Exploration of Burnout, Emotional Thriving, and Emotional Recovery in an Academic Medical Center: a Mixed Methods Quality Improvement Project

Introduction: Healthcare provider burnout, an indicator of wellbeing, impacts patient safety, provider distress, and employee turnover. In this mixed methods, multi-site quality improvement study conducted \u3c6 months prior to the start of the COVID-19 pandemic, we assessed employee wellbeing in a large clinical department. Methods: Wellbeing surveys were sent electronically to Department of Medicine clinicians, researchers, administrators, and staff from August-September 2019 assessing perceptions of Burnout, Emotional Thriving (ET), and Emotional Recovery (ER). Qualitative responses were reviewed for themes using mixed inductive-deductive analysis. The initial coding was done by small teams with consensus obtained through large group discussions. This study was IRB-approved as non-human subjects research. Results: Of the 671 respondents, 54% met criteria for burnout (Burnout+), 65% for ER (ER+), and 61% for ET (ET+). ER+ and ET+ were present in nearly half of Burnout+ respondents (53% and 43% respectively). Several themes emerged in the qualitative analysis: workload and expectations; tangible resources; work culture; and salary/benefits, with leadership influencing each of the domains. Conclusion: Burnout, ET, and ER can co-exist within the same individual. Employee wellbeing is not adequately reflected by the binary of whether or not an individual is experiencing burnout. All employees at academic medical centers, including staff, researchers, and clinicians, are vulnerable to the same workplace factors driving burnout. Our findings have been used to target areas of intervention during the COVID-19 pandemic at our institution. We propose that other academic medical centers may have similar workplace stressors that they could assess and target for improvement

Modeling eddy current analysis data to determine depth of weld penetration

The Applied Engineering Technology Croup in the Engineering Sciences and Applications Division at Los Alamos National Laboratory is currently providing the design, engineering, assembly, and testing of an eddy current instrument for weld inspection. This instrument is designed to provide an in situ weld depth measurement of nuclear weapons primary components during fabrication. The goal of this effort is to improve the accuracy and reliability of the measurement of the weld joint depth and provide a mechanism for inspection without removing the part from the fixture. This feature is essential to accommodate the re-welding process if the inspection fails. The production system consists of a commercially available eddy current instrument and eddy current probe connected to a portable PC. The objective of the system software is acquire and analyze voltage and phase angle data to produce a near-real time estimate of weld depth. The data obtained from the instrument are perfectly suited for analysis by a neural network technique. This paper compares the effectiveness of a neural network application with traditional mathematical models for the analysis of weld depth information

2003 AAPP Monograph Series

It is significant that the African American Professors Program (AAPP) at the University of South Carolina is producing the third edition of its annual monograph series at this time-the fifth anniversary of AAPP. The program graciously accepts the challenge of putting into place a requirement for the scholars to produce quality research papers worthy of publication. This provides widespread visibility for them and enhances their curriculum vitae concurrently. Scholars who have contributed manuscripts for this monograph are to be commended for adding this additional responsibility to their academic workload. Writing across disciplines adds to the intellectual diversity of these papers. From neophytes, relatively speaking, to an array of very experienced individuals, the chapters have been researched and comprehensively written. Founded in 1997 through the Department of Educational Leadership and Policies in the College of Education, AAPP was designed to address the underrepresentation of African American professors on college and university campuses. Its mission is to expand the pool of these professors in critical academic and research areas. Sponsored by the University of South Carolina, the W. K. Kellogg Foundation, and the South Carolina General Assembly, the program recruits students with bachelor\u27s, master\u27s, and doctoral degrees for disciplines in which African Americans currently are underrepresented. An important component of the program is the mentoring experience that is provided. Each student is assigned to a mentor/professor who guides the student through a selected academic program and provides various learning experiences. When possible, the mentor serves as chair of the student\u27s doctoral committee. The mentor also provides opportunities for the student to team teach, conduct research, and co-author publications. Students have the advantage of attending committee, faculty, and professional meetings, as well as engaging in a range of activities that characterize professional life in academia. Scholars enrolled in the program also are involved in programmatic and institutional workshops, independent research, and program development. The continuation of this monograph series is seen as responding to a window of opportunity to be sensitive to an academic expectation of graduates as they pursue career placement and, at the same time, one that allows for the dissemination of AAPP products to a broader community. The importance of this monograph series has been voiced by one of our 2002 AAPP graduates, Dr. Shundelle LaTjuan Dogan, a recent Harvard Administrative Fellow at Harvard University and now Program Officer for the Southern Education Foundation, Atlanta, Georgia. Dr. Dogan wrote: One thing in particular that I want to thank you for is having the African American Professors Program scholars publish articles for the monograph. I have to admit that writing the articles seemed like extra work at the time. However, in my recent interview process, organizations have asked me for samples of my writing. Including an article from a published monograph helped to make my portfolio much more impressive. You were right on target in having us do the monograph series. We hope that you will read this monograph of the African American Professors Program with enthusiasm or enlightenment. John McFadden, Ph.D. The Benjamin Elijah Mays Professor Director, African American Professors Program University of South Carolinahttps://scholarcommons.sc.edu/mcfadden_monographs/1006/thumbnail.jp

