A Longitudinal Study of Resident Emotional Stability, Self-Reported Health and Perceptions of Programmatic Support

Purpose: Certain characteristics such as acceptance, planning, and humility have correlated with less burnout among resident physicians. However, less is known about residency program culture, socialization, and support. The purpose of this study is to investigate social isolation, solidarity, stress, and frustration over time, their self-reported health, as well as the programmatic support. Methods: A longitudinal self-administered survey implemented within an academic pediatric residency program to track resident characteristics over time. Results: In Wave 1, among 101 residents, 78 (77%) responded. In Wave 2, among 98 residents, 73 (74%) responded. 45 residents were in both Wave 1 and 2. All measures of resident characteristics were stable over time. Worse overall health at Wave 2 is associated with feeling alone in residency at Wave 1 (r-.48). More stress (r.35), frustration (r.36) and feeling alone (r.53) (Wave 1) is associated with higher reports of bad mental health in Wave 2 while inversely associated with socializing frequently with other residents outside of work (r-.36) (Wave 1). Thinking the program helps residents cope with stress (r-.49) and that they communicate resources (r-.35) (Wave 1) correlate with improved mental health (Wave 2). Conclusion: Both negative characteristics such as stress and frustration as well as positive ones such as trust and socialization are stable over time. Some Wave 1 characteristics are healthful for residents while others deleterious at Wave 2. Perceptions of programmatic involvement may be helpful for resident mental health

Effects of rainfall on the atmosphere and the ocean during spurs-2

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Clayson, C. A., Edson, J. B., Paget, A., Graham, R., & Greenwood, B. Effects of rainfall on the atmosphere and the ocean during spurs-2. Oceanography, 32(2), (2019):86-97, doi: 10.5670/oceanog.2019.216.The salinity variability of the upper ocean is influenced by surface heat, momentum, and freshwater fluxes, which are in turn affected by atmospheric conditions. It is necessary to accurately measure these surface fluxes within their atmospheric environment to understand the linkages between rain events and the resulting upper-ocean salinity balance that occurs at cloud scales. We describe a comprehensive set of atmospheric and oceanic data collected during the second Salinity Processes in the Upper-ocean Regional Study (SPURS-2) experiment in the tropical eastern Pacific Ocean. These measurements included direct estimates of heat, moisture, and momentum fluxes using direct covariance flux systems on R/V Roger Revelle and a 3 m discus buoy. These are the first successful direct measurements of evaporation from a buoy over an extended period. The atmospheric moisture budget is estimated from a combination of data, including measured freshwater fluxes, upper air sounding data, and satellite data. This analysis reconfirms the important role of moisture convergence beneath the Intertropical Convergence Zone in this region. We perform an analysis of the near-surface vertical salinity structure and its relationship to these surface fluxes, highlighting the roles of stabilization by solar insolation and precipitation and the effects of rainfall on mixing of the upper ocean.This research was supported by NASA under grants NNX15AF70G and NNX15AG20G

Effects of a Severe Cold Event on the Subtropical, Estuarine-Dependent Common Snook, Centropomus undecimalis

The effects of infrequent disturbance events on marine fishes are often difficult to determine, due largely to lack of sufficient pre- and post-disturbance event data. In January 2010, subtropical southwestern Florida (USA) experienced extreme cold for 13 days, which caused extensive mortality of many fish species. The effect of this severe cold event on common snook (Centropomus undecimalis), an economically important gamefish, was assessed using three years (2007-2009) of pre-event and one year (2010) of post-event data from a tag-recapture program conducted over 28 km of Gulf of Mexico barrier islands of Florida. All metrics pointed to a significant effect of the severe cold event: post-disturbance apparent survival of marked fish was 96-97% lower than pre-disturbance, and post-disturbance common snook abundance was 75.57% and 41.88% less than in 2008 and 2009, the two years immediately pre-event. Although severe cold events have impacted subtropical Florida in the past, these events are infrequent (the previous recorded event was \u3e30 years prior), and documentation of the impacts on common snook have not previously been published

Innovations in the Art of Microneurosurgery for Reaching Deep-Seated Cerebral Lesions

Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator’s range of technical expertise. Increasingly, microneurosurgeons must select between multiple operative corridors that can access to the surgical target. Innovative trajectories have emerged for many indications that provide more flexible operative angles and superior exposure but result in longer working distances and more technically demanding maneuvers. In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues

