Work expectations, their fulfillment, and exhaustion among radiologists of all career levels: what can be learned from the example of Germany.

OBJECTIVES: To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. METHODS: A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). RESULTS: The most frequent expectations were "joy at work" (97%) and a "good working atmosphere" (97%), which were considered fulfilled by at least 78%. The expectation of a "structured residency within the regular time interval" (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95-9.52]), chief physicians (85%, 6.81 [95% CI 1.91-24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40-24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5-10 extra hours: OR 2.54 [95% CI 1.54-4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32-3.13]) and emotional (2.15 [95% CI 1.39-3.33]) exhaustion. CONCLUSIONS: While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. KEY POINTS: • Most important work expectations of radiologists who work in Germany are "joy at work," a "good working atmosphere," "support for further qualification," and a "structured residency within the regular time interval," with the latter containing potential for improvement according to residents. • Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. • Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.

Assessing capacity to consent to treatment with cholinesterase inhibitors in dementia using a specific and standardized version of the MacArthur Competence Assessment Tool (MacCAT-T).

BACKGROUND: The use of assessment tools has been shown to improve the inter-rater reliability of capacity assessments. However, instrument-based capacity assessments of people with dementia face challenges. In dementia research, measuring capacity with instruments like the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) mostly employ hypothetical treatment vignettes that can overwhelm the abstraction capabilities of people with dementia and are thus not always suitable for this target group. The primary aim of this study was to provide a standardized real informed consent paradigm that enables the dementia-specific properties of capacity to consent to treatment in people with dementia to be identified in a real informed consent process that is both externally valid and ethically justifiable. METHODS: The sample consisted of 53 people with mild to moderate dementia and a group of 133 people without cognitive impairment. Rather than using a hypothetical treatment vignette, we used a standardized version of the MacCAT-T to assess capacity to consent to treatment with cholinesterase inhibitors in people with dementia. Inter-rater reliability, item statistics, and psychometric properties were also investigated. RESULTS: Intraclass correlations (ICCs) (0.951-0.990) indicated high inter-rater reliability of the standardized real informed consent paradigm. In the dementia group, performance on different items of the MacCAT-T varied. Most people with dementia were able to express a treatment choice, and were aware of the need to take a tablet. Further information on the course of the disorder and the benefits and risks of the treatment were less understood, as was comparative reasoning regarding treatment alternatives. CONCLUSION: The standardized real informed consent paradigm enabled us to detect dementia-specific characteristics of patients' capacity to consent to treatment with cholinesterase inhibitors. In order to determine suitable enhanced consent procedures for this treatment, we recommend the consideration of MacCAT-T results on an item level. People with dementia seem to understand only basic information. Our data indicate that one useful strategy to enhance capacity to consent is to reduce attention and memory demands as far as possible.

Measuring four perspectives of justice sensitivity with two items each.

People differ systematically in their vulnerability to injustice. We present two-item scales for the efficient measurement of justice sensitivity from 4 perspectives (victim, observer, beneficiary, perpetrator). In Study 1 using a quota-based sample of German adults, a latent state-trait analysis revealed the factorial validity and high reliabilities of the scales. In Study 2 employing a large random sample, we tested for measurement invariance of the items within the context of our short 2-item scales compared to the original 10-item scales. Multigroup confirmatory factor analyses confirmed that the validity of the indicators and the internal structure of the assessed constructs did not change across item contexts. In both studies, correlations with personality dimensions and life satisfaction provide evidence for the validity of our scales. With the presented instrument, future research can extend scientific knowledge regarding the role of individual differences in reactions to injustice for the explanation of well-being and physical health.

Comparing indirect methods of digit ratio (2D:4D) measurement.

The ratio of the lengths of the second and fourth finger (2D:4D) has been proposed to index prenatal exposure to androgens. Different methods have been utilized to measure digit ratio, however, their measurement precision and economy have not been systematically compared yet. Using different indirect methods (plastic ruler, caliper, computer software), three independent raters measured finger lengths of 60 participants. Generally, measurement precision (intraclass correlation coefficient, technical error of measurement, and relative technical error of measurement) was acceptable for each method. However, precision estimates were highest for the computer software, indicating excellent measurement precision. Estimates for the caliper method were somewhat lower followed by ruler which had the lowest precision. On the contrary, the software-based measurements took somewhat longer to complete than the other methods. Nonetheless, we would favor the use of these tools in digit ratio research because of their relative superior reliability which could be crucial when associations with other variables are expected to be low to moderate or sample size is limited. Software offers several promising opportunities that may contribute to an accurate identification of the proximal finger crease (e.g., zooming, adjusting contrast, etc.).

Short Versus Long Scales in Clinical Assessment: Exploring the Trade-Off Between Resources Saved and Psychometric Quality Lost Using Two Measures of Obsessive-Compulsive Symptoms.

Short measures of psychological constructs are routinely used to save assessment time and cost. The downside is a trade-off between resource savings and psychometric quality. When evaluating tests, a pragmatic strategy is frequently applied that neglects the assessment objective, which may result in unfair rejection or unmindfully acceptance of short scales. Our main aim is to demonstrate the consequences of applying a pragmatic test evaluation strategy. We used two tests that measure the same construct-obsessive-compulsive symptomatology-but differ considerably in test length (1:3) and evaluated the measures by taking the assessment objective into account. The two scale scores showed distinct profiles of psychometric qualities. Whereas routinely evaluated reliability, factorial validity, and convergent/discriminant validity did not differ, rendering both tests useful for research purposes, substantial differences were found for qualities that are rarely focused on-measurement precision and diagnostic validity-which are highly relevant for accurate decisions in clinical practice.

Agentic extraversion as a predictor of effort-related cardiovascular response.

The present study examined an extraversion-based extension of the integrative model of cardiovascular effort regulation by Wright and Kirby [Wright, R.A., Kirby, L.D., 2001. Effort determination of cardiovascular response: an integrative analysis with applications in social psychology. In: Zanna, M.P. (Ed.), Advances in Experimental Social Psychology, Academic Press, San Diego, CA, pp. 255-307.]. This model explains cardiovascular effort reactivity in terms of task difficulty, ability appraisal, and success importance. Aggregate measures of cardiovascular variables (alpha-adrenergic, beta-adrenergic, and cholinergic activation components) were used to measure extraversion-based differences in effort. Subjects performed a sequential letter task (n-back verbal working memory task) with four levels of difficulty. Agentic extraverts (n=10) appraised their ability and happiness as significantly higher than introverts (n=10). Introverts showed the expected shark-fin shaped pattern of effort-related cardiovascular reactivity for the alpha-adrenergic and cholinergic activation components. Effort decreased after the moderately difficult 2-back task. Results provide first evidence for an extraversion-based extension of the model and are discussed with regard to mood and resource allocation as possible mechanisms.

Construct validity of the Anxiety Sensitivity Index-3 in clinical samples.

Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index-3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.