Impact of Small Body Weight on Tenofovir-Associated Renal Dysfunction in HIV-Infected Patients: A Retrospective Cohort Study of Japanese Patients

BACKGROUND: Treatment with tenofovir is sometimes associated with renal dysfunction. Limited information is available on this side effect in patients with small body weight, although the use of tenofovir will spread rapidly in Asia and Africa, where patients are likely to be of smaller body weight. METHODS: In a single-center cohort, Japanese patients with HIV infection who started tenofovir-containing antiretroviral therapy were retrospectively analyzed. The incidence of tenofovir-associated renal dysfunction, defined as more than 25% decrement of estimated glomerular filtration rate (eGFR) from the baseline, was determined. The effects of small body weight and body mass index (BMI) on tenofovir-associated renal dysfunction, respectively, were estimated in univariate and multivariate Cox hazards models as the primary exposure. Other possible risk factors were evaluated by univariate analysis and those found significant were entered into the multivariate analysis. RESULTS: The median weight of 495 patients was 63 kg. Tenofovir-related renal dysfunction occurred in 97 (19.6%) patients (incidence: 10.5 per 100 person-years). Univariate analysis showed that the incidence of tenofovir-related renal dysfunction was significantly associated with smaller body weight and BMI, respectively (per 5 kg decrement, HR = 1.23; 95% CI, 1.10-1.37; p<0.001)(per 1 kg/m(2) decrement, HR = 1.14; 95% CI, 1.05-1.23; p = 0.001). Old age, high baseline eGFR, low serum creatinine, low CD4 count, high HIV viral load, concurrent nephrotoxic drugs, hepatitis C infection, and current smoking were also associated with tenofovir-related renal dysfunction. Multivariate analysis identified small body weight as a significant risk (adjusted HR = 1.13; 95% CI, 1.01-1.27; p = 0.039), while small BMI had marginal significance (adjusted HR = 1.07; 95% CI 1.00-1.16; p = 0.058). CONCLUSION: The incidence of tenofovir-associated renal dysfunction in Japanese patients was high. Small body weight was identified as an independent risk factor for tenofovir-associated renal dysfunction. Close monitoring of renal function is advocated for patients with small body weight treated with tenofovir

2005 AAPP Monograph Series

The African American Professors Program (AAPP) at the University of South Carolina is proud to publish the fifth edition of its annual monograph series. The program recognizes the significance of offering its scholars avenue to engage actively in research and publish papers related thereto. Parallel with the publication of their refereed manuscripts is the opportunity to gain visibility among scholars throughout institutions worldwide. Scholars who have contributed manuscripts for this monograph are to be commended for adding this additional responsibility to their academic workload. Writing across disciplines adds to the intellectual diversity of these papers. From neophytes, relatively speaking, to an array of very experienced individuals, the chapters have been researched and comprehensively written. Founded in 1997 through the Department of Educational Leadership and Policies in the College of Education, AAPP was designed to address the underrepresentation of African American professors on college and university campuses. Its mission is to expand the pool of these professors in critical academic and research areas. Sponsored by the University of South Carolina, the W. K. Kellogg Foundation, and the South Carolina General Assembly, the program recruits doctoral students for disciplines in which African Americans currently are underrepresented among faculty in higher education. The continuation of this monograph series is seen as responding to a window of opportunity to be sensitive to an academic expectation of graduates as they pursue career placement and, at the same time, one that allows for the dissemination of AAPP products to a broader community. The importance of this monograph series has been voiced by one of our 2002 AAPP graduates, Dr. Shundele LaTjuan Dogan, a recent Administrative Fellow at Harvard University and now a Program Officer for the Southern Education Foundation, Atlanta, Georgia. Dr. Dogan wrote: One thing in particular that I want to thank you for is having the African American Professors Program scholars publish articles for the monograph. I have to admit that writing the articles seemed like extra work at the time. However, in my recent interview process, organizations have asked me for samples of my writing. Including an article from a published monograph helped to make my portfolio much more impressive. You were \u27right on target\u27 in having us do the monograph series. (MPP 2003 Monograph, p. xi) The African American Professors Program offers this 2005 publication as a contribution to its readership and hopes that you will be inspired by this select group of manuscripts. John McFadden, Ph.D. The Benjamin Elijah Mays Professor Director, African American Professors Program University of South Carolinahttps://scholarcommons.sc.edu/mcfadden_monographs/1007/thumbnail.jp