Expression and Site-Directed Mutagenesis of Type III Polyketide Synthases

Natural products are a well-established source of drugs, and evolution has yielded polyketides such as leinamycin and iso-migrastatin that have demonstrated anti-tumor activity. Polyketides are large metabolites with a high degree of chemical variability and are commonly produced by soil bacteria. Polyketide synthases (PKS) exist as three different archetypes, and the reaction mechanisms of ketosynthases from all archetypes is not understood. Type III PKSs exist as an independently functioning ketosynthase (KS), which primarily use coenzyme A (CoA), with some exceptions, for the biosynthesis of polyketides. We elected to focus our studies on ketosynthases, because they are responsible for forming the carbon-carbon bonds seen in polyketides. To study these Type III PKS KS, we expressed Streptomyces coelicolor germicidin synthase (Gcs) and tetrahydroxynaphthlene synthase (THNS) in E. coli and mutant versions where the catalytic active cysteine was changed to a serine or glutamine. In previous studies, serine slowed the overall progress of the reaction, and glutamine abolished carbon-carbon bond formation but promoted malonyl-CoA decarboxylation. We verified our mutations using a third party organization’s fluorescent sequencing by dye termination services, as well as confirmed that an acceptable level of expression of our protein is occurring in our BL21 cell lines using SDS-PAGE and Fast Protein Liquid Chromatography (FPLC). Now that we have successfully expressed and mutated our protein, we can move forward and use substrate mimics in conjunction with our mutants to further understand the catalytic mechanism of ketosynthases

FACILITY UPGRADES FOR RECEIPT FROM ACTINIDE REMOVAL AND MODULAR CAUSTIC SIDE SOLVENT EXTRACTION PROCESSES AT THE SAVANNAH RIVER SITE

The Savannah River Site (SRS) is currently on an aggressive program to empty its High Level Waste (HLW) tanks and immobilize its radioactive waste into a durable borosilicate glass in the Defense Waste Processing Facility (DWPF). As a part of that program, two new processes will be brought on-line to assist in emptying the HLW tanks. These processes are in addition to the current sludge removal process and are called the Actinide Removal Process (ARP) and the Modular Caustic Side Solvent Extraction (MCU) Process. In order to accept and process the streams generated from these two new processes, several facility modifications are required and are broken down into several projects. These projects are handling the facility modifications required for the Tank Farm (241-96H), and DWPF vitrification facility (221-S), and DWPF ancillary facilities (511-S, and 512-S). Additional modifications to the 221-S building were required to address the flammability concern from the solvent carryover from the MCU process. This paper will describe a summary of the modifications impacting the 511-S, 512-S, and the 221-S facilities in order to receive the new streams from the ARP and MCU processes at the DWPF

Visual Prognosis after Explantation of Small-Aperture Corneal Inlays in Presbyopic Eyes: A Case Series

The purpose of this study was to report visual prognosis after explantation of a small-aperture corneal inlay used for the treatment of presbyopia. This is a retrospective case series conducted at a single site in Draper, Utah, USA (Hoopes Vision). Medical records of 176 patients who had received a small-aperture corneal inlay (KAMRA™, AcuFocus Inc., Irvine, CA, USA) were reviewed. Patients who had undergone explantation of the device were identified. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and manifest refraction spherical equivalent (MRSE) were measured pre-implantation, post-implantation, pre-explantation, and post-explantation of the inlay. Ten eyes from ten patients were included in this study. The explantation rate was 5.7% over 31 months, with blurry vision as the most common complaint. After explantation, six patients achieved pre-implantation UDVA, and six achieved pre-implantation UNVA. Eight of nine patients who underwent final manifest refraction achieved pre-operative CDVA. All patients had residual donut-shaped corneal haze in the stroma at the previous position of the inlay. All patients experienced improvement in haze with 20% experiencing complete resolution. The degree of stromal haze was not related to the duration of implantation. Of the subset of patients who underwent explantation of their small-aperture corneal inlay, there was persistent loss of CDVA in 10%. The majority of patients experienced some level of residual stromal haze, which may contribute to deficits in UNVA and CDVA in few patients. A hyperopic shift induced by the corneal inlay may contribute to the blurry vision these patients experienced; there was a reduction of this shift post-explantation. While this device is removable, patients should expect some post-explantation changes such as residual haze with a small subset experiencing persistent deficits in CDVA