A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center

BACKGROUND: The Accreditation Council for Graduate Medical Education's (ACGME) new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. METHODS: Residents and faculty (1330) in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. RESULTS: Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. CONCLUSION: Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function

Subthalamic Nucleus and Sensorimotor Cortex Activity During Speech Production

The sensorimotor cortex is somatotopically organized to represent the vocal tract articulators such as lips, tongue, larynx, and jaw. How speech and articulatory features are encoded at the subcortical level, however, remains largely unknown. We analyzed LFP recordings from the subthalamic nucleus (STN) and simultaneous electrocorticography recordings from the sensorimotor cortex of 11 human subjects (1 female) with Parkinson´s disease during implantation of deep-brain stimulation (DBS) electrodes while they read aloud three-phoneme words. The initial phonemes involved either articulation primarily with the tongue (coronal consonants) or the lips (labial consonants). We observed significant increases in high-gamma (60?150 Hz) power in both the STN and the sensorimotor cortex that began before speech onset and persisted for the duration of speech articulation. As expected from previous reports, in the sensorimotor cortex, the primary articulators involved in the production of the initial consonants were topographically represented by high-gamma activity. We found that STN high-gamma activity also demonstrated specificity for the primary articulator, although no clear topography was observed. In general, subthalamic high-gamma activity varied along the ventral?dorsal trajectory of the electrodes, with greater high-gamma power recorded in the dorsal locations of the STN. Interestingly, the majority of significant articulator-discriminative activity in the STN occurred before that in sensorimotor cortex. These results demonstrate that articulator-specific speech information is contained within high-gamma activity of the STN, but with different spatial and temporal organization compared with similar information encoded in the sensorimotor cortex.Fil: Chrabaszcz, Anna. University of Pittsburgh; Estados UnidosFil: Neumann, Wolf Julian. Universität zu Berlin; AlemaniaFil: Stretcu, Otilia. University of Pittsburgh; Estados UnidosFil: Lipski, Witold J.. University of Pittsburgh; Estados UnidosFil: Dastolfo Hromack, Christina A.. University of Pittsburgh; Estados UnidosFil: Bush, Alan. University of Pittsburgh; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; ArgentinaFil: Wang, Dengyu. Tsinghua University; China. University of Pittsburgh; Estados UnidosFil: Crammond, Donald J.. University of Pittsburgh; Estados UnidosFil: Shaiman, Susan. University of Pittsburgh; Estados UnidosFil: Dickey, Michael W.. University of Pittsburgh; Estados UnidosFil: Holt, Lori L.. University of Pittsburgh; Estados UnidosFil: Turner, Robert S.. University of Pittsburgh; Estados UnidosFil: Fiez, Julie A.. University of Pittsburgh; Estados UnidosFil: Richardson, R. Mark. University of Pittsburgh; Estados Unido

The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions

BACKGROUND: To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes. METHODS: A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions. RESULTS: The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions. CONCLUSION: With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements

Effects of linguistic complexity and executive attentional demands on sentence comprehension in persons with aphasia and normal controls: Exploring on-line and offline measures with two reading versions of the Computerized Revised Token Test

Verbal Working Memory (VWM) specifies the fundamental cognitive components (language computations (LC), short term memory, executive attention (EA)) for sentence comprehension.  Tests for VWM do not assess their differential impairments.  The Computerized Revised Token Test (Reading) (CRTT-R) was administered in normal reading and “Stroop” conditions to controls and persons with aphasia (PWA).  CRTT-R captured the LC and EA components of VWM in both groups.  On-line color word reading times and errors captured the EA effects.  Off-line CRTT-R scores, reading and response times captured the LC effects.  Response time yielded the expected PWA by EA and PWA by LC complexity interactions

The changing environment of conservation conflict: geese and farming in Scotland

Conflict between conservation objectives and human livelihoods is ubiquitous and can be highly damaging, but the processes generating it are poorly understood. Ecological elements are central to conservation conflict, and changes in their dynamics — for instance due to anthropogenic environmental change — are likely to influence the emergence of serious human–wildlife impacts and, consequently, social conflict.  We used mixed-effects models to examine the drivers of historic spatio-temporal dynamics in numbers of Greenland barnacle geese (Branta leucopsis) on the Scottish island of Islay to identify the ecological processes that have shaped the environment in which conflict between goose conservation and agriculture has been triggered.  Barnacle goose numbers on Islay increased from 20,000 to 43,000 between 1987 and 2016. Over the same period, the area of improved grassland increased, the number of sheep decreased and the climate warmed.  Goose population growth was strongly linked to the increasing area of improved grassland, which provided geese with more high quality forage. Changing climatic conditions, particularly warming temperatures on Islay and breeding grounds in Greenland, have also boosted goose numbers.  As the goose population has grown, farms have supported geese more frequently and in larger numbers, with subsequent damaging effects on grassland. The creation of high-quality grassland appears to have largely driven the problem of serious economic damage by geese. Our analysis also reveals the drivers of spatial variation in goose impacts: geese were more likely to occur on farms closer to roosts and those with more improved grassland. However, as geese numbers have increased they have spread to previously less favoured farms.  Synthesis and applications. Our study demonstrates the primary role of habitat modification in the emergence of conflict between goose conservation and agriculture, alongside a secondary role of climate change. Our research illustrates the value of exploring socio-ecological history to understand the processes leading to conservation conflict. In doing so, we identify those elements that are more controllable, such as local habitat management, and less controllable, such as climate change, but which both need to be taken into account when managing conservation conflict

Implementing academic detailing for breast cancer screening in underserved communities

<p>Abstract</p> <p>Background</p> <p>African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs) are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians.</p> <p>Methods</p> <p>Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (<it>i.e</it>., not hospital based) physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE), and whether PCPs taught women how to perform breast self examination (BSE).</p> <p>Results</p> <p>Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician involvement in additional educational programs, enhanced self-efficacy in counseling for prevention, the routine use of chart reminders, computer- rather than paper-based prompting and tracking approaches, printed patient education materials, performance targets for mammography, and increased involvement of nursing and other office staff were associated with increased screening.</p> <p>Conclusion</p> <p>We found some evidence of improvement in breast cancer screening practices due to enhanced academic detailing among primary care physicians practicing in urban underserved communities.</p

Self-love and sociability: the ‘rudiments of commerce’ in the state of nature

Istvan Hont’s classic work on the theoretical links between the seventeenth-century natural jurists Hugo Grotius and Samuel Pufendorf and the eighteenth-century Scottish political economists remains a popular trope among intellectual and economic historians of various stamps. Despite this, a common criticism levelled at Hont remains his relative lack of engagement with the relationship between religion and economics in the early modern period. This paper challenges this aspect of Hont’s narrative by drawing attention to an alternative, albeit complementary, assessment of the natural jurisprudential heritage of eighteenth-century British political economy. Specifically, the article attempts to map on to Hont’s thesis the Christian Stoic interpretation of Grotius and Pufendorf which has gained greater currency in recent years. In doing so, the paper argues that Grotius and Pufendorf’s contributions to the ‘unsocial sociability’ debate do not necessarily lead directly to the Scottish school of political economists, as is commonly assumed. Instead, it contends that a reconsideration of Grotius and Pufendorf as neo-Stoic theorists, particularly via scrutiny of their respective adaptations of the traditional Stoic theory of oikeiosis, steers us towards the heart of the early English ‘clerical’ Enlightenment

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

The spotted skunk of the Channel Islands of southern California

Volume: 42Start Page: 157End Page: 15

A new marsupial from El Salvador

Volume: 41Start Page: 15End Page: 1