about 30% in 2030 (relative to 2005), mainly as a consequence of lower coal use in the power sector. Full implementation of the available technical emission controls, especially of certain measures to reduce PM emissions, could eliminate Hg emissions in the EU by another third, so that in 2030 the total release of Hg in the EU could be more than 50% lower than in 2005

MatricS—A novel tool for monitoring professional role development in surgical disciplines

Introduction: Mentoring is an effective method for human resource development. Monitoring the process is important for individual mentee/mentor pairs as well as for program directors. Due to individual personality differences of both mentees and mentors and their respective interactions, it is challenging to monitor the individual development process of mentees in a structured manner. This study investigates to what extent a novel instrument, the mentee-based assessment tool for role development of interpersonal competencies in surgical professions (MatricS) can adequately monitor the professional role development process of residents during an established mentoring program. Material and methods: In a prospective longitudinal study, the competence development of 31 mentees in two subsequent cohorts was assessed by a modified role matrix based on Canadian Medical Education Directives for Specialists. The evaluation focused on three defined roles (D, developer; N, networker; M, multiplicator) at three levels (private, employer-related, national/international) with four stages of development. For validation of mentee self-assessments, the assessments of the respective mentors were recorded alongside. For correlation analyses, Pearson coefficients were calculated, pre-post-comparisons were done by paired t-tests; significance was assumed at p < 0.05, respectively. Results: Mentee self-assessments overall correlated well with the objective mentor assessments (Pearson's r 0.8, p 75% of all roles and levels. Conclusion: The role development process during mentoring can be reliably monitored by using MatricS. MatricS scores highly correlate between mentees and mentors, indicating that mentee self-assessments are suitable and sufficient for monitoring. These findings help to lessen the work burden on senior surgeons and thus can help to increase the acceptance of mentoring programs in surgical disciplines

Further vehicle exhaust emission controls and their impact on NO2 air quality in Europe

About 8% of the urban population in the European Union (EU28) is exposed to ambient NO2 concentrations in excess of the annual air quality limit value of 40 μg/m3 (Guerreiro et al. 2014, 56f.). In addition, eleven Member States have not met their 2010 NOx emissions cap under the EU Directive on Emission Ceilings, and six countries continue failing still in 2013 (EEA 2015b). High on-road NOx emissions notably from diesel cars are made responsible for the persistent exceedance of the NO2 air quality limit value, in particular along urban roads (EEA 2015a). NOx emissions from all sectors are expected to decrease by more than 40% between 2015 and 2030 if legislation is implemented as planned in EU28. NOx emissions from diesel heavy duty and light duty vehicles are expected to decline by 80% and 60%, respectively, in the same period (Markus Amann et al. 2014). In consequence, exceedances of the NO2 ambient limit values are expected to decrease. However, there is particular uncertainty about the on-road emissions from future light duty diesel vehicles. Therefore, how many stations will still remain in excess of the ambient air quality limit value does crucially depend on the real-world NOx emissions of Euro 6 light duty diesel vehicles (Borken-Kleefeld and Ntziachristos 2012) (Fig. 1). In case of high on-road NOx emissions from Euro 6 diesel cars and light commercial vehicles there might be a need for further emission controls. This study explores how much an additional hypothetical emission control stage (called Euro 7/VII) for light- and heavy-duty diesel vehicles could help to reduce further or quicker the NO2 ambient concentrations

Rationality as the Rule of Reason

The demands of rationality are linked both to our subjective normative perspective (given that rationality is a person-level concept) and to objective reasons or favoring relations (given that rationality is non-contingently authoritative for us). In this paper, I propose a new way of reconciling the tension between these two aspects: roughly, what rationality requires of us is having the attitudes that correspond to our take on reasons in the light of our evidence, but only if it is competent. I show how this view can account for structural rationality on the assumption that intentions and beliefs as such involve competent perceptions of downstream reasons, and explore various implications of the account