The theory of pulsar winds and nebulae

We review current theoretical ideas on pulsar winds and their surrounding nebulae. Relativistic MHD models of the wind of the aligned rotator, and of the striped wind, together with models of magnetic dissipation are discussed. It is shown that the observational signature of this dissipation is likely to be point-like, rather than extended, and that pulsed emission may be produced. The possible pulse shapes and polarisation properties are described. Particle acceleration at the termination shock of the wind is discussed, and it is argued that two distinct mechanisms must be operating, with the first-order Fermi mechanism producing the high-energy electrons (above 1 TeV) and either magnetic annihilation or resonant absorption of ion cyclotron waves responsible for the 100 MeV to 1 TeV electrons. Finally, MHD models of the morphology of the nebula are discussed and compared with observation.Comment: 33 pages, to appear in Springer Lecture Notes on "Neutron stars and pulsars, 40 years after the discovery", ed W.Becke

Does HAART Efficacy Translate to Effectiveness? Evidence for a Trial Effect

Background: Patients who participate in clinical trials may experience better clinical outcomes than patients who initiate similar therapy within clinical care (trial effect), but no published studies have evaluated a trial effect in HIV clinical trials. Methods: To examine a trial effect we compared virologic suppression (VS) among patients who initiated HAART in a clinical trial versus in routine clinical care. VS was defined as a plasma HIV RNA #400 copies/ml at six months after HAART initiation and was assessed within strata of early (1996–99) or current (2000–06) HAART periods. Risk ratios (RR) were estimated using binomial models. Results: Of 738 persons initiating HAART, 30.6 % were women, 61.7 % were black, 30 % initiated therapy in a clinical trial and 67 % (n = 496) had an evaluable six month HIV RNA result. HAART regimens differed between the early and current periods (p,0.001); unboosted PI regimens (55.6%) were more common in the early and NNRTI regimens (46.4%) were more common in the current period. Overall, 78 % (95%CI 74, 82%) of patients achieved VS and trial participants were 16 % more likely to achieve VS (unadjusted RR 1.16, 95%CI 1.06, 1.27). Comparing trial to non-trial participants, VS differed by study period. In the early period, trial participants initiating HAART were significantly more likely to achieve VS than non-trial participants (adjusted RR 1.33; 95%CI 1.15, 1.54), but not in the current period (adjusted RR 0.98; 95%CI 0.87, 1.11). Conclusions: A clear clinical trial effect on suppression of HIV replication was observed in the early HAART period but not i

Difficulties in assessing cytomegalovirus-associated gastric perforation in an HIV-infected patient

BACKGROUND: Active Cytomegalovirus (CMV) infection is a common complication in advanced symptomatic Human Immunodeficiency Virus (HIV) infection. CMV-induced intestinal perforations are hard to diagnose and may be observed throughout the gastrointestinal tract. Isolated stomach perforation is exceptional. CASE PRESENTATION: A 47-year-old man was admitted to our intensive care unit with multiorgan failure. Gastrointestinal endoscopic examination showed erythematous gastritis but normal duodenum and colon. CMV blood culture was positive. Histologic examination of a gastric biopsy showed inflammatory infiltrate and immunostaining typical intranuclear CMV inclusion bodies. Concomitant abdominal CT scan disclosed large peripancreatic hypodensities without pneumoperitoneum. The patient died despite supportive therapies and ganciclovir infusion. Postmortem examination showed a 4-cm gastric perforation adhering to the transverse colon and liver, with a thick necrotic inflammatory coating around the pancreas. The whole GI tract, except the stomach, was normal. As other causes, especially Helicobacter pylori infection could be ruled out, a causal relationship between CMV and gastric disease was assumed. CONCLUSION: CMV may be responsible for gastric perforations, with difficulties in assessing the diagnosis. Early diagnosis based on cautious endoscopy and histopathologic examination is needed to make a favorable outcome possible