Early Career Experiences of Pediatricians Pursuing or Not Pursuing Fellowship Training

BACKGROUND AND OBJECTIVES: Choosing career paths can be difficult decisions for residents contemplating fellowship training. This study compares the experiences of early career pediatricians who did and did not pursue fellowships. METHODS: We analyzed national, weighted data from pediatricians 8 to 10 years after residency (n = 842). Work environment, work–life balance, and satisfaction were compared for pediatricians who had pursued fellowship training (fellowship trained) and those who did not pursue fellowship training (generalist trained). Logistic and linear regression examined the independent effects of fellowship training while controlling for demographic differences. RESULTS: A total of 39% of the pediatricians (328/842) pursued fellowship training. The fellowship-trained group was less likely than the generalist-trained group to spend time in direct patient care and more likely to report learning opportunities in their work environment. This group was also more likely to report an income of ≥$150 000, although no difference was found when only full-time pediatricians were examined. Generalist-trained pediatricians were more likely to work <50 hours per week, have flexibility with their schedules, and be satisfied with time spent with their own children. Pediatricians in both the fellowship-trained and generalist-trained groups generally found their work to be rewarding and were satisfied with their lives. CONCLUSIONS: Although residents need to consider important life and career differences when contemplating fellowship training and general care, pediatricians in both groups can achieve overall life and career satisfaction

Computer Modeling of Non-Isothermal Crystallization

A realistic computer model for simulating isothermal and non-isothermal phase transformations proceeding by homogeneous and heterogeneous nucleation and interface-limited growth is presented. A new treatment for particle size effects on the crystallization kinetics is developed and is incorporated into the numerical model. Time-dependent nucleation rates, size-dependent growth rates, and surface crystallization are also included. Model predictions are compared with experimental measurements of DSC/DTA peak parameters for the crystallization of lithium disilicate glass as a function of particle size, Pt doping levels, and water content. The quantitative agreement that is demonstrated indicates that the numerical model can be used to extract key kinetic data from easily obtained calorimetric data. The model can also be used to probe nucleation and growth behavior in regimes that are otherwise inaccessible. Based on a fit to data, an earlier prediction that the time-dependent nucleation rate in a DSC/DTA scan can rise above the steady-state value at a temperature higher than the peak in the steady-state rate is demonstrated

Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls

Citation: Cull, B. J., Rosenkranz, S. K., Dzewaltowski, D. A., Teeman, C. S., Knutson, C. K., & Rosenkranz, R. R. (2016). Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls. Pilot and Feasibility Studies, 2(1), 26. https://doi.org/10.1186/s40814-016-0066-yChildhood obesity is a major public health problem, with one third of America’s children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants

The effect of moderate intensity exercise in the postprandial period on the inflammatory response to a high-fat meal: an experimental study

Citation: Teeman, C. S., Kurti, S. P., Cull, B. J., Emerson, S. R., Haub, M. D., & Rosenkranz, S. K. (2016). The effect of moderate intensity exercise in the postprandial period on the inflammatory response to a high-fat meal: an experimental study. Nutrition Journal, 15, 13. doi:10.1186/s12937-016-0134-4Background: Consuming a high-fat meal (HFM) may lead to postprandial lipemia (PPL) and inflammation. Postprandial exercise has been shown to effectively attenuate PPL. However, little is known about the impact of postprandial exercise on systemic inflammation and whether PPL and inflammation are associated. The purpose of this study was to determine whether moderate intensity exercise performed 60 min following a true-to-life HFM would attenuate PPL and inflammation. Methods: Thirty-nine young adults (18-40 year) with no known metabolic disease were randomized to either a control group (CON) who remained sedentary during the postprandial period or an exercise (EX) group who walked at 60 % VO2peak to expend approximate to 5 kcal/kgbw one-hour following the HFM. Participants consumed a HFM of 10 kcal/kgbw and blood draws were performed immediately before, 2 h and 4 h post-HFM. Results: At baseline, there were no differences between EX and CON groups for any metabolic or inflammatory markers (p > 0.05). Postprandial triglycerides (TRG) increased from baseline to 4 h in the EX and CON groups (p 0.05). There was an increase in soluble vascular adhesion molecule (sVCAM-1) from baseline to 4 h (p = 0.027) for all participants along with a group x time interaction (p = 0.020). Changes in TRG were associated with changes in interleukin-10 (IL-10) from 0 to 2 h (p = 0.007), but were not associated with changes in any other inflammatory marker in the postprandial period (p > 0.05). Conclusions: Despite significant increases in PPL following a HFM, moderate intensity exercise in the postprandial period did not mitigate the PPL nor the inflammatory response to the HFM. These results indicate that in populations with low metabolic risk, PPL and inflammation following a HFM may not be directly related

