Examining stress and response to stress in medical students and new medical graduates

MOST MEMBERS OF THE MEDICAL PROFESSION feel stressed at some time. If stress is ongoing, impairment may occur (defined as being unable to safely or reliably perform one’s role). A continuum appears to exist between functioning well, being distressed and becoming impaired, with external (environment-related) and internal (personalrelated) stressors determining where an individual will lie on the continuum. We are conducting a study which aims to determine whether distress in new medical graduates can be predicted before the graduates become impaired and unable to safely or reliably perform their role. Study commencement Our study, which commenced in 1997, initially looked at predictors for “troubled” and “troublesome” interns. Hospital- based focus groups comprising interns (postgraduate Year 1), resident medical officers (postgraduate Year 2 and above), ward-based nursing staff and medical administrators reported on internal and external stressors for junior medical staff. Residents and nurses reported similar external stressors, whereas the internal stressors reported by the two groups were quite different (Box 1). Residents tended to report issues relating to “troubled” interns (eg, poor support, few outside interests), whereas nurses identified factors relating more to “troublesome” interns (eg, poor attitude, unprofessionalism). In other words, resident staff seemed to be able to identify their stressed and at-risk peers before effects on performance were observed (Box 1)

Top 10 Blockchain Predictions for the (Near) Future of Healthcare

To review blockchain lessons learned in 2018 and near-future predictions for blockchain in healthcare, Blockchain in Healthcare Today (BHTY) asked the world's blockchain in healthcare experts to share their insights. Here, our internationally-renowned BHTY peer-review board discusses their major predictions. Based on their responses, presented in detail below, ten major themes (Table) for the future of blockchain in healthcare will emerge over the 12 months

An irradiated brown-dwarf companion to an accreting white dwarf

Interacting compact binary systems provide a natural laboratory in which to study irradiated substellar objects. As the mass-losing secondary (donor) in these systems makes a transition from the stellar to the substellar regime, it is also irradiated by the primary (compact accretor)1, 2. The internal and external energy fluxes are both expected to be comparable in these objects, providing access to an unexplored irradiation regime. The atmospheric properties of donors are largely unknown3, but could be modified by the irradiation. To constrain models of donor atmospheres, it is necessary to obtain accurate observational estimates of their physical properties (masses, radii, temperatures and albedos). Here we report the spectroscopic detection and characterization of an irradiated substellar donor in an accreting white-dwarf binary system. Our near-infrared observations allow us to determine a model-independent mass estimate for the donor of 0.055 ± 0.008 solar masses and an average spectral type of L1 ± 1, supporting both theoretical predictions and model-dependent observational constraints that suggest that the donor is a brown dwarf. Our time-resolved data also allow us to estimate the average irradiation-induced temperature difference between the dayside and nightside of the substellar donor (57 kelvin) and the maximum difference between the hottest and coolest parts of its surface (200 kelvin). The observations are well described by a simple geometric reprocessing model with a bolometric (Bond) albedo of less than 0.54 at the 2σ confidence level, consistent with high reprocessing efficiency, but poor lateral heat redistribution in the atmosphere of the brown-dwarf donor4, 5. These results add to our knowledge of binary evolution, in that the donor has survived the transition from the stellar to the substellar regime, and of substellar atmospheres, in that we have been able to test a regime in which the irradiation and the internal energy of a brown dwarf are comparable

The Solar Activity Monitor Network – SAMNet

The Solar Activity Magnetic Monitor (SAMM) Network (SAMNet) is a future UK-led international network of ground-based solar telescope stations. SAMNet, at its full capacity, will continuously monitor the Sun’s intensity, magnetic, and Doppler velocity fields at multiple heights in the solar atmosphere (from photosphere to upper chromosphere). Each SAMM sentinel will be equipped with a cluster of identical telescopes each with a different magneto-optical filter (MOFs) to take observations in K I, Na D, and Ca I spectral bands. A subset of SAMM stations will have white-light coronagraphs and emission line coronal spectropolarimeters. The objectives of SAMNet are to provide observational data for space weather research and forecast. The goal is to achieve an operationally sufficient lead time of e.g., flare warning of 2–8 h and provide many sought-after continuous synoptic maps (e.g., LoS magnetic and velocity fields, intensity) of the lower solar atmosphere with a spatial resolution limited only by seeing or diffraction limit, and with a cadence of 10 min. The individual SAMM sentinels will be connected to their master HQ hub where data received from all the slave stations will be automatically processed and flare warning issued up to 26 h in advance

