Association Between Empathy and Burnout Among Emergency Medicine Physicians

Background: The association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation. Methods: This was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups. Results: A total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores. Conclusion: Self-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians

Diffuse Galactic Gamma Rays from Shock-Accelerated Cosmic Rays

A shock-accelerated particle flux \propto p^-s, where p is the particle momentum, follows from simple theoretical considerations of cosmic-ray acceleration at nonrelativistic shocks followed by rigidity-dependent escape into the Galactic halo. A flux of shock-accelerated cosmic-ray protons with s ~ 2.8 provides an adequate fit to the Fermi-LAT gamma-ray emission spectra of high-latitude and molecular cloud gas when uncertainties in nuclear production models are considered. A break in the spectrum of cosmic-ray protons claimed by Neronov, Semikoz, & Taylor (PRL, 108, 051105, 2012) when fitting the gamma-ray spectra of high-latitude molecular clouds is a consequence of using a cosmic-ray proton flux described by a power law in kinetic energy.Comment: Version to correspond to published letter in PRL; corrected Fig.

Comparing internal migration across the countries of Latin America: A multidimensional approach.

While considerable progress has been made in understanding the way particular aspects of internal migration, such as its intensity, age profile and spatial impact, vary between countries around the world, little attention to date has been given to establishing how these dimensions of migration interact in different national settings. We use recently developed measures of internal migration that are scale-independent to compare the overall intensity, age composition, spatial impact, and distance profile of internal migration in 19 Latin American countries. Comparisons reveal substantial cross-national variation but cluster analysis suggests the different dimensions of migration evolve systematically to form a broad sequence characterised by low intensities, young ages at migration, unbalanced flows and high friction of distance at lower levels of development, trending to high intensities, an older age profile of migration, more closely balanced flows and lower friction of distance at later stages of development. However, the transition is not linear and local contingencies, such as international migration and political control, often distort the migration-development nexus, leading to unique migration patterns in individual national contexts

Black Football Student-Athletes’ Perceived Barriers to Seeking Mental Health Services

Black male student-athletes have endured frequent stereotyping on college campuses (Hawkins, 2010). Additionally, Black student-athletes have experienced educational, campus, and athletic stressors (Miller & Hoffman, 2009). Many student-athletes do not seek mental health services because of their status on campus (Watson, 2005). The general population has experienced common barriers in seeking mental health services including low socio-economic status (Hurd, Stoddard, & Zimmerman, 2013) and negative stigmas related to metal illness (Wang et al., 2005). While it is reasonable to assume similar challenges exist for Black student-athletes, it must be investigated empirically. As such, the purpose of this study was to examine the perceived barriers Black Division I football student-athletes face in seeking professional mental health services. Using phenomenological methodology, semi-structured interviews were conducted with nine Black football student-athletes. The data revealed two themes: weakness and silence. The results of this study will allow stakeholders to better assist this population in seeking mental health treatment and eliminating the barriers associated with seeking mental health services

A Mid-Infrared Study of the Young Stellar Population in the NGC 2024 Cluster

We present the results of the first broadband 10.8 um survey of the NGC 2024 cluster. The mid-infrared data were combined with our previously published JHKL photometry in order to construct spectral energy distributions for all detected sources. The main scientific goals were to investigate the nature of the young stellar objects (YSOs) in the cluster, and to examine the efficiency of detecting circumstellar disk sources from near-infrared JHKL color-color diagrams. Out of 59 sources surveyed having K-band magnitudes K < 10.5, we detected 35 (~59%) at 10 um. Combining these detections, and upper limits for the non-detections, with existing JHKL data, we identify 1 Class I, 6 flat spectrum, 28 Class II and 5 Class III sources. We find a circumstellar disk fraction for NGC 2024 of ~85% +/- 15%, which confirms earlier published suggestions that the majority, if not all, of the stars in NGC 2024 formed with disks, and these disks still exist at the present time. In addition, all but one of the disk sources identified in our survey lie in the infrared excess region of the JHKL color-color diagram for the cluster. This demonstrates that JHKL color-color diagrams are extremely efficient in identifying YSOs with disks. Of the 14 sources with K - L colors suggestive of protostellar objects, \~29% are protostellar in nature, while ~7% are true Class I YSOs. This may be due to extinction producing very red K - L colors in Class II YSOs, thus making them appear similar in color to protostars. This suggests caution must be applied when estimating the sizes and lifetimes of protostellar populations within star forming regions based on K - L colors alone. Finally, we calculate the luminosities of the Class II YSOs in NGC 2024, rho Oph and Taurus and discuss the results.Comment: 30 pages, 8 figures, paper to appear in March A

A DNA methylation signature in the stress driver gene Fkbp5 indicates a neuropathic component in chronic pain