Postprandial lipemic and inflammatory responses to high-fat meals: a review of the roles of acute and chronic exercise

Citation: Teeman, C. S., Kurti, S. P., Cull, B. J., Emerson, S. R., Haub, M. D., & Rosenkranz, S. K. (2016). Postprandial lipemic and inflammatory responses to high-fat meals: a review of the roles of acute and chronic exercise. Nutrition & Metabolism, 13, 14. doi:10.1186/s12986-016-0142-6Postprandial lipemia is an independent risk factor for development of cardiovascular disease. Postprandial inflammation following the prolonged elevation of triglycerides occurring subsequent to ingestion of high-fat meals, provides a likely explanation for increased disease risk. Substantial evidence has shown that acute exercise is an effective modality for attenuation of postprandial lipemia following a high-fat meal. However, much of the evidence pertaining to exercise intensity, duration, and overall energy expenditure for reducing postprandial lipemia is inconsistent. The effects of these different exercise variables on postprandial inflammation is largely unknown. Long-term, frequent exercise, however, appears to effectively reduce systemic inflammation, especially in at-risk or diseased individuals. With regard to an acute postprandial response, without a recent bout of exercise, high levels of chronic exercise do not appear to reduce postprandial lipemia. This review summarizes the current literature on postprandial and inflammatory responses to high-fat meals, and the roles that both acute and chronic exercise play. This review may be valuable for health professionals who wish to provide evidence-based, pragmatic advice for reducing postprandial lipemia and cardiovascular disease risk for their patients. A brief review of proposed mechanisms explaining how high-fat meals may result in pro-inflammatory and pro-atherosclerotic environments is also included

Optimization of Naked DNA Delivery for Interferon Subtype Immunotherapy in Cytomegalovirus Infection

Type I interferon (IFN) gene therapy modulates the immune response leading to inflammatory heart disease following cytomegalovirus (CMV) infection in a murine model of post-viral myocarditis. Efficacy of different immunisation protocols for the IFN constructs was influenced by the dose of DNA, subtype choice, combination use, pre-medication, and timing of DNA administration. Optimal efficacy was found with bupivacaine treatment prior to DNA inoculation of 200mg IFN DNA 14 days prior to virus challenge. Maximal antiviral and antimyocarditic effects were achieved with this vaccination schedule. Furthermore, inoculation of synergistic IFN subtypes demonstrated enhanced efficacy when delivered either alone or with CMV gB DNA vaccination in the CMV model. Thus naked DNA delivery of IFN provides an avenue of immunotherapy for regulating herpesvirus-induced diseases

Gender, climate change, agriculture, and food security: a CCAFS training-of-trainers (TOT) manual to prepare South Asian rural women to adapt to climate change

This training-of-trainers manual is designed to train you to be able to deliver a capacity enhancement workshop (CEW) to rural women on climate change and gender. It has been designed by the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) and is appropriate to the South Asian context

Does moderate intensity exercise attenuate the postprandial lipemic and airway inflammatory response to a high-fat meal?