A rotating white dwarf shows different compositions on its opposite faces

White dwarfs, the extremely dense remnants left behind by most stars after their death, are characterised by a mass comparable to that of the Sun compressed into the size of an Earth-like planet. In the resulting strong gravity, heavy elements sink toward the centre and the upper layer of the atmosphere contains only the lightest element present, usually hydrogen or helium. Several mechanisms compete with gravitational settling to change a white dwarf's surface composition as it cools, and the fraction of white dwarfs with helium atmospheres is known to increase by a factor ~2.5 below a temperature of about 30,000 K; therefore, some white dwarfs that appear to have hydrogen-dominated atmospheres above 30,000 K are bound to transition to be helium-dominated as they cool below it. Here we report observations of ZTF J203349.8+322901.1, a transitioning white dwarf with two faces: one side of its atmosphere is dominated by hydrogen and the other one by helium. This peculiar nature is likely caused by the presence of a small magnetic field, which creates an inhomogeneity in temperature, pressure or mixing strength over the surface. ZTF J203349.8+322901.1 might be the most extreme member of a class of magnetic, transitioning white dwarfs -- together with GD 323, a white dwarf that shows similar but much more subtle variations. This new class could help shed light on the physical mechanisms behind white dwarf spectral evolution.Comment: 45 pages, 11 figure

Review and analysis of fire and explosion accidents in maritime transportation

The globally expanding shipping industry has several hazards such as collision, capsizing, foundering, grounding, stranding, fire, and explosion. Accidents are often caused by more than one contributing factor through complex interaction. It is crucial to identify root causes and their interactions to prevent and understand such accidents. This study presents a detailed review and analysis of fire and explosion accidents that occurred in the maritimetransportation industry during 1990–2015. The underlying causes of fire and explosion accidents are identified and analysed. This study also reviewed potential preventative measures to prevent such accidents. Additionally, this study compares properties of alternative fuels and analyses their effectiveness in mitigating fire and explosionhazards. It is observed that Cryogenic Natural Gas (CrNG), Liquefied Natural Gas (LNG) and methanol have properties more suitable than traditional fuels in mitigating fire risk and appropriate management of their hazards could make them a safer option to traditional fuels. However, for commercial use at this stage, there exist several uncertainties due to inadequate studies, and technological immaturity. This study provides an insight into fire and explosion accident causation and prevention, including the prospect of using alternative fuels for mitigating fire and explosion risks in maritime transportation

A large ground-based observing campaign of the disintegrating planet K2-22b

We present 45 ground-based photometric observations of the K2-22 system collected between 2016 December and 2017 May, which we use to investigate the evolution of the transit of the disintegrating planet K2-22b. Last observed in early 2015, in these new observations we recover the transit at multiple epochs and measure a typical depth of <1.5%. We find that the distribution of our measured transit depths is comparable to the range of depths measured in observations from 2014 and 2015. These new observations also support ongoing variability in the K2-22b transit shape and time, although the overall shallowness of the transit makes a detailed analysis of these transit parameters difficult. We find no strong evidence of wavelength-dependent transit depths for epochs where we have simultaneous coverage at multiple wavelengths, although our stacked Las Cumbres Observatory data collected over days-to-months timescales are suggestive of a deeper transit at blue wavelengths. We encourage continued high-precision photometric and spectroscopic monitoring of this system in order to further constrain the evolution timescale and to aid comparative studies with the other few known disintegrating planets