BACKGROUND: Epigenetic changes can bring insight into gene regulatory mechanisms associated with disease pathogenicity, including chronicity and increased vulnerability. To date, we are yet to identify genes sensitive to epigenetic regulation that contribute to the maintenance of chronic pain and with an epigenetic landscape indicative of the susceptibility to persistent pain. Such genes would provide a novel opportunity for better pain management, as their epigenetic profile could be targeted for the treatment of chronic pain or used as an indication of vulnerability for prevention strategies. Here, we investigated the epigenetic profile of the gene Fkbp5 for this potential, using targeted bisulphite sequencing in rodent pre-clinical models of chronic and latent hypersensitive states. RESULTS: The Fkbp5 promoter DNA methylation (DNAm) signature in the CNS was significantly different between models of persistent pain, and there was a significant correlation between CNS and peripheral blood Fkbp5 DNAm, indicating that further exploration of Fkbp5 promoter DNAm as an indicator of chronic pain pathogenic origin is warranted. We also found that maternal separation, which promotes the persistency of inflammatory pain in adulthood, was accompanied by long-lasting reduction in Fkbp5 DNAm, suggesting that Fkbp5 DNAm profile may indicate the increased vulnerability to chronic pain in individuals exposed to trauma in early life. CONCLUSIONS: Overall, our data demonstrate that the Fkbp5 promoter DNAm landscape brings novel insight into the differing pathogenic origins of chronic pain, may be able to stratify patients and predict the susceptibility to chronic pain

A Serpin shapes the extracellular environment to prevent influenza A virus maturation

Interferon-stimulated genes (ISGs) act in concert to provide a tight barrier against viruses. Recent studies have shed light on the contribution of individual ISG effectors to the antiviral state, but most have examined those acting on early, intracellular stages of the viral life cycle. Here, we applied an image-based screen to identify ISGs inhibiting late stages of influenza A virus (IAV) infection. We unraveled a directly antiviral function for the gene SERPINE1, encoding plasminogen activator inhibitor 1 (PAI-1). By targeting extracellular airway proteases, PAI-1 inhibits IAV glycoprotein cleavage, thereby reducing infectivity of progeny viruses. This was biologically relevant for IAV restriction in vivo. Further, partial PAI-1 deficiency, attributable to a polymorphism in human SERPINE1, conferred increased susceptibility to IAV in vitro. Together, our findings reveal that manipulating the extracellular environment to inhibit the last step in a virus life cycle is an important mechanism of the antiviral response

Microarray and pathway analysis reveals decreased CDC25A and increased CDC42 associated with slow growth of BCL2 overexpressing immortalized breast cell line

Bcl-2 is an anti-apoptotic protein that is frequently overex-pressed in cancer cells but its role in carcinogenesis is not clear. We are interested in how Bcl-2 expression affects non-cancerous breast cells and its role in the cell cycle. We prepared an MCF10A breast epithelial cell line that stably overexpressed Bcl-2. We analyzed the cells by flow cytometry after synchronization, and used cDNA microarrays with quantitative reverse-transcription PCR (qRTPCR) to determine differences in gene expression. The microarray data was subjected to two pathway analysis tools, parametric analysis of gene set enrichment (PAGE) and ingenuity pathway analysis (IPA), and western analysis was carried out to determine the correlation between mRNA and protein levels. The MCF10A/Bcl-2 cells exhibited a slow-growth phenotype compared to control MCF10A/Neo cells that we attributed to a slowing of the G1-S cell cycle transition. A total of 363 genes were differentially expressed by at least two-fold, 307 upregulated and 56 downregulated. PAGE identified 22 significantly changed gene sets. The highest ranked network of genes identified by IPA contained 24 genes. Genes that were chosen for further analysis were confirmed by qRT-PCR, however, the western analysis did not always confirm differential expression of the proteins. Downregulation of the phosphatase CDC25A could solely be responsible for the slow growth pheno-type in MCF10A/Bcl-2 cells. Increased levels of GTPase Cdc42 could be adding to this effect. PAGE and IPA are valuable tools for microarray analysis, but protein expression results do not always follow mRNA expression results. Originally published Cell Cycle, Vol. 7, No. 19, Oct. 200

The Photo Essay: A Visual Research Method for Educating Obstetricians and Other Health Care Professionals

When it comes to issues related to low-income women seeking early, adequate, or continuous prenatal ca re, the public health and medical communities continue to tell women to take responsibility for their actions. Rarely are messages aimed at providers. To help physicians see how factors in their offices and clinics can affect service utilization, the photo essay, a visual qualitative research strategy was developed using low- income minority and disenfranchised women who had recently given birth or were near to giving birth. Eight photo essays were completed. Together, the narratives, in collaboration with the photos, provided an opportunity for physicians to hear and observe women, as consumers, as they expanded their descriptions of their prenatal care experience