Citation: Stephanie P. Kurti, Sara K. Rosenkranz, Morton Levitt, et al., “Does Moderate Intensity Exercise Attenuate the Postprandial Lipemic and Airway Inflammatory Response to a High-Fat Meal?,” BioMed Research International, vol. 2015, Article ID 647952, 10 pages, 2015. doi:10.1155/2015/647952We investigated whether an acute bout of moderate intensity exercise in the postprandial period attenuates the triglyceride and airway inflammatory response to a high-fat meal (HFM) compared to remaining inactive in the postprandial period. Seventeen (11 M/6 F) physically active (≥150 min/week of moderate-vigorous physical activity (MVPA)) subjects were randomly assigned to an exercise (EX; 60% VO[subscript 2peak]) or sedentary (CON) condition after a HFM (10 kcal/kg, 63% fat). Blood analytes and airway inflammation via exhaled nitric oxide (eNO) were measured at baseline, and 2 and 4 hours after HFM. Airway inflammation was assessed with induced sputum and cell differentials at baseline and 4 hours after HFM. Triglycerides doubled in the postprandial period (~113 ± 18%, P < 0.05 ), but the increase did not differ between EX and CON. Percentage of neutrophils was increased 4 hours after HFM (~17%), but the increase did not differ between EX and CON. Exhaled nitric oxide changed nonlinearly from baseline to 2 and 4 hours after HFM (P < 0.05, ƞ² = 0.36) . Our findings suggest that, in active individuals, an acute bout of moderate intensity exercise does not attenuate the triglyceride or airway inflammatory response to a high-fat meal

A Longitudinal Study of Pediatricians Early in their Careers: PLACES

The American Academy of Pediatrics (AAP) launched the Pediatrician Life and Career Experience Study (PLACES), a longitudinal study that tracks the personal and professional experiences of early career pediatricians, in 2012. We used a multipronged approach to develop the study methodology and survey domains and items, including review of existing literature and qualitative research with the target population. We chose to include 2 cohorts of US pediatricians on the basis of residency graduation dates, including 1 group who were several years out of residency (2002–2004 Residency Graduates Cohort) and a second group who recently graduated from residency at study launch (2009–2011 Residency Graduates Cohort). Recruitment into PLACES was a 2-stage process: (1) random sample recruitment from the target population and completion of an initial intake survey and (2) completion of the first Annual Survey by pediatricians who responded positively to stage 1. Overall, 41.2% of pediatricians randomly selected to participate in PLACES indicated positive interest in the study by completing intake surveys; of this group, 1804 (93.7%) completed the first Annual Survey and were considered enrolled in PLACES. Participants were more likely to be female, AAP members, and graduates of US medical schools compared with the target sample; weights were calculated to adjust for these differences. We will survey PLACES pediatricians 2 times per year. PLACES data will allow the AAP to examine career and life choices and transitions experienced by early-career pediatricians

Factors associated with the decision to investigate child protective services referrals: a systematic review

Background: Limited resources for child protection create challenging decision situations for child protective services (CPS) workers at the point of intake. A body of research has examined the factors associated with worker decisions and processes using a variety of methodological approaches to gain knowledge on decision-making. However, few attempts have been made to systematically review this literature. Objective: As part of a larger project on decision-making at intake, this systematic review addressed the question of the factors associated with worker decisions to investigate alleged maltreatment referrals. Methods: Quantitative studies that examined factors associated with screening decisions in CPS practice settings were included in the review. Database and other search methods were used to identify research published in English over a 35-year period (1980-2015). Findings: Of 1,147 identified sources, 18 studies were selected for full data extraction. The studies were conducted in the U.S., Canada, and Sweden and varied in methodological quality. Most studies examined case factors with few studies examining other domains. Conclusions: To inform CPS policy and practice, additional research is needed to examine the relationships between decision-making factors and case outcomes. Greater attention needs to be given to the organizational and external factors that influence decision-making